Efficacy of Photodynamic Therapy in Controlling Gingival Inflammation in Orthodontic Patients: A Network...

The objective of this systematic review and network meta-analysis (NMA) was to verify the effectiveness of photodynamic therapy (PDT) compared with other treatments in controlling gingival inflammation in patients undergoing treatment with fixed orthodontic appliances. An electronic search was performed in six databases and gray literature through clinical trials. The outcome of interest was the decrease in gingival inflammation, microbiological culture, and inflammatory cytokines. We conducted a random and fixed effects Bayesian NMA based on the smallest residual effect using mean difference and its credibility intervals (CI) as effect measures for the different outcomes. Six randomized clinical trials (RCTs; 173 patients) were included. It was demonstrated that treatment with PDT (MD, -0.10; 95% CI, -0.14 to -0.05) was more effective in reducing the Gingival Index compared with ultrasound (US). PDT + US treatment was superior or similar compared with US (MD, -0.36; 95% CI, -0.87 to 0.14) for decreasing Tannerella forsythia. In NMA, all treatments had very low certainty, demonstrating a lack of certainty regarding efficacy. The CI crossed the null effect line for treatments on the outcomes of Plaque Index, Gingival Bleeding Index, and Porphyromonas gingivalis; in probing depth, this occurred for the PDT-US treatment (0.15: -0.09, 0.38), and Fusobacterium nucleatum, except for the PDT-US treatment (0.65: 0.0, 1.29), demonstrating very serious inaccuracy. We conclude with very low certainty that there is no strong evidence to support PDT in this treatment. The patient can benefit from either US or PDT.