Photodynamic therapy as an adjunct to periodontal treatment: literature review




Periodontal diseases; Periodontal Diseases; Lasers; Photochemotherapy.; Lasers; Photochemotherapy.


Periodontal disease is a chronic inflammatory process of infectious character which affects the tooth support tissues and can lead to tooth loss. Acting as an adjuvant in the treatment of periodontal diseases, the Phodynamic Therapy has gained visibility. This work aims to address the application of this procedure in periodontal treatment, its advantages and disadvantages, indications and contraindications, concept of the technique, materials used and clinical results. The methodology used consisted of a literature review, which was conducted by accessing the PubMed database and the VHL Regional Portal, with publications selected between 1993 and 2021, using keywords on the subject. The technique consists in the association of a light source and a photosensitizer, for the purpose of promoting microbial death, disinfection and assist in the healing process. Research confirms several advantages of its application in dental practice such as for example the inability to generate bacterial resistance and harmful side effects as well as, promotes localized action, affordability and ease of management. Studies demonstrate the effectiveness of this therapy against periodontopathogenic bacteria and their positive results when applied as an aid in periodontal treatment, as it allows the elimination of retained pathogens in areas of furcation grooves, concavities, distal areas of the molars and deep periodontal pockets, which because of the limitation of the mechanical treatment, they end up remaining and recolonizing those places. The future perspective is that photodynamic therapy will gain more space in the clinical performance, being a promising adjuvant in obtaining satisfactory results in periodontics.


Allaker, R.P. & Douglas, C.W. (2009). Novel anti-microbial therapies for dental plaque-related diseases. The International Journal of Antimicrobial Agents, 33(1), 8-13.

Alvarenga, L.H., Prates, R.A., Yoshimurad, T.M., Katoe, I.T., Suzuki, L.C., Ribeiro, M.S., Ferreira, L.R., Pereira, S.A.S., Martinez, E.F. & Saba-Chujfia, E. (2015). Aggregatibacter actinomycetemcomitans biofilm can be inactivated by methylene blue-mediated photodynamic therapy. Photodiagnosis and Photodynamic Therapy, 12(1), 131-135.

Alwaeli, H.A., Al-Khateeb, S.N. & Al-Sadi, A. (2015). Long-term clinical effect of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. Lasers in Medical Science, 30(2), 801-807.

Andersen, R., Loebel, N., Hammond, D. & Wilson, M. (2007). Treatment of periodontal disease by photodisinfection compared to scaling and root planing. The Journal of Clinical Dentistry, 18(2), 34-38.

Aoki, A, Sasaki, K.M., Watanabe, H. & Ishikawa, I. (2004). Laser in nonsurgical periodontal therapy. Periodontology 2000, 36(1), 59-97.

Araújo, N.C., Fontana, C.R., Gerbi, M.E.M. & Bagnato, V.S. (2012). Overall-mouth disinfection by photodynamic therapy using curcumin. Photomedicine and Laser Surgery, 30(2), 96-101.

Armitage, G.C. (1999). Development of a classification system for periodontal diseases and conditions. Annals of Periodontology, 4(1), 1-6.

Armitage, G.C., Cullinan, M.P. & Seymour, G.J. (2010). Comparative biology of chronic and aggressive periodontitis: introduction. Periodontology 2000, 53(1), 7-11.

Armitage, G.C. (2000). Periodontal infections and cardiovascular disease - how strong is the association? Oral Diseases, 6(6) 335-350.

Azarpazhooh, A., Shah, P.S., Tenenbaum, H.C. & Goldberg, M.B. (2010). The effect of photodynamic therapy for periodontitis: A systematic review and meta-analysis. Journal of Periodontology, 81(1), 4-14.

Bagnato, V.S. (2008). Novas técnicas óticas para as áreas da saúde. São Paulo: Editora Livraria da Física.

Betsy, J., Prasanth, C.S., Baiju, K.V., Prasanthila, J. & Subhash, N. (2014). Efficacy of antimicrobial photodynamic therapy in the management of chronic periodontitis: a randomized controlled clinical trial. Journal of Clinical Periodontology, 41(6), 573-581.

