The Effect of Photodynamic Therapy in Root Canal Disinfection: A Systematic Review

doi:10.1016/j.joen.2014.03.005

Journal of Endodontics

Volume 40, Issue 7, July 2014, Pages 891-898

https://doi.org/10.1016/j.joen.2014.03.005 Get rights and content

Abstract

Introduction

Effective root canal disinfection is a fundamental component of successful root canal treatment. Photodynamic therapy (PDT) has been proposed as a new adjunctive method for additional disinfection of the root canal system with the possibility of improved treatment outcomes. The aim of this systematic review was to investigate the effect of PDT on bacterial load reduction during root canal disinfection.

Methods

Two reviewers independently conducted a comprehensive literature search using a combination of medical subject heading terms and key words to identify studies relevant to the Population Intervention Control Outcome question. The selection of articles for inclusion was performed in 2 phases based on predetermined eligibility criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inter-reviewer agreement for each phase was recorded. The effect of PDT on bacterial load reduction during root canal disinfection was evaluated as the primary outcome variable during data extraction.

Results

The literature search provided 57 titles and abstracts. Three articles met the inclusion criteria and were selected for this systematic review. The reasons for study exclusion in each phase were recorded. Because of the heterogeneity in clinical indications and PDT protocols among the included studies, a meta-analysis could not be performed. All included studies showed a positive effect of PDT in the reduction of microbial load in root canal treatment ranging from 91.3%–100%.

Conclusions

Limited clinical information is currently available on the use of PDT in root canal disinfection. If supported by future clinical research, PDT may have efficacy for additional root canal disinfection, especially in the presence of multi–drug-resistant bacteria.

Section snippets

Population Intervention Control Outcome Question

To address the aim of this systematic review, the following question was constructed based on the Population Intervention Control Outcome (PICO) principle: “For patients undergoing root canal treatment, does the use of PDT compared with conventional chemomechanical techniques alone further reduce the bacterial load?”

Search Strategy

A search was conducted for articles related to the PICO question, which were published from January 2000 to June 2013. The literature search included an electronic search of the

Results

A total of 57 titles and abstracts were identified after an electronic search in both electronic databases using the specific combination of terms and key words. No additional studies were identified as relevant after a search of the reference lists. After the first phase of selection, 53 articles were excluded based on the predefined exclusion criteria (inter-reviewer agreement: κ = 0.938). Reasons for exclusion were studies identified as irrelevant to the specific PICO question (n = 16),

Discussion

Contemporary chemomechanical debridement techniques do not consistently eliminate bacteria during root canal treatment. The significance of complete or near complete bacterial load reduction has been underlined by several in vivo studies showing that the remaining bacterial load may negatively affect the treatment outcome 29, 30. The presence of persistent cultivable bacteria at the time of obturation has been shown to reduce the treatment success rate from 94% to 68% (29). Similarly, Molander

Conclusion

Limited clinical information is currently available on the use of PDT in root canal disinfection. All available studies showed a positive effect of PDT in the reduction of microbial load in root canal treatment. We cautiously conclude that a potential additive benefit from the use of PDT in root canal disinfection may exist, especially in the presence of multi–drug-resistant bacteria. A direction for future work would be to optimize and standardize PDT dosimetry with the use of an appropriate

Acknowledgments

The authors wish to thank Dr Aguinaldo Garcez, São Leopoldo Mandic Dental Research Center, Brazil; Dr Steve Bonsor, Private Practice, Aberdeen, UK; and Dr Gavin Pearson, Barts and London School of Medicine and Dentistry, Queen Mary University of London, UK, for their valuable contribution to this study with data from their original studies.

The authors deny any conflicts of interest related to this study.

