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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Adjunctive Strategies to Enhance Antimicrobial Photodynamic Therapy in Oral Infections: A Systematic Review of Randomized Controlled Trials

  • Aleksandra Warakomska1
  • Małgorzata Kępa2
  • Martin Starosta3
  • Barbara Lipka1
  • Hanna Hüpsch-Marzec1
  • Dariusz Skaba1
  • Rafał Wiench1
  1. 1Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
  2. 2Department of Microbiology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Jagiellońska 4, 41-200 Sosnowiec, Poland
  3. 3Department of Dentistry, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava-Jih, 703 00 Ostrava, Czech Republic
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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.

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Cite

BibTeXRIS
BibTeX
@article{warakomska2026adjunctive,
  title = {{Adjunctive Strategies to Enhance Antimicrobial Photodynamic Therapy in Oral Infections: A Systematic Review of Randomized Controlled Trials}},
  author = {Aleksandra Warakomska and Małgorzata Kępa and Martin Starosta and Barbara Lipka and Hanna Hüpsch-Marzec and Dariusz Skaba and Rafał Wiench},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207959},
  url = {https://www.mdpi.com/2077-0383/15/20/7959},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Adjunctive Strategies to Enhance Antimicrobial Photodynamic Therapy in Oral Infections: A Systematic Review of Randomized Controlled Trials
AU  - Aleksandra Warakomska
AU  - Małgorzata Kępa
AU  - Martin Starosta
AU  - Barbara Lipka
AU  - Hanna Hüpsch-Marzec
AU  - Dariusz Skaba
AU  - Rafał Wiench
PY  - 2026
DA  - 2026/10/14
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207959
UR  - https://www.mdpi.com/2077-0383/15/20/7959
AB  - 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.
SN  - 2077-0383
ER  -