Bottura, P.E., Milanezi, J., Fernandes, L.A., Caldas, H.C., Abbud-Filho, M., Garcia, V.G. & Baptista, M.A.S.F. (2011). Nonsurgical periodontal therapy combined with laser and photodynamic therapies for periodontal disease in immunosuppressed rats. Transplantation Proceedings, 43(5), 2009-2016.

Braun, A., Dehn, C., Krause, F. & Jepsen, S. (2008) Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. Journal of Clinical Periodontology, 35(10), 877-884.

Carrera, E.T, Dias H.B., Corbi, S.C.T., Marcantonio, R.A.C., Bernardi A.C.A., Bagnato V.S., Hamblin M.R. & Rastelli, A.N.S. (2016). The application of antimicrobial photodynamic therapy (aPDT) in dentistry: a critical review. Laser Physics, 26(12), 1-23.

Chambrone, L., Wang, H-L. & Romanos, G. (2018). Antimicrobial photodynamic therapy for the treatment of periodontitis and peri-implantitis: An American Academy of Periodontology best evidence review. Journal of Periodontology, 89(7), 783-803.

Chan, Y. & Lai, C.H. (2003). Bactericidal effects of different laser wavelengths on periodontopathic germs in photodynamic therapy. Lasers in Medical Science, 18(1), 51-55.

Christodoulides, N., Nikolidakis, D., Chondros, P., Becker, J., Schwarz, F., Rössler, R. & Sculean, A. (2008). Photodynamic therapy as an adjunct to nonsurgical periodontal treatment: a randomized, controlled clinical trial. Journal of Periodontology, 79(9), 1638-1644.

Cieplik, F., Deng, D., Crielaard, W., Buchalla, W., Hellwig, E., Al-Ahmad, A. & Maisch, T. (2018). Antimicrobial photodynamic therapy - what we know and what we don't. Critical Reviews in Microbiology, 44(5), 571-589.

Cieplik, F., Tabenski, L., Buchalla, W. & Maisch, T. (2014). Antimicrobial photodynamic therapy for inactivation of biofilms formed by oral key pathogens. Frontiers in Microbiology, 12(5), 405.

Cordeiro, A.M., De Oliveira, G.M., Rentería, J.M., Guimarães, C.A. (2007). Revisão sistemática: uma revisão narrativa. Revista do Colégio Brasileiro de Cirurgiões, 34(6), 428-431.

Dai, T., Huang, Y.Y. & Hamblin, M.R. (2009). Photodynamic therapy for localized infections--state of the art. Photodiagnosis and Photodynamic Therapy, 6(3-4), 170-188.

De Almeida, J.M., Theodoro, L.H., Bosco, A.F., Nagata, M.J.H., Oshiiwa, M. & Garcia, V.G. (2007). Influence of photodynamic therapy on the development of ligature-induced periodontitis in rats. Journal of Periodontology, 78(3), 566-575.

De Almeida, J.M., Theodoro, L.H., Bosco, A.F., Nagata, M.J.H., Bonfante, S., Garcia, V.G. (2008). Treatment of experimental periodontal disease by photodynamic therapy in rats with diabetes. Journal of Periodontology, 79(11), 2156-2165.

De Oliveira, R.R., Schwartz-Filho, H.O., Novaes-Jr, A.B. & Taba-Jr, M. (2009). Antimicrobial photodynamic therapy in the non-surgical tretment of aggressive periodontitis: a preliminary randomized controlled clinical study. Journal of Periodontology, 78(6), 965–973.

Dörtbudak, O., Haas, R., Bernhart, T. & Mailath-Pokorny, G. (2001). Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis. Clinical Oral Implants Research, 12(2), 104-108.

Dovigo, L.N., Pavarina, A.C., Carmello, J.C., Machado, A.L., Brunetti, I.L. & Bagnato, V.S. (2011). Susceptibility of clinical isolates of Candida to photodynamic effects of curcumin. Laser Medicine & Surgery, 43(9), p.927-934.

