***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Photodynamic therapy ( PDT ) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access , such as deep pockets and furcations . The aim of this r and omized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis . Material and Methods : Twenty-two patients with at least one pocket with a probing depth ( PD ) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing ( BOP ) on each side of the mouth were included , characterizing a split mouth design . The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT . The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005 % methylene blue dye . Two minutes after applying the photosensitizer , the low power laser - AsGaAl ( Photon Lase III - PL7336 , DMC , São Carlos -São Paulo , Brazil ) was applied ( 660 nm , 100 mW , 9 J , 90 seconds per site , 320 J/cm2 , diameter tip 600 µm).The following clinical parameters were evaluated : plaque index , gingival index , BOP , gingival recession ( GR ) , PD , and clinical attachment level ( CAL ) . All parameters were collected before , 1 , 3 and 6 months after treatment . Results : An improvement in BOP , PD and CAL was observed after treatment , in both groups , but without any difference between them . After 6 months , the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group ( p<0.05 ) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group ( p<0.05 ) . The CAL changed , after 6 months , from 5.49±0.76 mm to 3.41±0.84 mm in the test group ( p<0.05 ) and from 5.53±0.54 to 3.39±0.51 mm in the control group ( p<0.05 ) . Conclusion : Both approaches result ed in significant clinical improvements in the treatment of severe chronic periodontits , however , the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone The aim of this study was to compare the short-term performance of a session of single photodynamic therapy ( PDT ) and of a conventional ultrasonic debridement ( UST ) in persistent pockets of maintenance patients . In a prospect i ve , r and omized , controlled , single-blind clinical study , patients with chronic periodontitis with at least two persistent pockets ( > 4 mm ) were enrolled . They were treated either with UST ( n = 29 ) or PDT ( n = 25 ) . Clinical and microbiological examinations were performed at baseline and after 3 month . For UST , the mean probing depth was reduced from 5.3 to 4.5 mm ( p = < 0.001 ) and for PDT from 5.3 to 4.7 mm ( p < 0.001 ) with no difference between the two treatment modalities . Microbial counts were significantly reduced about 30 % to 40 % immediately after debridement but returned to baseline values at month 3 irrespective of treatment . PDT is not superior to conventional mechanical treatment of persistent pockets , but it may be a meaningful therapeutic alternative ; the clinical effects were too minor to draw a definitive conclusion This study aims to assess in residual periodontal pockets the clinical , microbiological , and local biological effects of antimicrobial photodynamic therapy ( PDT ) , delivered after ultrasonic instrumentation either once or twice in a 1-week interval . A single center , three-arm r and omized longitudinal study was carried out for 6 months . Twenty-eight systemically healthy patients on periodontal maintenance with residual pockets ( pocket depth ( PD ) ≥5 mm , clinical attachment loss ≥2 mm , and bleeding upon probing ( BOP+ ) ) were included . Residual pockets on three teeth , separated from each other by at least two other teeth , served as study sites . After ultrasonic debridement , they were r and omly assigned to either PDT delivered twice within 1 week ( group A ) , PDT delivered only once ( group B ) , or sham treatment without activating the laser ( group C ) . Methylene blue was applied with a blunt irrigator tip into the pockets . Sites were irradiated with laser light at a wavelength of 670 nm using a light-diffusing tip introduced into the pocket . Initial PD was 5.9 ± 0.9 , 6.3 ± 1.3 , and 6.3 ± 1.5 mm in groups A , B , and C , respectively , differences being nonsignificant . PD was significantly reduced in all groups . At month 3 , PD was significantly lower in groups A ( 2.9 ± 1.1 mm ; p = 0.04 ) and B ( 2.8 ± 1.1 mm ; p = 0.03 ) compared to group C ( 3.5 ± 1.2 mm ) . At month 6 , none of the sites in group A had persisting pockets PD > 4 mm and BOP+ , whereas two sites in group B and four sites in group C stayed in this category . Detection frequencies of the studied microorganisms at > 1,000 and > 100.000 cells/ml did not change significantly from baseline to months 3 or 6 in any group . A significant overall decrease was observed from baseline to month 6 for C-reactive protein , serum amyloid A , fibrinogen , procalcitonin , and α-2 macroglobulin . When looking at the groups separately , C-reactive protein was significantly lower only if the laser had been activated twice ( p < 0.05 ) . Other differences between groups were not significant . A single or double episodes of PDT had some additional benefit over ultrasonic instrumentation alone AIM A r and omized controlled clinical trial was design ed to evaluate the efficacy of the photodynamic therapy ( PDT ) in the treatment of residual pockets of chronic periodontitis patients . MATERIAL AND METHODS Thirty-four patients with at least four residual periodontal pockets undergoing maintenance care were included and r and omly assigned to test group ( PDT , n = 18 ) or control group ( sham procedure , n = 16 ) . The intervention was performed at baseline , 3 , 6 and 12 months . Clinical parameters such as pocket probing depth ( PPD ) , clinical attachment level ( CAL ) , bleeding on probing ( BoP ) and plaque index ( PI ) were measured before intervention and after 3 , 6 and 12 months . Subgingival sample s were obtained at baseline , and after 7 days , 3 , 6 and 12 months to quantify Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Treponema denticola and Tannerella forsythia by real-time polimerase chain reaction ( PCR ) . RESULTS All clinical variables showed significant improvement during the study , but there was no