Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2024 | Month : November | Volume : 18 | Issue : 11 | Page : ZC33 - ZC39 Full Version

Emerging Role of Photodynamic Therapy in Management of Periodontitis: A Systematic Review


Published: November 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/69286.20255
Monali Shah, Sanyukta Chipre, Prasad Nadig, Suchit Dana

1. Professor and Head, Department of Periodontology, K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India. 2. Postgraduate Student, Department of Periodontology, K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India. 3. Professor, Department of Periodontology, K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India. 4. Reader, Department of Periodontology, K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India.

Correspondence Address :
Monali Shah,
B-46/267, Kalpana Park Society, Uma Char Rasta, Waghodia Road, Vadodara-390019, Gujarat, India.
E-mail: smonali2011@gmail.com

Abstract

Introduction: Photodynamic Therapy (PDT) presents a non invasive avenue for treating various infections, including periodontal disease, offering an alternative to mechanical methods like scaling and root planing. Concerns about antibiotic resistance have fueled the exploration of PDT as an antimicrobial therapy. PDT combines low-power lasers with photosensitising drugs to eliminate microorganisms through the generation of cytotoxic reactive oxygen species upon light activation.

Aim: To evaluate the scope of PDT and its role in periodontology.

Materials and Methods: A comprehensive electronic search was conducted in major medical databases, including Google Scholar, PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Wiley. A total of 43 studies from 2007 to 2023 were selected, focusing on PDT for the treatment of periodontal disease. The review included Randomised Controlled Trials (RCTs), case-control studies, and cohort studies involving human subjects, using Photosensitisers (PSs) or Indocyanine Green (ICG) for subgingival irrigation in chronic periodontitis patients after scaling and root planing, with follow-ups extending over one month. The outcomes measured were Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Plaque Index (PI), and Gingival Index (GI).

Results: In present review, after thorough analysis, a total of 21 studies were selected from databases including Google Scholar, PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Wiley. The risk of bias assessment showed high-risk in 1 out of 128 studies (0.59%), low risk in 139 out of 168 studies (82.74%), and unclear risk in 28 out of 168 studies (16.67%). The results indicated significant clinical improvements when PDT was combined with conventional treatments.

Conclusion: The PDT in periodontology showcases varied roles, from antimicrobial action to tissue healing and the promotion of periodontal health. Its efficacy as an adjunctive treatment, especially in challenging cases or against resistant microbes, is evident, accentuated by its non invasive nature and minimal adverse effects, making it an appealing option in periodontal care.

Keywords

Antibiotic resistance, Microbial infections, Non invasive treatment, Oral health, Photochemical reaction, Photosensitiser drugs

Periodontal diseases are a group of prevalent oral health conditions that affect the supporting structures of teeth, including the gums, periodontal ligament, and alveolar bone (1). These diseases are primarily caused by the accumulation of dental plaque, a complex biofilm comprising bacteria and their by-products, which leads to inflammation, tissue destruction, and potential tooth loss if left untreated. Traditional methods of periodontal therapy involve mechanical scaling and root planing to remove bacterial deposits and promote tissue healing (2). While effective, these approaches may have limitations in sites with difficult access and may not fully address the rising concerns of antibiotic resistance (3).

In recent years, PDT has emerged as a promising non invasive treatment approach for various infections, including periodontal diseases caused by dental plaque (4). PDT utilises low-power lasers with specific wavelengths in combination with PSs drugs to selectively target and destroy microorganisms. The activation of photosensitising compounds by light initiates a photochemical reaction, leading to the production of cytotoxic reactive oxygen species, particularly singlet oxygen, which effectively kills bacteria (5).

The simplicity and high efficacy of bacterial killing with PDT have led to its extensive use as an antimicrobial therapy in various medical fields (6). In periodontology, PDT offers a potential alternative to traditional mechanical methods, with the advantage of addressing concerns about bacterial resistance and providing an adjunct to non-surgical periodontal therapy (7).

The findings from this systematic review will contribute to a better understanding of the potential of PDT in periodontology, its limitations, and areas for further research. With the rising concerns of antibiotic resistance and the need for innovative and effective treatments, exploring PDT’s role in periodontal disease management holds promise for revolutionising the way we approach the treatment of periodontal diseases and combating dental plaque-associated infections.