Eduardo, C.P., Bello-Silva, M.S., Ramalho, K.M., Lee, E.M.R. & Aranha, A.C.C. (2015). A terapia fotodinâmica como benefício complementar na clínica odontológica. Revista da Associação Paulista de Cirurgiões Dentistas, 69(3), 226-235.

Eick, S., Markauskaite, G., Nietzsche, S., Laugisch, O., Salvi, G.E. & Sculean, A. (2013). Effect of photoactivated disinfection with a light-emitting diode on bacterial species and biofilms associated with periodontitis and peri-implantitis. Photodiagnosis and Photodynamic Therapy, 10(2), 156–167.

Feng, Z. & Weinberg, A. (2006). Role of bacteria in health and disease of periodontal tissues. Periodontology 2000, 40(1), 50-76.

Fernandes, L.A., Almeida, J.M., Theodoro, L.H., Bosco, A.F., Nagata, M.J.H., Martins, T.M., Okamoto, T. & Garcia, V.G. (2009). Treatment of experimental periodontal disease by photodynamic therapy in immunosuppressed rats. Journal Clinic of Periodontology, 36(3), 219-228.

Fernandes, L.A., Martins, T.M., Almeida, J.M., Theodoro, L.H. & Garcia, V.G. (2010). Radiographic assessment of photodynamic therapy as an adjunctive treatment on induced periodontitis in immunosuppressed rats. Journal of Applied Oral Science, 18(3), 237-43.

Flemming, T. F. (1999). Periodontitis. Annals of Periodontology, 4(1), 32-37.

Garcez, A.S., Nuñez, S.C., Hamblin, M.R. & Ribeiro, M.S. (2008). Antimicrobial effects of photodynamic therapy on patients with necrotic pulps and periapical lesion. Journal of Endodontics, 34(2), 138-142.

Grossi, S.G., Skrepcinski, F.N., DeCaro, T., Zambon, J.J., Cummins, D. & Genco, R.J. (1996). Response to periodontal therapy in diabetics and smokers. Journal of Periodontology, 67(10), 1094-1102.

Hengzhuang, W., Wu, H., Ciofu, O., Song, Z. & Høiby, N. (2011). Pharmacokinetics/Pharmacodynamics of Colistin and Imipenem on Mucoid and Nonmucoid Pseudomonas aeruginosa Biofilms. Antimicrobial Agents and Chemotherapy, 55(9), 4469-4474.

Huang, L., Dai, T. & Hamblin, M.R. (2010). Antimicrobial photodynamic inactivation and photodynamic therapy for infections. Methods in Molecular Biology, 3(5), 155-173.

Jori, G., Fabris, C., Soncin, M., Ferro, S., Coppellotti, O., Dei, D., Fantetti, L., Chiti, G. & Roncucci, G. (2006). Photodynamic therapy in the treatment of microbial infections: basic principles and perspective applications. Lasers in Surgery and Medicine, v. 38(5), 468-481.

Karmakova, T., Feofanov, A., Pankratov, A., Kazachkina, N., Nazarova, N., Yakubovskaya, R., Lebedeva, R., Ruziyev, R., Mironov, A., Maurizot, J.C. & Vigny, P. (2006). Tissue distribution and in vivo photosensitizing activity of 13,15-[N-(3-hydroxypropyl)]cycloimide chlorin p6 and 13,15-(N-methoxy)cycloimide chlorin p6 methyl ester. The Journal of Photochemistry and Photobiology, 82(1), 28-36.

Kikuchi, T., Mogi, M., Okabe, I., Okada, K., Goto, H., Sasaki, Y. Fujimura, T., Fukuda, M. & Mitani, A. (2015). Adjunctive Application of Antimicrobial Photodynamic Therapy in Nonsurgical Periodontal Treatment: A Review of Literature. International Journal of Molecular Sciences, 16(10), 24111-24126.

