{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T04:09:50Z","timestamp":1789790990547,"version":"4.0.1"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Lasers Med Sci"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To systematically evaluate the efficacy of photodynamic therapy in treating peri-implantitis and compare the effectiveness of various photosensitizers based on randomized clinical trials.\u00a0A systematic review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, incorporating data from PubMed\/MEDLINE, Embase, Web of Science, and CNKI up to December 31, 2024. Randomized clinical trials that assessed the efficacy of photodynamic therapy with various photosensitizers for peri-implantitis were included. Primary outcomes included bleeding on probing, probing depth, plaque index, clinical attachment level, crestal bone loss, and bleeding index. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated for each outcome to quantify the effect size. Risk of bias was assessed using the Cochrane risk-of-bias tool.\u00a013 randomized clinical trials involving 678 participants were included in the analysis. Photodynamic therapy significantly improved several clinical outcomes compared to controls: bleeding on probing (SMD = -0.49, 95% CI: -0.89 to -0.09), probing depth (SMD = -1.49, 95% CI: -2.31 to -0.66), plaque index (SMD = -1.11, 95% CI: -1.98 to -0.25), and crestal bone loss (SMD = -0.53, 95% CI: -0.89 to -0.17). Subgroup analyses revealed that Toluidine Blue was the most effective photosensitizer, showing superior improvements across multiple outcomes.\u00a0Photodynamic therapy is an effective treatment for peri-implantitis, particularly when using Toluidine Blue, which consistently outperformed other photosensitizers in improving clinical outcomes. These findings provide strong evidence for integrating photodynamic therapy into peri-implantitis management protocols, offering a promising, minimally invasive alternative to conventional treatments. Future studies should focus on optimizing photodynamic therapy protocols, assessing long-term outcomes, and evaluating its effectiveness in diverse patient populations.<\/jats:p>\n                  <jats:p>Clinical trial number:\u00a0PROSPERO (CRD42024600326).<\/jats:p>","DOI":"10.1007\/s10103-025-04612-7","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T05:43:40Z","timestamp":1758001420000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of photodynamic therapy with various photosensitizers for peri-implantitis treatment: a systematic review and meta-analysis of randomized clinical trials"],"prefix":"10.1007","volume":"40","author":[{"given":"Xin","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingli","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiqi","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanhua","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shichen","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoyu","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"4612_CR1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1089361","volume":"10","author":"Y Ou-Yang","year":"2023","unstructured":"Ou-Yang Y, Zheng Y, Mills KE (2023) Photodynamic therapy for skin carcinomas: a systematic review and meta-analysis. Front Med 10:1089361","journal-title":"Front Med"},{"issue":"2","key":"4612_CR2","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/php.14000","volume":"101","author":"P Joshi","year":"2025","unstructured":"Joshi P et al (2025) Enhancing the efficacy of antimicrobial photodynamic therapy through curcumin modifications. Photochem Photobiol 101(2):359\u2013372","journal-title":"Photochem Photobiol"},{"issue":"7","key":"4612_CR3","first-page":"Cd011778","volume":"7","author":"PM Jerv\u00f8e-Storm","year":"2024","unstructured":"Jerv\u00f8e-Storm PM et al (2024) Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri-implant diseases. Cochrane Database Syst Rev 7(7):Cd011778","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"4612_CR4","doi-asserted-by":"publisher","first-page":"e493","DOI":"10.1016\/j.dental.2021.08.016","volume":"37","author":"MA Rodrigues","year":"2021","unstructured":"Rodrigues MA et al (2021) Antimicrobial profile of a dental implant abutment coating to prevent adhesion and migration of bacteria and screw loosening. Dent Mater 37(10):e493\u2013e501","journal-title":"Dent Mater"},{"key":"4612_CR5","doi-asserted-by":"publisher","first-page":"S152","DOI":"10.1111\/jcpe.12369","volume":"42","author":"S Jepsen","year":"2015","unstructured":"Jepsen S et al (2015) Primary prevention of peri-implantitis: managing peri-implant mucositis. J Clin Periodontol 