Non-surgical management of peri-implantitis with photodynamic therapy: a systematic review and meta-analysis of clinical parameters and biomarkers

Objective: To evaluate the clinical and biomarker outcomes of photodynamic therapy (PDT) as an adjunct to non-surgical mechanical debridement (MD) in the management of peri‑implantitis, and to compare its efficacy to MD alone or other non-surgical treatment modalities. Data and Sources: Electronic searches in PubMed, Web of Science, and CENTRAL were conducted. 4675 studies published until November 2023 were screened. Clinical studies reporting on non-surgical treatments involving PDT were selected. Meta-analyses assessed clinical parameters (bleeding on probing [BOP], probing depth [PD], plaque index [PI], crestal bone loss [CBL], clinical attachment level [CAL]) and biomarkers. Study selection: A total of 25 studies were included. The meta-analysis of randomized controlled trials revealed that both MD alone and MD+PDT significantly improved clinical and biomarker outcomes compared to baseline. The addition of PDT provided greater improvements at 3 months for BOP (SMD:0.90; 95 % CI:1.53 to –0.28; p = 0.005), PD (SMD:1.15; 95 % CI:1.72 to –0.58; p < 0.0001), PI (SMD:0.74; 95 % CI:1.15 to –0.33; p = 0.0004) and CBL (SMD:0.38; 95 % CI:0.73 to –0.03; p = 0.04). The additional benefits of PDT were less pronounced on CAL, mucosal recession, and inflammatory biomarkers. No significant changes were observed over extended follow-up periods. Conclusions: Adjunct PDT significantly enhanced clinical outcomes, particularly for the short-term, with the most notable benefits observed in BOP, PD, PI, and CBL reductions. However, additional benefits in CAL, mucosal recession, and inflammatory biomarkers outcomes remain limited. Standardized protocols and long-term studies are warranted. Clinical significance: PDT as an adjunct in non-surgical peri-implantitis management improves short-term clinical outcomes, particularly for BOP, PD, PI, and CBL. The benefits of adjunctive use with mechanical debridement offer a promising and minimally invasive approach. Further long-term research is needed to establish its role in routine clinical practice.