Kolbe, M.F., Ribeiro, F.V., Luchesi, V.H., Casarin, R.C., Sallum, E.A., Nociti Jr, F.H., Ambrosano, G.M.B., Cirano, F.R., Pimentel, S.P. & Casati, M.Z. (2014). Photodynamic Therapy During Supportive Periodontal Care: Clinical, Microbiologic, Immunoinflammatory, and Patient-Centered Performance in a Split-Mouth Randomized Clinical Trial. Journal of Periodontology, 85(8), 277-286.

Komerik, N., Nakanishi, H., MacRobert, A.J., Henderson, B., Speight, P. & Wilson, M. (2003). In vivo killing of Phorphiromonas gingivalis by toluidine blue-mediated photosensitization in an animal model. Antimicrobial Agents and Chemotherapy, 47(3), 932- 940.

Kyungwon, C., Lee, S.Y., Chang, B.S., Um, H.S. & Lee, J.K. (2015). The effect of photodynamic therapy on Aggregatibacter actinomycetemcomitans attached to surface-modified titanium. Journal of Periodontal and Implant Science, 45(2), 38-45.

Lulic, M., Görög, I.L., Salvi, G.E., Ramseier, C.A., Mattheos, N. & Lang, N.P. (2009). One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof of principle randomized controlled clinical trial. Journal Clinic of Periodontology, 36(8), 661-666.

Machado, A.E.H. (2000). Terapia fotodinâmica: princípios, potencial de aplicação e perspectivas. Revista Química Nova, 23(2), 237-243.

Marques, E.C.P., Lopes, F.P., Nascimento, I.C., Morelli, J., Pereira, M.V., Meiken, V.M.M. & Pinheiro, S.L. (2019). Photobiomodulation and photodynamic therapy for the treatment of oral mucositis in patients with câncer. Photodiagnosis and Photodynamic Therapy, 29(1), 10-16.

Marotti, J., Aranha, A.C., Eduardo, C. P. & Ribeiro, M.S. (2009). Photodynamic therapy can be effective as a treatment for herpes simplex labialis. Photomedicine and Laser Surgery, 27(2), 357-63.

Melo, W., Avci, P., Oliveira, M.N., Gupta, A., Vecchio, D., Sadasivam, M., Chandran, R., Huang, Y.Y., Yin, R., Perussi, L.R., Tegos, G.P., Perussi, J.R., Dai, T. & Hamblin, M.R. (2013). Photodynamic inactivation of biofilm: taking a lightly colored approach to stubborn infection. Expert Review of Anti-infective Therapy, 11(7), 669-693.

Mima, E.G., Vergani, C.E., Machado, A.L., Massucato, E.M.S., Colombo, A.L., Bagnato, V.S. & Pavarina, A.C. (2012). Comparison of Photodynamic Therapy versus conventional antifungal therapy for the treatment of denture stomatitis: a randomized clinical trial. Clinical Microbiology and Infection, 18(10), 380-388.

Nagata, J.Y., Hioka, N., Kimura, E., Batistela, V.R., Terada, R.S.S., Graciano, A.X., Baesso, M.L. & Hayacibara, M.R. (2012). Antibacterial photodynamic therapy for dental caries: evaluation of the photosensitizers used and light source properties. Photodiagnosis and Photodynamic Therapy, 9(2), 122-131.

Nishihara, T. & Koseki, T. (2004). Microbial etiology of periodontitis. Periodontology 2000, 36(1), 14-26.

Nuñez, S.C., Yoshimura, T.M., Ribeiro, M.S., Junqueira, H.C., Maciel, C., Coutinho-Neto, M.D. & Baptista, M.S. (2015). Urea enhances the photodynamic efficiency of methylene blue. The Journal of Photochemistry and Photobiology B, 150(1), 31-37.

O'connor, A.E., Gallagher, W.M. & Byrne, A.T. (2009). Porphyrin and nonporphyrin photosensitizers in oncology: preclinical and clinical advances in photodynamic therapy. Photochemistry and Photobiology, 85(5), 1053-74.

Paschoal, M.A., Lin, M., Santos-Pinto, L. & Duarte, S. (2015). Photodynamic antimicrobial chemotherapy on Streptococcus mutans using curcumin and toluidine blue activated by a novel LED device. Lasers in Medical Science, 30(2), 885-890.