The present systematic review aimed to comprehensively assess the existing literature on the application of PDT in periodontology. By exploring the current evidence, authors aimed to evaluate the scope of PDT in periodontal disease management, its impact on clinical outcomes, factors affecting its efficacy, and potential safety considerations. Furthermore, authors will identify gaps in the literature and provide insights into future perspectives and recommendations for integrating PDT into clinical practice.

Material and Methods

A comprehensive electronic search was conducted in major medical databases, including PubMed, Embase, and the Cochrane Library, to identify relevant studies published upto the date of this review. The following keywords and Medical Subject Headings (MeSH) terms were used: “Chronic Periodontitis,” “Scaling and Root Planning,” “Non Surgical Periodontal Therapy,” “Subgingival,” and “PDT,” as shown in (Table/Fig 1). After conducting a thorough analysis, duplicates were eliminated based on relevant databases, titles, authors, publication years, and abstracts. For present review article, a meticulous manual screening process was carried out to ensure the removal of duplicates.

Inclusion criteria: Randomised Controlled Trails (RCTs), case-control studies, and cohort studies involving human subjects (both parallel and split-mouth designs) from 2007 to 2023 were included. Studies in which either PSs, ICG, or antimicrobial PDT (aPDT) was used for subgingival irrigation or subgingival application as an adjunct to scaling and root planning in chronic periodontitis patients were considered. Studies reporting outcomes such as probing pocket depth, Clinical Attachment Level (CAL), Plaque Index (PI), Gingival Index (GI), and other correlated outcomes were included.

Exclusion criteria: Animal studies, in-vitro studies, and studies in which patients were under systemic medication that may affect clinical outcomes were excluded. Additionally, studies that did not have proper follow-up and articles published in languages other than English were also excluded. Studies in which interventions were conducted using other antimicrobials were not considered.

In present review article, the included studies were selected from electronic databases covering the past 16 years, specifically from 2007 to 2023. After a complete analysis, duplicate entries were eliminated based on the titles and abstracts of the studies (Table/Fig 2).

Study Procedure

Data assessment: The risk of bias for RCTs was assessed using the Cochrane Collaboration tool and performed with RevMan 2 software (8). Risk of bias was evaluated by two independent reviewers for the RCTs included in the review, and discrepancies were resolved through discussion and consultation with a third reviewer. The domains for risk assessment were graded as high, unclear, or low risk based on selection bias, random sequence generation, allocation concealment, selective reporting, other bias, blinding of participants, blinding of outcome assessment, incomplete outcome data, and overall risk of bias. A study was assessed to have a low overall risk only if, all domains were found to have low risk; it was assessed to have a high overall risk if, one or more of the six domains were found to be at high-risk. An unclear risk assessment was assigned to studies when one or more domains were uncertain, provided none were at high-risk.

Results

Risk of bias: RevMan software version 5.4 was used to analyse the risk of bias in the present study. Authors evaluated individual studies for various domains, including selection bias (creation of a random sequence), performance bias (blinding of cases and staff), attrition bias (incomplete results data), selective reporting (reporting bias), and other biases. Each study was classified as having low risk (+), high-risk (-), or unclear risk (?), as depicted in (Table/Fig 3) (9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29). The present review of PDT in periodontology consolidated 43 articles into 21 relevant RCTs, as highlighted in (Table/Fig 3), providing a comprehensive summary of findings. Among these studies, the most concerning issues were the inadequacy or absence of randomisation, which resulted in a high-risk for 1 out of 168 trials (0.59%). In contrast, low risk was noted in 139 out of 168 trials (82.74%), and unclear risk was noted in 28 out of 168 trials (16.67%), as represented in (Table/Fig 4).

The assessment of study quality within the pool of 21 included studies was conducted using the Cochrane risk of bias tool, as detailed in (Table/Fig 4) (9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29). Among the 21 studies, one study showed a high-risk of bias (13), and six of them were found to exhibit an overall unclear risk of bias [9,16,20,21,26,29]. Despite this unclear risk, the quality of these studies was deemed acceptable, suggesting that while they had some methodological limitations, they still provided valuable contributions to the research area.

In contrast, the majority of the studies, specifically 17 out of the 21, demonstrated an overall low risk of bias (9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29). These studies were recognised for their robust methodology and study design, resulting in a classification of good quality. Their lower risk of bias underscores the reliability and trustworthiness of their findings within the context of the systematic review.