significant difference between test and control groups . The microbiological analyses showed no differences between groups at any time during the study . CONCLUSION Within the limits of this clinical trial and considering the laser and photosensitizer protocol used , PDT failed to demonstrate additional clinical and bacteriological benefits in residual pockets treatment INTRODUCTION Clinical studies have shown the usefulness of antimicrobial photodynamic therapy ( aPDT ) as an adjunctive in periodontal therapy . These studies did not utilize indocyanine green ( ICG ) as a recently introduced photosensitizer . The aim of this study was to perform a full-mouth double-blind r and omized controlled clinical study to test the efficacy of adjunctive aPDT with ICG compared with scaling and root planing ( SRP ) alone in chronic periodontitis treatment . MATERIAL S AND METHODS Fifty patients were selected for this study . All patients received SRP . Then , each patient was r and omly assigned to either the test group ( aPDT+SRP ) or the control group ( SRP ) . aPDT was performed with a diode laser ( wavelength : 810 nm , power : 200mW ) and ICG as photosensitizer . The adjunctive procedure was repeated after 7 , 17 and 27 days . The clinical parameters including bleeding on probing ( BOP ) , clinical attachment loss ( CAL ) , plaque index ( PI ) , probing pocket depth ( PPD ) , full mouth plaque score ( FMPS ) and full mouth bleeding score ( FMBS ) were measured at baseline and after 1 and 3 months . RESULTS There were no significant differences between two groups at baseline . BOP , PPD and FMBS showed significant improvements in the test group ( P≤0.001 ) . In terms of PI , FMPS and CAL , no significant differences were observed between both groups ( P≥0.05 ) . CONCLUSION aPDT as an adjunctive approach yielded complete resolution of inflammation and significant reduction in periodontal pocket depth . However , aPDT had no additional advantages in clinical attachment gain and plaque score BACKGROUND Single photodynamic therapy ( PDT ) has been effective in initial periodontal therapy , but only improved bleeding on probing ( BoP ) in maintenance patients after a single use . Repeated PDT has not been addressed . OBJECTIVES To study the possible added benefits of repeated adjunctive PDT to conventional treatment of residual pockets in patients enrolled in periodontal maintenance . MATERIAL AND METHODS Ten maintenance patients with 70 residual pockets [ probing pocket depth (PPD)>or=5 mm ] were r and omly assigned for treatment five times in 2 weeks ( Days 0 , 1 , 2 , 7 , 14 ) with PDT ( test ) or non-activated laser ( control ) following debridement . The primary outcome variable was PPD , and the secondary variables were clinical attachment level ( CAL ) and BoP. These were assessed at 3 , 6 and 12 months following the interventions . RESULTS Greater PPD reductions were observed in the test ( -0.67 + /- 0.34 ; p=0.01 ) compared with the control patients ( -0.04 + /- 0.33 ; NS ) after 6 months . Significant CAL gain ( + 0.52 + /- 0.31 ; p=0.01 ) was noted for the test , but not in the control ( -0.27 + /- 0.52 ; NS ) patients after 6 months . BoP percentages decreased significantly in test ( 97 - 64 % , 67 % , 77 % ) , but not control patients after 3 , 6 and 12 months . CONCLUSIONS Repeated ( five times ) PDT adjunctive to debridement yielded improved clinical outcomes in residual pockets in maintenance patients . The effects were best documented after 6 months BACKGROUND This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy , on clinical and patient-centered outcomes in patients with periodontitis . METHODS R and omized clinical trials ( RCTs ) with a follow-up duration ≥3 months that evaluated root surface debridement ( i.e. , scaling and root debridement with or without surgical access ) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients ( ≥18 years old ) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion . The MEDLINE , EMBASE and CENTRAL data bases were search ed for articles published up to and including March 2016 . R and om effects meta-analyses were used throughout the review using continuous data ( i.e. , mean changes from baseline ) , and pooled estimates were expressed as weighted mean differences ( MDs ) with their associated 95 % confidence intervals ( CIs ) . Additionally , summaries are presented of the included RCTs , critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures . RESULTS Of the 475 potentially eligible articles , 28 were included in the review . Individual study outcomes and seven sets of meta- analysis ( 1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP ) showed a benefit of laser therapy in improving clinical attachment level ( CAL ) and probing depth ( PD ) . However , the comparative differences in clinical outcomes were modest ( < 1 mm ) and the level of certainty for different therapies was considered low-to-moderate ( i.e. , more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes ) . Overall , most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion . CONCLUSIONS In patients with moderate to severe periodontitis , the nonsurgical treatment of AgP and CP by SRP plus infrared diode laser , and the surgical treatment of CP by Er : YAG laser therapy alone may promote statistically significant improvements in PD and CAL . However , these gains are relatively small ( < 1 mm ) and provide modest clinical relevance compared with SRP alone Experimental studies in animals and in vitro have shown the usefulness of photodynamic therapy ( PDT ) as an adjunct to periodontal treatment . The aim of this study was to evaluate the long-term clinical and microbiological effects of PDT associated with nonsurgical periodontal treatment . Three sites in each of 33 patients with chronic periodontitis were r and omly allocated in a split-mouth design to a treatment group : ( 1 ) scaling and root planing ( SRP group ) ; ( 2 ) SRP and irrigation with toluidine blue O ( TBO group ) ; 
    Output:
    
CONCLUSIONS aPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and peri-implantitis patients .