Adjunctive Strategies to Enhance Antimicrobial Photodynamic Therapy in Oral Infections: A Systematic Review of Randomized Controlled Trials

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.