Clinical Efficacy of Adjunctive Photodynamic Therapy with Periodontal Regenerative Surgery in Severe Periodontitis: A Randomized Controlled Trial on Gingival Thickness Remodeling and Inflammatory Cytokine Modulation

Abstract

Objective:

Assess clinical efficacy of photodynamic therapy (PDT) combined with periodontal regenerative surgery (PTR) in severe periodontitis, focusing on gingival thickness (GT), inflammatory markers, and bone repair.

Methods:

Sixty patients were randomized to Combination (PDT + PTR) or Control (PTR alone) groups. PDT utilized 660 nm laser with methylene blue. Outcomes included probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), keratinized tissue width (KTW), GT, cone-beam computed tomography bone parameters, and gingival crevicular fluid cytokines (IL-1β, TNF-α, PGE2, MMP-8) at 3/6/12 months.

Results:

At 12 months, Combination group showed superior PD reduction (p < 0.05), CAL gain (p < 0.05), lower BOP (16.67% vs. 43.33%, p < 0.05), increased KTW/GT, and enhanced bone density/defect filling versus Control. Inflammatory markers were significantly reduced at 3 months (p < 0.05). Three-wall defects exhibited better CAL/GT outcomes than two-wall defects (p < 0.05).

Conclusions:

The combined PDT and PTR therapy demonstrated significant improvements in key clinical parameters, reduced inflammatory biomarkers, and enhanced radiographic bone fill in severe periodontitis patients.