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Adjunctive laser or antimicrobial photodynamic therapy to nonsurgical mechanical instrumentation in patients with untreated

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190  |     SALVI et AL.
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     |  191SALVI et AL.
power of the lasers ranged from 30 to 1,000 mW with an irradia-
tion time of 10 to 150 s per site. Wavelengths of lasers ranged from 
655 to 980 nm. In three articles, laser densities were reported and 
ranged from 5.4 to 60 J/cm2 (Betsy et al., 2014; Raut et al., 2018; 
Theodoro et al., 2012).
Five articles reported the application of methylene blue in 
different concentrations as photosensitizer, while three articles 
(Bundidpun et al., 2018; Raut et al., 2018; Theodoro et al., 2012) 
reported the use of toluidine blue O, phenothiazine chloride or in-
docyanine green for laser activation. Application time of the photo-
sensitizer per site amounted to 1 min (Bundidpun et al., 2018; Raut 
et al., 2018) or 3 min (Betsy et al., 2014; Dilsiz et al., 2013; Malgikar 
et al., 2016), if reported.
All studies included test and control groups. In both groups, 
non-surgical mechanical instrumentation was performed by hand 
instruments, that is curettes (Berakdar et al., 2012; Theodoro et al., 
2012), or power-driven instruments, that is ultrasonic devices (Al-
Askar et al., 2017; Bundidpun et al., 2018), or a combination of both 
(Betsy et al., 2014; Dilsiz et al., 2013; Malgikar et al., 2016; Raut et al., 
2018). In all studies but 1 (Dilsiz et al., 2013), non-surgical mechanical 
instrumentation was performed in one single session. Five articles 
reported full-mouth instrumentation (Al-Askar et al., 2017; Betsy 
et al., 2014; Bundidpun et al., 2018; Dilsiz et al., 2013; Malgikar et 
al., 2016). Treatment in controls consisted of non-surgical mechan-
ical instrumentation without adjunctive measures. In two studies, a 
placebo laser was additionally used in the control group (Dilsiz et 
al., 2013; Raut et al., 2018). Treatment in the test groups consisted 
of non-surgical mechanical instrumentation with adjunctive aPDT, 
which was applied immediately after mechanical instrumentation in 
five studies (Al-Askar et al., 2017; Berakdar et al., 2012; Betsy et 
al., 2014; Raut et al., 2018; Theodoro et al., 2012). In three studies, 
aPDT was applied with a time lag after mechanical instrumentation, 
that is after 24 hrs (Malgikar et al., 2016) or 1 week (Bundidpun et 
al., 2018; Dilsiz et al., 2013). In all studies, aPDT was applied once.
In all studies, maximum follow-up time amounted to 6 months. 
None of the included articles reported on PPD measurements and/
or subgingival mechanical debridement within 6 months after initial 
treatment. Oral hygiene instructions and/or professional prophylaxis 
were performed after 1, 3 and 6 months in three studies (Bundidpun 
et al.,

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