42:S152\u2013S157","journal-title":"J Clin Periodontol"},{"key":"4612_CR6","doi-asserted-by":"publisher","first-page":"S246","DOI":"10.1111\/jcpe.12954","volume":"45","author":"F Schwarz","year":"2018","unstructured":"Schwarz F et al (2018) Peri-implantitis. J Clin Periodontol 45:S246\u2013s266","journal-title":"J Clin Periodontol"},{"key":"4612_CR7","doi-asserted-by":"publisher","DOI":"10.5051\/jpis.2303360168","author":"I Hong","year":"2024","unstructured":"Hong I et al (2024) Comprehensive treatment protocol for peri-implantitis: an up-to-date narrative review of the literature. J Periodontal Implant Sci. https:\/\/doi.org\/10.5051\/jpis.2303360168","journal-title":"J Periodontal Implant Sci"},{"key":"4612_CR8","doi-asserted-by":"publisher","first-page":"S172","DOI":"10.1111\/jcpe.12346","volume":"42","author":"S Renvert","year":"2015","unstructured":"Renvert S, Polyzois I (2015) Risk indicators for peri-implant mucositis: a systematic literature review. J Clin Periodontol 42:S172\u2013S186","journal-title":"J Clin Periodontol"},{"key":"4612_CR9","doi-asserted-by":"publisher","first-page":"119845","DOI":"10.1016\/j.biomaterials.2020.119845","volume":"240","author":"X Sun","year":"2020","unstructured":"Sun X et al (2020) Photodynamic therapy produces enhanced efficacy of antitumor immunotherapy by simultaneously inducing intratumoral release of Sorafenib. Biomaterials 240:119845","journal-title":"Biomaterials"},{"issue":"18","key":"4612_CR10","doi-asserted-by":"publisher","first-page":"9054","DOI":"10.7150\/thno.62479","volume":"11","author":"P Sarbadhikary","year":"2021","unstructured":"Sarbadhikary P, George BP, Abrahamse H (2021) Recent advances in photosensitizers as multifunctional theranostic agents for imaging-guided photodynamic therapy of cancer. Theranostics 11(18):9054\u20139088","journal-title":"Theranostics"},{"issue":"1","key":"4612_CR11","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s10103-016-2079-4","volume":"32","author":"JS Monteiro","year":"2017","unstructured":"Monteiro JS et al (2017) Effectiveness of antimicrobial photodynamic therapy (AmPDT) on Staphylococcus aureus using phenothiazine compound with red laser. Lasers Med Sci 32(1):29\u201334","journal-title":"Lasers Med Sci"},{"issue":"1","key":"4612_CR12","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1186\/s12903-024-04198-6","volume":"24","author":"J Guo","year":"2024","unstructured":"Guo J et al (2024) Efficacy of adjunctive photodynamic therapy to conventional mechanical debridement for peri-implant mucositis. BMC Oral Health 24(1):464","journal-title":"BMC Oral Health"},{"issue":"3","key":"4612_CR13","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1111\/adj.12705","volume":"64","author":"H Wang","year":"2019","unstructured":"Wang H et al (2019) Adjunctive photodynamic therapy improves the outcomes of peri-implantitis: a randomized controlled trial. Aust Dent J 64(3):256\u2013262","journal-title":"Aust Dent J"},{"key":"4612_CR14","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.pdpdt.2016.04.015","volume":"14","author":"MD Al Amri","year":"2016","unstructured":"Al Amri MD et al (2016) Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in patients with type 2 diabetes mellitus. Photodiagnosis Photodyn Ther 14:166\u2013169","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"4612_CR15","doi-asserted-by":"crossref","unstructured":"Page MJ et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews, vol 372. BMJ (Clinical Research ed.), p n160","DOI":"10.1136\/bmj.n160"},{"key":"4612_CR16","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898","journal-title":"BMJ"},{"issue":"11","key":"4612_CR17","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JP Higgins","year":"2002","unstructured":"Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539\u20131558","journal-title":"Stat Med"},{"issue":"10","key":"4612_CR18","doi-asserted-by":"publisher","first-page":"e76654","DOI":"10.1371\/journal.pone.0076654","volume":"8","author":"A Chaimani","year":"2013","unstructured":"Chaimani A et al (2013) Graphical tools for network meta-analysis in STATA. PLoS ONE 8(10):e76654","journal-title":"PLoS ONE"},{"key":"4612_CR19","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.pdpdt.2016.10.011","volume":"17","author":"T Abduljabbar","year":"2017","unstructured":"Abduljabbar T (2017) Effect of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant diseases in prediabetic patients. Photodiagnosis Photodyn Ther 17:9\u201312","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"4612_CR20","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2020.102077","volume":"32","author":"P Ahmed","year":"2020","unstructured":"Ahmed