Pereira, A.S., Shitsuka, D.M., Parreira, F.J., Shitsuka, R. (2018). Metodologia da pesquisa científica. E-book.

Pfitzner, A., Sigusch, B.W., Albrecht, V. & Glockmann, E. (2004). Killing of periodontopathogenic bacteria by photodynamic therapy. Journal of Periodontology, 75(10), 1343-1349.

Polansky, R., Haas, M., Heschl, A. & Wimmer, G. (2009). Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. Journal of Clinical Periodontology, 36(7), 575–580.

Puri, K. & Puri, N. (2013). Local drug delivery agents as adjuncts to endodontic and periodontal therapy. Journal of Medicine and Life, 6(4), 414-419.

Qin, Y.L., Luan, X.L., Bi, L.J., Sheng, Y.Q., Zhou, C.N. & Zhang, Z.G. (2008). Comparison of toluidine blue-mediated photodynamic therapy and conventional scaling treatment for periodontitis in rats. Journal of Periodontal Research, 43(2), 162-7.

Rhemrev, G.E., Timmerman, M.F., Veldkamp, I., Winkelhoff, A.J.V. & Velden, U.V. (2006). Immediate effect of instrumentation on the subgingival microflora in deep inflamed pockets under strict plaque control. Journal of Clinical Periodontology, 33(1), 42-48.

Roberts, G.J., Longhurst, P.P., Black, A.E., Lucas, V.S. (2000). Is there need for antibiotic prophylaxis for soem aspects of paediatric conservative dentistry? British Dental Journal, 188(2), 95-98.

Sarkar, S. & Wilson, M. (1993). Lethal photosensitization of bacteria in subgingival plaque from patients with chronic periodontitis. Journal of Periodontal Research, 28(3), 204-210.

Seguier, S., Souza, S.L.S, Sverzut, A.C.V., Simioni, A.R.S., Primo, F.L.P., Bodineau, A., Corrêa, V.M.A., Coulomb, B. & Tedesco, A.C. (2010). Impact of photodynamic therapy on inflammatory cells during human chronic periodontitis. Journal of Photochemistry and Photobiology B, 101(3), 348-354.

Selva, A.L., Negreiros, R.M., Bezerra, D.T., Rosa, E.P., Pavesi, V.C.S., Navarro, R.S., Bello-Silva, M.S., Ramalho, K.M., Aranha, A.C.C., Braz-Silva, P.H., Fernandes, K.P.S., Bussadori, S.K. & Horliana, A.C.R.T. (2020). Treatment of herpes labialis by photodynamic therapy: Study protocol clinical trial (SPIRIT compliant). Medicine, 99(12), 1-9.

Shibli, J.A., Martins, M.C., Theodoro, L.H., Lotufo, R.F.M., Garcia, V.G. & Marcantonio, E.J. (2003). Lethal photosensitization in microbiological treatment of ligature-induced peri-implantitis: a preliminary study in dogs. Journal of Oral Science, 45(1), 17-23.

Shrestha, A., Hamblin, M.R. & Kishen, A. (2014). Photoactivated rose bengal functionalized chitosan nanoparticles produce antibacterial/biofilm activity and stabilize dentin-collagen. Nanomedicine, 10(3), 491-501.

Soukos, N.S. & Goodson, J.M. (2011). Photodynamic therapy in the control of oral biofilms. Periodontology 2000, 55(1), 143-166.

Soukos, N.S., Ximenez-Fyvie, L.A., Hamblin, M.R., Socransky, S.S. & Hasan, T. (1998). Targeted antimicrobial photochemotherapy. Antimicrobial Agents and Chemotherapy, 42(10), 2595-2601.

Souza, R.C., Junqueira, J.C., Rossoni, R.D., Pereira, C.A., Munin, E. & Jorge, A.O.C. (2010). Comparison of the photodynamic fungicidal efficacy of methylene blue, toluidine blue, malachite green and low-power laser irradiation alone against Candida albicans. Lasers in Medical Science, 25(3), 385-389.

