Background: Peri-implantitis, an inflammatory condition leading to progressive bone loss around dental implants, represents a significant challenge in modern implant dentistry. Conventional mechanical debridement and adjunctive antibiotics or antiseptics often fail to fully eradicate complex biofilms and may promote antibiotic resistance. Photodynamic therapy (PDT) mediated by natural photosensitizers (e.g., curcumin, riboflavin, and 5-aminolevulinic acid) has emerged as a potential adjunctive strategy for peri-implantitis management due to its targeted antimicrobial and anti-inflammatory effects. Objectives: This systematic review aimed to evaluate the antimicrobial efficacy, clinical outcomes, and safety of PDT mediated by natural photosensitizers in the treatment of peri-implantitis and to identify optimal protocols regarding photosensitizer concentrations, light source parameters, and application techniques. Methods: Following PRISMA 2020 guidelines, databases (PubMed/Medline, Embase, Scopus, and Cochrane Library) were searched from 1 January 2015 to 3 January 2025 for English-language publications. Studies assessing naturally based PDT interventions for peri-implantitis or in vitro biofilms from diseased implant surfaces were included. Quality assessment used the Revised Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials and a tailored nine-item framework for in vitro studies. Eleven studies met the inclusion criteria. Results: Despite heterogeneity in methodologies, especially regarding light wavelengths, energy densities, and photosensitizer formulations, most studies reported notable reductions in bacterial viability, biofilm mass, and clinical indices (probing depth and bleeding on probing). Curcumin and riboflavin frequently demonstrated comparable antimicrobial efficacy to standard disinfectants, while 5-aminolevulinic acid (5-ALA)-based PDT also showed promising clinical and microbiological improvements. However, complete biofilm eradication was rarely achieved. Conclusions: Natural-photosensitizer-based PDT appears to be a valuable adjunct to mechanical debridement for peri-implantitis, enhancing microbial control and clinical outcomes. Standardization of PDT protocols and further well-designed clinical trials with extended follow-up periods are warranted to confirm long-term efficacy and inform evidence-based guidelines.

Background: Candida albicans is increasingly recognized in peri-implantitis due to its capacity to form resilient biofilms on implant surfaces, limiting treatment success. Antimicrobial photodynamic therapy (aPDT) may offer a non-invasive adjunct by leveraging photosensitizer activation to produce reactive oxygen species that disrupt microbial cells. This in vitro study assessed the antifungal efficacy of QroxB2, a dual-photosensitizer containing riboflavin and curcumin, activated by 450 nm blue light against C. albicans biofilms on titanium implants. Methods: C. albicans biofilms were formed on 63 titanium implants and randomly assigned to nine groups (n = 7): untreated control (GC), chlorhexidine (CHX), riboflavin (RIB), curcumin (CUR), QroxB2 (QBX), laser only (L), and three photodynamic therapy groups combining laser irradiation with each photosensitizer (L + RIB, L + CUR, L + QBX). Treatments were followed by colony-forming unit (CFU) enumeration. Results: The L + QBX group showed the strongest antifungal effect, achieving a 94% reduction in fungal load, with median CFU counts decreasing from 49,000 in the untreated control to 2800 CFU/mL. CHX eradicated all viable cells (0 CFU/mL). Among photosensitizer-only groups, QBX produced a moderate reduction (median 21,800 CFU/mL), whereas laser irradiation alone (L) exhibited no meaningful antifungal activity, with median counts comparable to the untreated control (49,000 CFU/mL). Conclusions: QroxB2-mediated aPDT achieved a significant reduction in Candida albicans colony-forming units on implant surfaces. While not as potent as chlorhexidine, this light-activated, biocompatible approach may serve as a complementary tool in managing peri-implant fungal infections. Clinical validation is warranted.

Periodontitis is a chronic inflammatory disease with multifactorial aetiology. The relationship between periodontal disease and systemic diseases such as diabetes, obesity, metabolic syndrome, atherosclerotic, cardiovascular disease, and cognitive disorders has been the subject of many studies. The purpose of this study was to evaluate the effectiveness of hyperbaric oxygen therapy on periodontal health in patients suffering from periodontitis and type 2 diabetes. The study was conducted with 14 patients. A total of 369 periodontal pockets in the study group and 431 in the control group were examined. For further analysis, the pockets were classified as moderately deep (4–5 mm) and deep (≥6 mm). All patients received standard non-surgical treatment: scaling and root planing (SRP). Additionally, a series of 30 hyperbaric chamber sessions was carried out in the study group. The following parameters were compared between groups: PD (probing depth), CAL (clinical attachment level), and BOP (bleeding on probing). The results of the study showed significantly better results in terms of PD reduction and CAL gain in the study group in comparison to the control group. Both groups showed a reduction in BOP (bleeding on probing) after treatment. The use of hyperbaric oxygen therapy seems to have considerable benefits in patients with type 2 diabetes.