Study characteristics: In the present review, approximately 21 studies were included, which primarily focused on evaluating aPDT alongside traditional methods such as ultrasonic debridement and Scaling and Root Planing (SRP). Thirteen studies specifically compared these approaches, with five studies showing significant improvements in outcomes like Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) gain (17),(19),(21),(22),(26). Two studies reported enhancements in BOP only (14),(20). However, five studies did not find notable differences between aPDT combined with conventional treatments and conventional treatments alone (10),(13),(15),(16),(28).

The aPDT protocols in the trials used various PSs like phenothiazine chlorine, methylene blue, toluidine blue, and Indocyanine Green (ICG). These were incubated for upto five minutes. Different light strategies were employed depending on the PS, with ICG treated at 810 nm and others at 628 to 680 nm. Light power ranged from 2 to 100 mW/cm2, with energy levels between 20 and 320 J/cm2 (10),(11),(12),(13),(14),(15). Moreover, the integration of ICG as a PS was consistently combined with conventional treatments in the studies, showing clinical improvements. Follow-up durations ranged from seven days to 12 months, allowing for the assessment of both short-term and long-term effects.

Discussion

The systematic review on PDT in periodontology has provided valuable insights into the potential of this innovative treatment approach for managing periodontal diseases caused by dental plaque. This discussion will delve into the key findings, implications, and future perspectives identified in the review, shedding light on the current evidence and its significance in the field of periodontal therapy.

Effectiveness of PDT in periodontal disease management: The review demonstrated that PDT, when used as an adjunct to conventional periodontal treatments, can lead to significant clinical improvements. The ability of PDT to target and kill microorganisms through the generation of cytotoxic reactive oxygen species, particularly singlet oxygen, provides a promising alternative to traditional mechanical approaches for eliminating bacterial deposits (30),(31). These findings suggest that PDT has the potential to enhance the outcomes of non-surgical periodontal therapies and address the limitations of conventional methods in sites with difficult access.

Effectiveness of PDT in various test groups: Similarly, another study introduced a test group infused with probiotics in conjunction with PDT and SRP. The outcomes reported by Patyna M et al., favoured this combination, resulting in significant clinical improvements and a microbiological achievement marked by a substantial reduction of specific pathogens (27).

The review also included two studies that explored the implications of repeated applications of PDT in supportive periodontal therapy. The outcomes of these studies underscored the potential for multiple applications of adjunctive PDT to yield improved clinical results in residual pockets among maintenance patients (11),(12).

Furthermore, a comparison between PDT and antibiotics in the context of scaling and root planing revealed comparable long-term improvements in periodontal parameters for both interventions. Another investigation examined the adjunctive effect of PDT in surgical periodontal therapy, showing significant reductions in probing depth and gains in clinical attachment level for the PDT group. Notably, changes in the subgingival microbiota were consistent across both groups; however, the PDT group exhibited a higher concentration of bacteria associated with periodontal disease at the conclusion of the study (29).

Andersen R et al., and Christodoulides N et al., employed more complex methodologies in their investigations, each characterised by three distinct study arms. One study introduced a supplementary experimental group exclusively undergoing PDT, with three study arms designed to comprehensively investigate the effects of different interventions. Each arm represented a unique aspect, enhancing internal validity and providing insights into the effectiveness of the interventions. In a prior investigation, patients underwent SRP before being randomised into either a no further treatment arm or an adjunctive PDT arm (9),(10).

Variability in study outcomes: While the majority of studies demonstrated favourable outcomes, it is important to acknowledge the variability in the results. Some studies did not observe significant differences between PDT in combination with conventional treatment and conventional treatment alone (10),(13),(15),(16),(28). This variability could be attributed to several factors, including differences in study design, patient populations, PDT protocols, PSs used, and light parameters. These variations highlight the need for standardisation and consistency in future research to obtain more robust and generalisable results.

In the analysis of the 21 studies included in present review, it is noteworthy that one study was identified as having a high-risk of bias, as indicated by the risk of bias assessment tool utilised (13). This finding emphasises the importance of critically evaluating the methodological quality of studies in research synthesis, as studies with a high-risk of bias may introduce substantial uncertainty and potential inaccuracies in the conclusions drawn. Additionally, the discovery that six studies demonstrated an overall unclear risk of bias further underscores the need for transparent reporting and robust methodological approaches in future research endeavours. Addressing and minimising bias in study design, conduct, and reporting are imperative to enhance the reliability and validity of research outcomes, ultimately contributing to evidence-based decision-making in healthcare and clinical practice.