Sridharan, G. & Shankar, A.A. (2012). Toluidine blue: A review of its chemistry and clinical utility. Journal of Oral and Maxillofacial Pathology, 16(2), 251-255.

Street, C.N., Pedigo, L.A. & Loebel, N.G. (2010). Energy dose parameters affect antimicrobial photodynamic therapy-mediated eradication of periopathogenic biofilm and planktonic cultures. Photomedicine and Laser Surgery, 28(1), 61-66.

Szeimies, R.M. & Karrer, S. (2021). Photodynamic therapy-trends and new developments. Der Hautarzt, 72(1), 27-33.

Tabenski, L., Buchalla, W. & Maisch, T. (2014). Antimicrobial photodynamic therapy for inactivation of biofilms formed by oral key pathogens. Frontiers in Microbiology, 5(1), 1-17.

Takasaki, A.A., Aoki, A., Mizutani, K., Schwarz, F., Sculean, A., Wang, C-Y., Koshy, G., Romanos, G., Ishikawa, I. & Izumi, Y. (2009). Application antimicrobial photodynamic therapy in periodontal and peri-implant diseases. Periodontology 2000, 51(1), 109-140.

Tardivo, J.P., Giglio, A.D., Oliveira, C.S., Gabrielli, D.S., Junqueira, H.C., Tada, D.B., Severino, D., Turchiello, R.F. & Baptista, M.S. (2005). Methylene blue in photodynamic therapy: From basic mechanisms to clinical applications. Photodiagnosis and Photodynamic Therapy, 2(3), 175-191.

Tortora, G.J. (2010). Microbiologia: uma introdução. São Francisco: Pearson Benjamin Cummings.

Wainwright, M., Byrne, M.N. & Gattrell, M.A. (2006). Phenothiazinium-based photobactericidal materials. The Journal of Photochemistry and Photobiology B, 84(3), 227-230.

Wainwright, M. (2010). ‘Safe’ photoantimicrobials for skin and soft-tissue infections. International Journal of Antimicrobial Agents, 36(1), 14-18.

Watanabe, T., Fukuda, M., Mitani, A., Ting, C-C., Osawa, K., Nagahara, A., Satoh, S., Fujimura, T., Takahashi, S., Iwamura, Y., Murakami, T. & Noguchi, T. (2013). Nd:Yag laser irradiation of the tooth root surface inhibits demineralization and root surface softening caused by minocycline application. Photomedicine and Laser Surgery, 31(12), 571-557.

Wiebe, C.B. & Putnins, E.E. (2000). The periodontal disease classification system of the American academy of periodontology–an update. Journal of the Canadian Dental Association, 66(11), 594-597, 2000.

Wilson, B.C. & Patterson, M.S. (2008). The physics, biophysics and technology of photodynamic therapy. Physics in Medicine & Biology, 53(9), 61–109.

Yin, R., Dai, T., Avci, P., Jorge, A.E.S., Melo, W.C.M.A., Vecchio, D., Huang, Y-Y., Gupta, A. & Hamblin, M.R. (2013). Light based anti-infectives: ultraviolet C irradiation, photodynamic therapy, blue light, and beyond. Current Opinion in Pharmacology, 13(5), 731-762.

Zanin, I.C. & Brugnera, A. (2007). Terapia fotodinâmica no tratamento da doença periodontal. Perionews, 1(1), 79-85.

Zanin, I.C., Gonçalves, R.B., Junior, A.B., Hope, C.K. & Pratten, J. (2005). Susceptibility of Streptococcus mutans biofilms to photodynamic therapy: an in vitro study. Journal of Antimicrobial Chemotherapy, 56(2), 324-230.



How to Cite

PEREIRA, I. de L. .; ANDRAUS, L. P. M. .; PEDRIALI, M. B. B. P. .; TIOSSI, P. P. C. .; ITO, F. A. N. . Photodynamic therapy as an adjunct to periodontal treatment: literature review. Research, Society and Development, [S. l.], v. 10, n. 13, p. e585101321534, 2021. DOI: 10.33448/rsd-v10i13.21534. Disponível em: Acesso em: 19 jan. 2022.



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