P et al (2020) The effectiveness of photodynamic and antibiotic gel therapy as an adjunct to mechanical debridement in the treatment of peri-implantitis among diabetic patients. Photodiagnosis Photodyn Ther 32:102077","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"4612_CR21","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.pdpdt.2018.03.002","volume":"22","author":"MQ Al Rifaiy","year":"2018","unstructured":"Al Rifaiy MQ et al (2018) Effectiveness of adjunctive antimicrobial photodynamic therapy in reducing peri-implant inflammatory response in individuals vaping electronic cigarettes: a randomized controlled clinical trial. Photodiagnosis Photodyn Ther 22:132\u2013136","journal-title":"Photodiagnosis Photodyn Ther"},{"issue":"2","key":"4612_CR22","doi-asserted-by":"publisher","first-page":"389","DOI":"10.3233\/THC-213062","volume":"30","author":"MH Al-Askar","year":"2022","unstructured":"Al-Askar MH et al (2022) Comparison of photobiomodulation and photodynamic therapy as adjuncts to mechanical debridement for the treatment of peri-implantitis. Technol Health Care 30(2):389\u2013398","journal-title":"Technol Health Care"},{"key":"4612_CR23","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.pdpdt.2019.09.003","volume":"28","author":"F Alqahtani","year":"2019","unstructured":"Alqahtani F et al (2019) Efficacy of mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implantitis among moderate cigarette-smokers and waterpipe-users. Photodiagnosis Photodyn Ther 28:153\u2013158","journal-title":"Photodiagnosis Photodyn Ther"},{"issue":"3","key":"4612_CR24","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1111\/clr.12155","volume":"25","author":"M Bassetti","year":"2014","unstructured":"Bassetti M et al (2014) Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial. Clin Oral Implants Res 25(3):279\u2013287","journal-title":"Clin Oral Implants Res"},{"key":"4612_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2019.101587","volume":"29","author":"MA Deeb","year":"2020","unstructured":"Deeb MA et al (2020) Clinical and microbiological outcomes of photodynamic and systemic antimicrobial therapy in smokers with peri-implant inflammation. Photodiagnosis Photodyn Ther 29:101587","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"4612_CR26","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.pdpdt.2017.04.015","volume":"18","author":"F Javed","year":"2017","unstructured":"Javed F et al (2017) Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: a randomized controlled clinical trial. Photodiagnosis Photodyn Ther 18:331\u2013334","journal-title":"Photodiagnosis Photodyn Ther"},{"issue":"3","key":"4612_CR27","doi-asserted-by":"publisher","first-page":"139","DOI":"10.15171\/jlms.2016.24","volume":"7","author":"MR Karimi","year":"2016","unstructured":"Karimi MR, Hasani A, Khosroshahian S (2016) Efficacy of antimicrobial photodynamic therapy as an adjunctive to mechanical debridement in the treatment of peri-implant diseases: a randomized controlled clinical trial. J Lasers Med Sci 7(3):139\u2013145","journal-title":"J Lasers Med Sci"},{"issue":"6","key":"4612_CR28","first-page":"848","volume":"29","author":"YY Li","year":"2013","unstructured":"Li YY, Fa YH, Yang YJ, Cai XW, Li G (2013) Treatment of peri-implantitis with photodynamic therapy. J Pract Stomatol 29(6):848\u2013850","journal-title":"J Pract Stomatol"},{"issue":"16","key":"4612_CR29","first-page":"2890","volume":"26","author":"Y Wang","year":"2017","unstructured":"Wang Y, Ma YY, Liu XX, Guo LY (2017) Short-term clinical effects on the treatment of peri-implantitis with photodynamic therapy. Henan Med Res 26(16):2890\u20132892","journal-title":"Henan Med Res"},{"issue":"1","key":"4612_CR30","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1186\/s40729-021-00388-x","volume":"7","author":"A Ramanauskaite","year":"2021","unstructured":"Ramanauskaite A, Fretwurst T, Schwarz F (2021) Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis. Int J Implant Dent 7(1):112","journal-title":"Int J Implant Dent"},{"key":"4612_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2020.101969","volume":"32","author":"P Zhao","year":"2020","unstructured":"Zhao P et al (2020) Efficacy of adjunctive photodynamic therapy and lasers in the non-surgical periodontal treatment: a bayesian network meta-analysis. Photodiagnosis Photodyn Ther 32:101969","journal-title":"Photodiagnosis Photodyn Ther"},{"issue":"8 Suppl","key":"4612_CR32","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1111\/j.1600-051X.2008.01276.x","volume":"35","author":"S Renvert","year":"2008","unstructured":"Renvert S, Roos-Jans\u00e5ker AM, Claffey N (2008) Non-surgical