Factors affecting PDT efficacy: The review identified various factors that can influence the efficacy of PDT in periodontal disease management. One crucial aspect is the selection of appropriate PSs and their concentrations. The PSs should possess the following properties: a high binding affinity for the target microorganism, a broad spectrum of action, a low binding affinity for mammalian cells to avoid the risk of photodestruction of host tissues, a low propensity for selecting resistant bacterial strains, a minimal risk of promoting mutagenic processes, and low chemical toxicity (32).

Different PSs exhibit varying levels of bacterial selectivity and activation wavelengths, which can impact the overall effectiveness of PDT. Generally, Gram-positive bacteria are susceptible to photo-inactivation, whereas Gram-negative bacteria are often resistant unless the permeability of their outer membrane is modified. This is connected to the difficulties encountered by PSs in penetrating gram negative bacterial cells. Antimicrobial PSs such as porphyrins, phthalocyanines, and phenothiasines (e.g., methylene blue and toluidine blue O) have been reported to penetrate both gram-positive and gram negative bacteria. The positive charge seems to promote the binding of the PSs to the gram negative bacterial membrane, leading to localised damage and resulting in increased permeability. Hence, toluidine blue O and methylene blue are commonly used in antimicrobial photodynamic therapy (aPDT). The hydrophilicity, low molecular weight, and positive charge of methylene blue facilitate its passage across the porin-protein channels in the gram negative outer bacterial membrane. Methylene blue’s interaction with the anionic lipopolysaccharide macromolecule of gram negative bacteria results in the generation of methylene blue dimers, which participate in the photosensitisation process (32),(33).

Moreover, the choice of light sources and their parameters, including light intensity and exposure time, can also influence the photodynamic reaction (34). Therefore, optimising these parameters is essential for achieving consistent and reproducible outcomes in PDT-based periodontal therapies.

Safety and adverse effects: The safety profile of PDT in periodontology was explored in the review. PDT is generally considered safe, with minimal adverse effects reported in the selected studies (35),(36),(37),(38). However, like any medical procedure, PDT is not entirely devoid of risks. Potential adverse effects may include mild discomfort, tissue sensitivity to light, and transient post-treatment inflammation (39). Nonetheless, the incidence of serious complications is low, indicating that PDT can be considered a safe treatment modality when appropriately administered. Long-term studies with larger sample sizes would be beneficial to further assess the safety and potential long-term effects of PDT in periodontal patients.

Future perspectives and recommendations: The systematic review has highlighted the potential of PDT as a valuable addition to periodontal disease management. However, several avenues for future research and improvements in PDT’s clinical application have been identified. Further investigations are needed to establish the long-term efficacy of PDT and to identify optimal treatment protocols, including the most suitable PSs and light parameters (40). Large-scale randomised controlled trials and comparative studies can provide stronger evidence for the effectiveness of PDT and enable the identification of specific patient populations that may benefit the most from this therapy. Additionally, exploring the use of PDT in combination with other emerging periodontal treatments or technologies may offer further benefits and enhance its efficacy.

Limitation(s)

Studies on PDT in periodontology may vary widely in terms of study designs, patient populations, intervention protocols, and outcome measures, making it challenging to draw direct comparisons or generalise findings and many studies may have short-term follow-up periods, which limits the assessment of the long-term efficacy and safety of PDT in periodontal treatment.

Conclusion

The PDT presents a promising scope in periodontology, showcasing varied roles ranging from antimicrobial action to tissue healing and periodontal health development. Its efficacy as an adjunctive treatment, especially in challenging cases or against resistant microbes, is evident. This is further accentuated by its non invasive nature and minimal adverse effects, making it an appealing option in periodontal care. Despite these advantages, PDT’s full potential remains untapped due to challenges such as protocol standardisation, optimising light sources, and identifying ideal PSs, which necessitates further investigation. Moreover, addressing cost-effectiveness and accessibility concerns is pivotal for the widespread adoption of PDT. In essence, PDT offers a pathway for advancements in periodontal therapy. Ongoing research and trials are vital to unravel its mechanisms, improve protocols, and solidify its role in enhancing periodontal treatment outcomes.

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DOI and Others

DOI: 10.7860/JCDR/2024/69286.20255

Date of Submission: Dec 26, 2023
Date of Peer Review: Feb 27, 2024
Date of Acceptance: Aug 22, 2024
Date of Publishing: Nov 01, 2024

Author declaration :
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 27, 2024
• Manual Googling: Feb 29, 2024
• iThenticate Software: Aug 21, 2024 (12%)

Etymology: Author Origin

Emendations : 9

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