Efficacy of photodynamic therapy with various photosensitizers for peri-implantitis treatment: a systematic review and meta-analysis of randomized clinical trials

To systematically evaluate the efficacy of photodynamic therapy in treating peri-implantitis and compare the effectiveness of various photosensitizers based on randomized clinical trials. A systematic review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, incorporating data from PubMed/MEDLINE, Embase, Web of Science, and CNKI up to December 31, 2024. Randomized clinical trials that assessed the efficacy of photodynamic therapy with various photosensitizers for peri-implantitis were included. Primary outcomes included bleeding on probing, probing depth, plaque index, clinical attachment level, crestal bone loss, and bleeding index. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated for each outcome to quantify the effect size. Risk of bias was assessed using the Cochrane risk-of-bias tool. 13 randomized clinical trials involving 678 participants were included in the analysis. Photodynamic therapy significantly improved several clinical outcomes compared to controls: bleeding on probing (SMD = -0.49, 95% CI: -0.89 to -0.09), probing depth (SMD = -1.49, 95% CI: -2.31 to -0.66), plaque index (SMD = -1.11, 95% CI: -1.98 to -0.25), and crestal bone loss (SMD = -0.53, 95% CI: -0.89 to -0.17). Subgroup analyses revealed that Toluidine Blue was the most effective photosensitizer, showing superior improvements across multiple outcomes. Photodynamic therapy is an effective treatment for peri-implantitis, particularly when using Toluidine Blue, which consistently outperformed other photosensitizers in improving clinical outcomes. These findings provide strong evidence for integrating photodynamic therapy into peri-implantitis management protocols, offering a promising, minimally invasive alternative to conventional treatments. Future studies should focus on optimizing photodynamic therapy protocols, assessing long-term outcomes, and evaluating its effectiveness in diverse patient populations.Clinical trial number: PROSPERO (CRD42024600326).