Abstract
OBJECTIVES: This RCT assessed the effectiveness of daily home-applied dual-light antimicrobial photodynamic therapy (aPDT) as an adjunct to non-surgical periodontal therapy (NSPT) in smokers with Stage III or IV periodontitis. MATERIALS AND METHODS: Sixty smokers were randomized to receive either NSPT alone (control) or NSPT with daily for four months at-home application of aPDT, prior to oral hygiene (test group). Clinical parameters-bleeding on probing (BoP), probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth plaque score (FMPS), and Turesky Index-were assessed at baseline, 2 weeks, 4 months, and 6 months. aMMP-8 levels and patient-reported outcomes were also recorded. RESULTS: Both groups demonstrated significant improvements in BoP, PD, and CAL (p < 0.05), but no significant intergroup differences were observed. BoP reduction at 2 weeks favored the test group (- 33.60% vs - 23.94%; p = 0.056). BoP continued to decrease at 4 and 6 months, reaching 29.55 ± 19.86% in the control group and 27.57 ± 16.43% in the test group at 6 months. The difference in mean BoP between the two groups at 6 months was not statistically significant (p = 0.680, Independent Samples Mann Whitney U Test). Plaque indices and aMMP-8 levels showed no significant differences. Compliance to dual-light aPDT averaged 77.7%; 72% of test participants were compliant. Greater compliance correlated with statistically significant improvements in mean values of all clinical parameters, whereas non-compliant patients presented with no changes (Related samples Friedman's Two-Way Analysis). Patient-centered outcomes revealed positive feedback, with 84% of the patients willing to recommend the device and minor adverse effects. CONCLUSION: In smokers with advanced periodontitis, adjunctive home use of dual-light aPDT did not result in statistically significant improvements over NSPT alone in clinical parameters such as BoP, PD, or CAL. Future placebo-controlled, long-term clinical trials are warranted to further assess its potential role in supportive periodontal care. CLINICAL RELEVANCE: Within the limitations of this study, dual-light aPDT cannot be recommended as a superior adjunct to conventional treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05962801.