Eficácia da terapia fotodinâmica no controle da inflamação gengival em pacientes ortodônticos: um meta-análise em rede

Abstract

The objective of this systematic review and network meta-analysis (NMA) was to verify the effectiveness of photodynamic therapy (PDT) compared to other treatments in controlling gingival inflammation in patients undergoing treatment with fixed orthodontic appliances. An electronic search was performed in six electronic databases, PubMed (Medline), Scopus, Web of Science, Medline Complete (EBSCO), Cochrane (Database for Systematic Review, CENTRAL and Protocols), and gray literature through clinical trials, without limitations on year of publication or language. Articles published until January 2024 were evaluated. Paired reviewers independently selected studies, extracted data, and performed risk of bias assessment. The outcome of interest was the decrease in gingival inflammation measured using different periodontal indices, microbiological culture and inflammatory cytokines. We conducted a random and fixed effects Bayesian network metaanalysis based on the smallest residual effect using mean difference or standardized mean difference and their credibility intervals (CI) as effect measure for the different outcomes. We assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 6 RCTs (173 patients) were included. MA data demonstrated that treatment with PDT (OR, -0.10; 95% CI, -0.14 to -0.05) had a greater chance of effectiveness in reducing the Gingival Index compared to Ultrasound (US) (certainty very low). PDT+US treatment was superior or similar compared to US (OR, -0.36; 95% CI, -0.87 to 0.14; very low certainty) for decreasing T. Forythia. In NMA, all treatments had very low certainty, which demonstrates the lack of certainty regarding their effectiveness. The CI crossed the line of null effect for the treatments in the outcomes of plaque index, gingival bleeding index, and P. Gingivalis, in probing depth this occurred for the PDT+US treatment (0.15: -0.09, 0.38), and in the outcome of F. Nucleatum, except for the PDT+US treatment (0.65: 0.0, 1.29) demonstrating very serious inaccuracy. It can be concluded with very low to low certainty that there is no strong evidence to support PDT as a more effective treatment for controlling gingival inflammation in orthodontic patients. Based on the present results, the patient may benefit from either US or PDT alone or combined with other therapies. From this perspective, the most economical and simple (US) seems to be satisfactory.