Efficacy of Antimicrobial Photodynamic Therapy as an adjunct periodontal intervention in periodontally diseased subjects undergoing orthodontic therapy

Photodynamic therapy in fixed orthodontic patients with gingival disease might be beneficial, being non-invasive and having accessibility to difficulty to reach areas like, interdental region with the presence of wires and brackets. This systematic review was designed to analyze the available evidence on the efficacy of antimicrobial photodynamic therapy as an adjunct to scaling in reduction of gingival inflammation in periodontally diseased subjects undergoing fixed orthodontic treatment. Comprehensive search was conducted in electronic databases like PubMed, Scopus and Google scholar along with hand search in relevant journals. Five studies satisfied the criteria and were included in qualitative synthesis of the systematic review. The results of the primary outcome showed adjunctive aPDT did not result in any difference in reduction of gingival inflammation (BOP) compared to scaling alone in fixed orthodontic patients. Only one study showed a significant reduction of gingival inflammation with aPDT, whereas it was better in the scaling group (one study) or no significant difference (3 study) in the other studies. However, aPDT resulted in significant reduction of most of the bacterial species count and proinflammatory cytokine levels in GCF compared to scaling alone. Within the limitations of this systematic review, there is no clear evidence that aPDT adjunctive to scaling has a better effect in reducing gingival inflammation in fixed orthodontic patients. Future studies addressing this area should focus on well planned standardized, long term RCTs that will aid clinicians in making a more evidence - based decision.