Discussion
periodontitis, PD
PERIODONTITIS
The recent EFP S3-level practice clinical guidelines for treatment of stage I–III periodontitis [In line with this recommendation, it was decided to carry out the present RCT. The findings obtained showed only a limited added clinical or microbiological benefit with the adjunctive use of ICG-aPDT, with a significant greater PD reduction at initially deep pockets and a greater increase in closed pockets 6 months after treatment.In the experimental group, ICG-aPDT was applied only at initial moderate-deep pockets, 1 and 4 weeks after FMUD. This timing was based on an adaptation of the protocol proposed by Wennström et al. [Few clinical trials have investigated the adjunctive use of ICG-aPDT to manual and/or ultrasonic debridement in the treatment of periodontitis and with conflicting results. Some investigations reported a significantly higher PD reduction and/or CAL gain in the ICG-aPDT group after 3 or 6 months [Another interesting finding relates to a more relevant effect of aPDT therapy found in initial deep sites, both in terms of mean PD reduction and percentage of closed pockets in the test compared to the control group. In a recent study applying ICG-aPDT [The difficulty in identifying all bacteria belonging to the oral microbiota is mainly represented by the fact that most species are uncultivable, and this makes it necessary to use alternative identification methods. The sequence analysis of 16S ribosomal RNA is currently the most frequently used, thanks to the ubiquitous presence of this polynucleotide in all organisms. Furthermore, through the design of specific primers for PCR-mediated amplification, followed by cloning and Sanger sequencing approach, this method allows describing all the species present in each sample or address specific genera. In the present study, a significant microbiological effect of aPDT was observed for two bacterial species (There is no consensus on the effect of aPDT on the subgingival microbiota, and the heterogeneity of aPDT and sampling protocols among the studies makes it very difficult to draw definitive conclusions. In the systematic review by Akram et al. [Certain limitations of the present study need to be mentioned to enable correct interpretation of the reported findings. Operators, unlike the patients, were aware of the treatment allocation. Nevertheless, in order to reduce possible bias, one calibrated and blinded evaluator, unaware of treatment group, performed all measurements. Moreover, no individual stents were used for periodontal probing, which may have influenced measurement reproducibility. Also only selected sites were treated with the test and control treatments, and a possible cross-influence of other periodontal sites cannot be excluded. Another limitation may be the inclusion of smokers among the patients, due to the noteworthy ability of smoking to affect periodontal treatment outcomes [