treatment of peri-implant mucositis and peri-implantitis: a literature review. J Clin Periodontol 35(8 Suppl):305\u2013315","journal-title":"J Clin Periodontol"},{"issue":"9","key":"4612_CR33","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1902\/jop.2014.130610","volume":"85","author":"GA Kotsakis","year":"2014","unstructured":"Kotsakis GA et al (2014) Systematic review and meta-analysis of the effect of various laser wavelengths in the treatment of peri-implantitis. J Periodontol 85(9):1203\u20131213","journal-title":"J Periodontol"},{"key":"4612_CR34","doi-asserted-by":"crossref","unstructured":"Knoblauch R, Geddes CD (2020) Carbon Nanodots in Photodynamic Antimicrobial Therapy: A Review. Materials (Basel), 13(18)","DOI":"10.3390\/ma13184004"},{"issue":"4","key":"4612_CR35","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1002\/med.21935","volume":"43","author":"M Kolarikova","year":"2023","unstructured":"Kolarikova M et al (2023) Photodynamic therapy: innovative approaches for antibacterial and anticancer treatments. Med Res Rev 43(4):717\u2013774","journal-title":"Med Res Rev"},{"issue":"1","key":"4612_CR36","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/prd.12123","volume":"71","author":"K Mizutani","year":"2016","unstructured":"Mizutani K et al (2016) Lasers in minimally invasive periodontal and peri-implant therapy. Periodontol 2000 71(1):185\u2013212","journal-title":"Periodontol 2000"},{"issue":"2","key":"4612_CR37","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s13770-021-00403-7","volume":"19","author":"S Shin","year":"2022","unstructured":"Shin S et al (2022) Tumor microenvironment modulating functional nanoparticles for effective cancer treatments. Tissue Eng Regen Med 19(2):205\u2013219","journal-title":"Tissue Eng Regen Med"},{"issue":"1","key":"4612_CR38","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s43046-021-00093-1","volume":"33","author":"N Sobhani","year":"2021","unstructured":"Sobhani N, Samadani AA (2021) Implications of photodynamic cancer therapy: an overview of PDT mechanisms basically and practically. J Egypt Natl Canc Inst 33(1):34","journal-title":"J Egypt Natl Canc Inst"},{"issue":"2","key":"4612_CR39","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1007\/s43630-022-00312-1","volume":"22","author":"KBP Dos Santos","year":"2023","unstructured":"Dos Santos KBP et al (2023) Toluidine blue O directly and photodynamically impairs the bioenergetics of liver mitochondria: a potential mechanism of hepatotoxicity. Photochem Photobiol Sci 22(2):279\u2013302","journal-title":"Photochem Photobiol Sci"},{"key":"4612_CR40","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens13040342","author":"B Bueno-Silva","year":"2024","unstructured":"Bueno-Silva B et al (2024) Antimicrobial activity of methylene blue associated with photodynamic therapy: in vitro study in multi-species oral biofilm. Pathogens. https:\/\/doi.org\/10.3390\/pathogens13040342","journal-title":"Pathogens"},{"issue":"7","key":"4612_CR41","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1359\/jbmr.090205","volume":"24","author":"A Nakajima","year":"2009","unstructured":"Nakajima A et al (2009) Loss of Cbl-b increases osteoclast bone-resorbing activity and induces osteopenia. J Bone Miner Res 24(7):1162\u20131172","journal-title":"J Bone Miner Res"},{"issue":"4","key":"4612_CR42","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1111\/bjd.17131","volume":"180","author":"SH Ibbotson","year":"2019","unstructured":"Ibbotson SH et al (2019) Adverse effects of topical photodynamic therapy: a consensus review and approach to management. Br J Dermatol 180(4):715\u2013729","journal-title":"Br J Dermatol"}],"container-title":["Lasers in Medical Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10103-025-04612-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10103-025-04612-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10103-025-04612-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T07:21:09Z","timestamp":1771399269000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10103-025-04612-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4612"],"URL":"https:\/\/doi.org\/10.1007\/s10103-025-04612-7","relation":{},"ISSN":["1435-604X"],"issn-type":[{"value":"1435-604X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,16]]},"assertion":[{"value":"31 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This is a systematic review and meta-analysis, ethics approval and consent to participate are not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable. This study does not involve human participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"359"}}