Gingival crevicular fluid level of tumor necrosis factor-alpha as a valuable biomarker for estimation of the efficacy of adjunctive antimicrobial photodynamic therapy in stage II-IV periodontitis: a systematic review and meta-analysis.

Purpose: This systematic review and meta-analysis aimed to assess the gingival crevicular fluid (GCF) level of tumor necrosis factor-alpha (TNF-alpha) as a valuable inflammatory cytokine for estimation of the efficacy of adjunctive antimicrobial photodynamic therapy (aPDT) in stage II-IV periodontitis patients.

Methods: This review was conducted in accordance with the PRISMA statements, and registered in PROSPERO (CRD42022321211). An electronic search was conducted for articles comparing the efficacy of aPDT versus scaling and root planing (SRP) published up until June 2023. The mean GCF level of TNF-alpha and clinical attachment loss (CAL) with 95% confidence interval (CI) were pooled and compared between the groups using a random-effect model after 1-2, 4-5, 12-13, and ≥ 24 weeks. The I² test was applied to assess the heterogeneity of the findings, and publication bias was evaluated by visual inspection of the funnel plot symmetry.

Results: Analysis of 11 studies indicated a significant difference in GCF level of TNF-alpha at the 1-2, 12-13 and ≥ 24-week follow-ups in patients treated with aPDT + SRP. However, at the 4-5-week follow-up, the results were significant in favor of the control group (mean difference = -0.17, 95% CI = -1.86-152, P < 0.00001).

Conclusion: Despite the limitations of the included studies, aPDT can decrease the GCF level of TNF-alpha inflammatory biomarker for a longer period of time than SRP alone in grade II-IV periodontitis. However, further investigations are required to assess the efficacy of higher frequency of aPDT applications.