Background: Oral biofilms are a major etiological factor in dental caries, periodontal disease, peri-implantitis, and endodontic infections. Increasing antimicrobial resistance and the limitations of conventional therapies have intensified interest in antimicrobial photodynamic therapy (aPDT). Hypericin, a natural photosensitizer derived from Hypericum perforatum, demonstrates potent reactive oxygen species generation and broad antimicrobial activity; however, its dental applications remain insufficiently synthesized. Objective: To systematically evaluate the antimicrobial efficacy, treatment parameters, safety, and clinical potential of hypericin-mediated aPDT against oral biofilms and infections in dentistry. Methods: This systematic review was conducted according to PRISMA 2020 and registered in PROSPERO CRD42024617727. Electronic searches of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library (January 2010 to December 2025) were performed. Studies assessing hypericin-mediated aPDT in oral or dental contexts were included. Methodological quality was evaluated using a predefined nine-domain risk-of-bias tool. Results: Eleven studies met the inclusion criteria. Hypericin-mediated aPDT demonstrated strong antimicrobial effects, achieving up to 99% planktonic inactivation and significant biofilm reduction across bacterial and fungal species. Activity was particularly pronounced against Gram-positive organisms, including Staphylococcus aureus and Enterococcus faecalis. However, efficacy against mature biofilms was variable and often dependent on formulation and irradiation parameters. Most studies showed moderate methodological quality, with frequent deficiencies in reporting light calibration and dosimetry. Advanced delivery systems, including liposomal and nanoparticle formulations, improved photodynamic performance. Conclusions: Hypericin-mediated aPDT shows promising antimicrobial activity against oral pathogens and biofilms, with favorable selectivity and safety profiles. Nevertheless, the evidence remains predominantly preclinical and heterogeneous. Standardized protocols and well-designed clinical trials are required before routine dental implementation can be recommended.

Background: Denture stomatitis, the most common form of oral candidiasis among denture wearers, remains highly prevalent, and antifungal resistance is an emerging concern. Essential oils and plant-derived volatile compounds show broad-spectrum antifungal activity in vitro, generating interest as complementary therapies. This review evaluated the clinical efficacy, mycological efficacy, and safety of these compounds versus conventional antifungals or placebo, based solely on randomized controlled trials (RCTs). Methods: Following PRISMA 2020 guidelines and PROSPERO registration (CRD420261473618), PubMed, Embase, Scopus, and Cochrane CENTRAL were searched on 20 July 2026 for English-language RCTs published up to 30 June 2026 and evaluating topical essential oils or volatile compounds against a conventional antifungal or placebo comparator in oral candidiasis. Two reviewers independently conducted screening, extraction and RoB 2 risk-of-bias assessment. Due to heterogeneity, findings were synthesized narratively. Results: Eight RCTs (347 participants), all in denture stomatitis patients, met inclusion criteria, evaluating oils from Zataria multiflora, Cinnamomum zeylanicum, Melaleuca alternifolia, Pelargonium graveolens, Satureja hortensis, Artemisia sieberi, and clove/cinnamon extracts. In active-comparator trials, no statistically significant differences in clinical outcomes were detected, but these trials were small and underpowered and none defined a non-inferiority margin; mycological efficacy varied, sometimes favoring nystatin or miconazole. Both placebo-controlled trials favored essential oil gels for clinical and mycological recovery. Adverse effects were inconsistently and mostly non-systematically reported; one trial reported vertigo, nausea and vomiting in the essential-oil group. Overall risk of bias was low in three trials and raised some concerns in five for both outcomes. Conclusions: The evidence for essential oils in denture stomatitis is preliminary and insufficient to support replacing conventional antifungal therapy; the findings cannot be extrapolated to other forms of oral candidiasis. Safety data are insufficient to draw firm conclusions. Standardized formulations and larger, well-designed RCTs with longer follow-up and safety assessment are needed.

Background/Objectives: Antimicrobial photodynamic therapy (aPDT) is a widely investigated adjunct for managing oral biofilm-associated bacterial and fungal infections, but poor photosensitizer penetration, aggregation, biofilm hypoxia, and protocol variability limit its clinical efficacy. Methods: This review was registered with PROSPERO (CRD420251207522) and conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library were searched for English-language RCTs. Eligible studies evaluated aPDT combined with physicochemical, delivery-based, light-based, biological, or host-modulating adjuncts in patients with oral biofilm-related bacterial or fungal disease, using an appropriate comparator. Data were synthesized narratively due to substantial clinical and methodological heterogeneity, and risk of bias was assessed using RoB 2. Results: Fourteen RCTs were included, predominantly addressing periodontal and peri-implant conditions, with additional studies involving orthodontic biofilms; no eligible RCT evaluated a fungal oral infection. Surfactant-based enhancement (e.g., sodium dodecyl sulfate) produced formulation- and protocol-dependent effects, with benefits reported for methylene blue and curcumin but not riboflavin. Nanocarrier-based photosensitizer delivery, evaluated in combination with Aloe vera vehicles, improved selected clinical outcomes without consistently superior microbiological effects; however, the independent contribution of the nanocarrier could not be isolated from the potential bioactive effects of the vehicle. An oxygen-releasing adjunct showed no significant between-group clinical benefit. Repeated dual-light irradiation improved bleeding on probing and pocket-related outcomes in some but not all trials. Probiotics, vitamin D, and low-level laser therapy showed inconsistent or preliminary benefits, each supported by limited trial numbers. Risk-of-bias assessments predominantly indicated low risk or some concerns, with one study judged at high overall risk. Conclusions: Enhancement of aPDT should not be regarded as a single therapeutic concept; its clinical benefit is strategy-, formulation-, and context-dependent. Current randomized evidence does not support a universally superior adjunct, highlighting the need for standardized, adequately powered trials with mechanism-oriented comparator designs.