Lasers and the treatment of chronic periodontitis
Dental Clinics of North America, Vol. 54(1), pp. 35-53
Abstract
OBJECTIVE: This systematic review and meta-analysis examined the adjunctive effect of indocyanine green-mediated antimicrobial photodynamic therapy (ICG-aPDT) with scaling and root planing (SRP) in periodontitis to address limited and inconsistent evidence regarding its clinical and microbiological efficacy.
DATA SOURCES: Electronic searches were conducted in MEDLINE (via PubMed), Scopus, Web of Science, Embase, Cochrane Library, ProQuest, and Google Scholar up to March 2025.
STUDY SELECTION: Controlled clinical trials comparing SRP+ICG-aPDT with SRP alone were included. Primary outcomes were PPD and CAL; secondary outcomes were plaque, gingival, and bleeding indices, and subgingival microbial load. Risk of bias followed the Cochrane Handbook, and random-effects meta-analyses with subgroup analyses were performed.
RESULTS: Sixteen studies involving 541 participants were included. Adjunctive ICG-aPDT led to additional mean reductions in PPD (-1.05, -0.86, and -0.84 mm at 1, 3, and 6 months; all p<0.001) and gains in CAL (-0.59 and -0.80 at 3, and 6 months; both p<0.001) compared with SRP alone. Plaque and gingival indices improved significantly at 3 months (SMD=-0.83 and -1.05; both p<0.001), and 6 months (SMD=-1.13 and -1.07; p<0.001 and p=0.02, respectively). Bleeding index showed marked reductions at both 3 and 6 months (SMD=-1.32 and -1.76; both p<0.001). The subgingival P. gingivalis load also decreased significantly (SMD=-0.33; p=0.04). Subgroup analyses showed no significant differences by irradiation type or session number (all p>0.05).
CONCLUSIONS: Adjunctive ICG-aPDT showed statistically significant but clinically modest improvements in periodontal outcomes, with PPD effects close to a 1-mm interpretive benchmark; however, high heterogeneity and methodological limitations warrant cautious interpretation and further standardized trials.
