Comparative Evaluation of Photodynamic Therapy and Photoablation as Adjuncts to Open Flap Debridement Versus Open Flap Debridement Alone in Periodontitis Patients: A Double-Blinded Randomised Controlled Trial.

BACKGROUND: Residual periodontal pockets may persist after Phase I therapy, contributing to recurrent inflammation and progressive periodontal breakdown. Photodynamic therapy (PDT) and photoablation have been proposed as adjuncts to open flap debridement, although direct comparative evidence remains limited. OBJECTIVE: This study aims to compare the clinical effectiveness of PDT and photoablation as adjuncts to open flap debridement with that of open flap debridement alone in patients with chronic periodontitis. METHODS: This participant- and outcome-assessor-blinded, parallel-arm randomised controlled trial enrolled 51 patients with residual probing pocket depths of 5-7 mm after Phase I therapy. Seventeen participants were allocated to each of three groups: open flap debridement alone, open flap debridement with PDT using methylene blue and a 650 nm diode laser, or open flap debridement with photoablation using a 980 nm diode laser. Forty-five participants completed the six-month follow-up. Plaque Index, Gingival Index, Probing Pocket Depth, Clinical Attachment Level, Gingival Recession, and Papillary Bleeding Index were assessed at baseline, three months, and six months. RESULTS: All groups improved significantly over time. At six months, Clinical Attachment Level, Gingival Recession, and Papillary Bleeding Index differed significantly among the groups (all p < 0.001). Mean Clinical Attachment Level values were 3.93 ± 1.10 mm, 2.47 ± 0.74 mm, and 2.80 ± 0.56 mm in the control, PDT, and photoablation groups, respectively. Corresponding Gingival Recession values were 1.60 ± 1.06 mm, 0.27 ± 0.46 mm, and 0.53 ± 0.52 mm, while Papillary Bleeding Index values were 0.59 ± 0.12, 0.41 ± 0.07, and 0.45 ± 0.07. Plaque Index, Gingival Index, and Probing Pocket Depth remained comparable among the groups. No significant differences were observed between the two laser-assisted groups. CONCLUSION: PDT and photoablation provided comparable additional benefits when combined with open flap debridement, particularly for clinical attachment, gingival recession, and bleeding control. Larger multicentre trials with longer follow-up are required to confirm the durability and clinical applicability of these findings.