{
  "abstract": "Background/Objectives: Antimicrobial photodynamic therapy (aPDT) is a widely investigated adjunct for managing oral biofilm-associated bacterial and fungal infections, but poor photosensitizer penetration, aggregation, biofilm hypoxia, and protocol variability limit its clinical efficacy. Methods: This review was registered with PROSPERO (CRD420251207522) and conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library were searched for English-language RCTs. Eligible studies evaluated aPDT combined with physicochemical, delivery-based, light-based, biological, or host-modulating adjuncts in patients with oral biofilm-related bacterial or fungal disease, using an appropriate comparator. Data were synthesized narratively due to substantial clinical and methodological heterogeneity, and risk of bias was assessed using RoB 2. Results: Fourteen RCTs were included, predominantly addressing periodontal and peri-implant conditions, with additional studies involving orthodontic biofilms; no eligible RCT evaluated a fungal oral infection. Surfactant-based enhancement (e.g., sodium dodecyl sulfate) produced formulation- and protocol-dependent effects, with benefits reported for methylene blue and curcumin but not riboflavin. Nanocarrier-based photosensitizer delivery, evaluated in combination with Aloe vera vehicles, improved selected clinical outcomes without consistently superior microbiological effects; however, the independent contribution of the nanocarrier could not be isolated from the potential bioactive effects of the vehicle. An oxygen-releasing adjunct showed no significant between-group clinical benefit. Repeated dual-light irradiation improved bleeding on probing and pocket-related outcomes in some but not all trials. Probiotics, vitamin D, and low-level laser therapy showed inconsistent or preliminary benefits, each supported by limited trial numbers. Risk-of-bias assessments predominantly indicated low risk or some concerns, with one study judged at high overall risk. Conclusions: Enhancement of aPDT should not be regarded as a single therapeutic concept; its clinical benefit is strategy-, formulation-, and context-dependent. Current randomized evidence does not support a universally superior adjunct, highlighting the need for standardized, adequately powered trials with mechanism-oriented comparator designs.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland",
    "Department of Microbiology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Jagiellońska 4, 41-200 Sosnowiec, Poland",
    "Department of Dentistry, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava-Jih, 703 00 Ostrava, Czech Republic"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Aleksandra Warakomska"
    },
    {
      "affs": [
        1
      ],
      "name": "Małgorzata Kępa",
      "orcid": "0000-0002-4013-6688"
    },
    {
      "affs": [
        2
      ],
      "name": "Martin Starosta",
      "orcid": "0000-0002-6843-349X"
    },
    {
      "affs": [
        0
      ],
      "name": "Barbara Lipka"
    },
    {
      "affs": [
        0
      ],
      "name": "Hanna Hüpsch-Marzec"
    },
    {
      "affs": [
        0
      ],
      "name": "Dariusz Skaba",
      "orcid": "0000-0001-8732-251X"
    },
    {
      "affs": [
        0
      ],
      "name": "Rafał Wiench",
      "orcid": "0000-0001-5673-7413"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/82mxgzr962858.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15207959",
  "fulltext_url": "https://europepmc.org/articles/PMC13705717",
  "id": "82mxgzr962858",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/7959",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Photodynamic Therapy Research Studies"
    ]
  ],
  "openalex": "W7221774071",
  "pdf_url": "https://europepmc.org/articles/PMC13705717?pdf=render",
  "pmcid": "PMC13705717",
  "pmid": "42941473",
  "published": "2026-10-14",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/82mxgzr962858.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15207959",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/7959"
    },
    {
      "first_seen": "2026-10-30T12:22:12Z",
      "native_id": "MED:42941473",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42941473"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Photodynamic Therapy Research Studies",
      "subfield": "general"
    }
  ],
  "title": "Adjunctive Strategies to Enhance Antimicrobial Photodynamic Therapy in Oral Infections: A Systematic Review of Randomized Controlled Trials",
  "title_text": "Adjunctive Strategies to Enhance Antimicrobial Photodynamic Therapy in Oral Infections: A Systematic Review of Randomized Controlled Trials",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:12Z",
  "url": "https://research.draconitic.com/paper/82mxgzr962858",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}