title: Clinical effectiveness of adjunctive antimicrobial photodynamic therapy for residual pockets during supportive periodontal therapy: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the clinical efficacy of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling and root planing (SRP) in the treatment of residual pockets for chronic periodontitis patients on supportive periodontal therapy (SPT).
  
  
  METHODS
  Bibliographic databases of MEDLINE and Cochrane Library were thoroughly searched up to July 2016 for eligible randomized controlled trials (RCTs). Mean differences (MD) and the corresponding 95% confidence intervals (CI) were synthesized for probing depth (PD) reduction and clinical attachment level (CAL) gain. The I2test and Q statistics were employed to assess inter-study heterogeneity. Subgroup analysis was performed based on the enrollment of smokers.
  
  
  RESULTS
  Four RCTs fulfilling the eligibility criteria were included. Pooled estimates demonstrated statistically significant improvements in both PD reduction (MD=0.69, CI: 0.11-1.28, p=0.02) and CAL gain (MD=0.60, CI: 0.11-1.10, p=0.02) for SRP+aPDT versus SRP alone. Meta-analysis of studies with smokers failed to produce a significant additional effect in PD (MD=0.32, CI: -0.30 to 0.94, p=0.31) and CAL (MD=0.42, CI: -0.26 to 1.09, p=0.23) when SRP was associated with aPDT. However, significant enhancements in PD reduction (MD=1.23, CI: 0.74-1.72, p<0.001) and CAL gain (MD=0.96, CI: 0.31-1.62, p=0.004) were observed for studies excluding smokers.
  
  
  CONCLUSIONS
  Pooled evidence indicates an additional clinical improvement in the maintenance of residual pockets in favor of SRP+aPDT compared with SRP alone. Subgroup analysis demonstrates an adverse impact of smoking on clinical effect of the combined therapy. Substantial heterogeneity and the paucity of included studies undermine the statistical power of this meta-analysis. Future well-designed and large-scale clinical trials evaluating the adjunctive efficacy of aPDT in periodontal maintenance phase are critically needed.
authors.affiliation: Department of Stomatology, Capital Medical University Xuanwu Hospital, No. 45 Changchun Street, West District, Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xue
authors.affiliation: Department of Stomatology, Capital Medical University Xuanwu Hospital, No. 45 Changchun Street, West District, Beijing, China. Electronic address: xw_dent@163.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000328:Adult; D055113:Chronic Periodontitis / Q000628:therapy*; D003131:Combined Modality Therapy; D012534:Dental Scaling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016745:Root Planing / Q000379:methods
keywords: Antimicrobial photodynamic therapy; Chronic periodontitis; Meta-analysis; Residual pockets; Scaling and root planing; Supportive periodontal therapy