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Evaluation of cytotoxicity impacts of combined methylene blue-mediated photodynamic therapy and intracanal antibiotic medicaments on dental stem cells
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Root canal therapy is a predominant method for treatment of dental pulp and periapical diseases. Conventional methods such as mechanical instrumentations, chemical irrigation and intracanal medicaments pose a huge limitation to root canal disinfection as they kill bacteria and dental stem cells simultaneously. Therefore, much attention has been focused on finding more efficacious antibacterial methods that has no or negligible cytotoxicity for dental stem cells. Herein, we hypothesized that combining antibacterial medicaments with Antimicrobial photodynamic therapy (aPDT) and methylene blue (MB) as a photosensitizer would be effective in reducing death of dental pulp stem cells (DPSCs). To examine this, DPSCs were isolated from third molar teeth through enzymatic digestion. Isolated cells were cultured in αMEM and when reached adequate confluency, were used for further analysis. Cytotoxicity effect of different groups of MB, DAP, MB, LED and their combination on DPSCs was analyzed using MTT assay. DPSCs membrane integrity as a marker of live cells was assessed through measuring lipid peroxidation and lactate dehydrogenase (LDH) release into extracellular space. Results showed that the combination of LED, MB and TAP or aPDT, MB and DAP was more effective in reducing DPSCs death rate compared to TAP and DAP administration alone. Moreover, Malondialdehyde (MDA) and LDH levels were found to be decreased in cells exposed to combination treatment in comparison with single TAP or DAP therapy. Our study shows the promising perspectives of employing combined aPDT, MB and antibiotic medicaments for reduction of dental stem cell death.
Evaluation the antibacterial efficacy of sodium hypochlorite in combination with two different photodynamic therapy protocols against Enterococcus Faecalis in Infected root canals: An in-vitro experiment
2023, Photodiagnosis and Photodynamic Therapy
Photodynamic therapy (PDT) is an antimicrobial approach that can be used as an adjunctive safe technique for root canal disinfection. In this study, we aimed to evaluate the antibacterial efficacy of PDT with indocyanine green and toluidine blue in combination with sodium hypochlorite (NaOCl) in compared with NaOCl alone against Enterococcus faecalis in infected root canals.
Sixty five root canals of sound human premolars were collected. First, the teeth were sterilized, then 60 root canals were inoculated with the E. faecalis, and 5 samples served as negative control remained uncontaminated. The contaminated root canals were randomly assigned into 4 experimental groups (n=15): (1) NaOCl, (2) NaOCl+ PDT-1 (toluidine blue + 630nm LED), (3) NaOCl+ PDT-2 (indocyanine green + 808nm diode laser), and (4): positive control (no treatment). Then, the colony-forming units (CFU/mL) of E. faecalis were calculated in all the groups. Moreover, 5 samples from each group were examined under a scanning electron microscope. The data were analyzed by independent T-test and the Mann-Whitney U test at the significance level of 0.05.
The CFU count was significantly lower in the indocyanine green-PDT group in comparison with other groups (p˂0.05). The mean of CFU in the positive control group was significantly higher than the other groups (p˂0.05). No significant difference was detected between NaOCl and toluidine blue –PDT group (p=1.00).
Indocyanine green- PDT improved the antibacterial effects of NaOCl against E. faecalis, while toluidine blue – mediated PDT had no significant additional effect on NaOCl.
Efficacy of curcumin-mediated photodynamic therapy for root canal therapy procedures: A systematic review
2023, Photodiagnosis and Photodynamic Therapy
This systematic review aimed to investigate the effectiveness of CUR-mediated PDT (Curcumin mediated PDT) as an adjunct to conventional chemo-mechanical debridement and/or standard PDT of the RC system with endodontic infections.
The focused research question was: “Whether the application Curcumin mediated PDT as an adjunct is more effective than the traditional chemo-mechanical debridement and/or standard PDT of the RC system alone for improving antibacterial and/or mechanical features among subjects undergoing RCT?”. An electronic literature search was performed in Scopus, PubMed, and Web of Science. In vitro reports utilizing Curcumin mediated PDT as an adjunct to conventional chemo-mechanical debridement considering permanent dentition assessing the antibacterial and/or mechanical effect were included.
Eighteen articles were included in the review, out of which 13 studies assessed the antibacterial activity, while 5 evaluated the mechanical properties. Most of the studies concluded that Curcumin mediated PDT had a significant antibacterial activity than the conventional chemo-mechanical debridement and/or standard PDT. Four of the five studies suggested that Curcumin mediated PDT had no impact on the push-out bond strength of root dentin. Furthermore, the significant heterogeneity in the data from the included studies did not permit the author to carry out a meta-analysis.
There is potential for application of Curcumin mediated PDT as an adjunct to the conventional chemo-mechanical debridement and/or standard PDT in reducing the bacterial load, however, Curcumin mediated PDT has minimal effect on enhancing the pushout bond strength of fiber posts to radicular dentin. Moreover, clinical studies are required to provide a more conclusive opinion on the efficacy of Curcumin mediated PDT for RCT procedures.
Effect of antimicrobial photodynamic therapy on the reduction of bacteria and virulence factors in teeth with primary endodontic infection
2023, Photodiagnosis and Photodynamic Therapy
To evaluate the effectiveness of supplemental photodynamic therapy for improving the bacterial removal and the levels of lipopolysaccharide (LPS) and lipoteichoic acid (LTA) by conducting a clinical trial.
Twenty-four root canals with pulp necrosis and periapical lesion were selected and randomly divided into conventional group using endodontic treatment with chemo-mechanical preparation (CMP) alone (n = 12) and a group using antimicrobial photodynamic therapy (aPDT) after CMP (n = 12). The samples were collected before and after CMP (conventional group) and after photodynamic therapy (aPDT group). A photosensitizer (0.005% methylene blue) was applied to the root canal for 3 minutes after CMP, whereas aPDT was performed by using a red laser with a power of 30Mw and energy density of 9J/cm² for 90 s per root canal. Culture technique was performed to determine the bacterial colony forming units. LPS and LTA levels were quantified by using limulus amoebocyte lysate (LAL) assay and enzyme-linked immunosorbent assay (ELISA), respectively.
All samples showed growth of viable bacteria on Fastidious Anaerobe Agar (FAA), with an average of 5.19 × 10⁵ CFU/ mL. CMP was effective in decreasing viable bacteria (p < 0.05), whereas there was a significant decrease (p < 0.05) in the samples treated with aPDT compared to those submitted to CMP. LPS and LTA were detected in all initial samples, with mean values of 20.561 EU/mL and 430.91 pg/mL, respectively. Both CMP and aPDT groups significantly decreased the levels of LPS and LTA (p < 0.05), with a statistical difference between the groups regarding aPDT (p < 0.05).
Photodynamic therapy as an adjunct to CMP proved to be effective in improving root canal disinfection and reducing the LPS and LTA levels in teeth with primary endodontic infection.
Global research trends on photodynamic therapy in endodontics: A bibliometric analysis
2022, Photodiagnosis and Photodynamic Therapy
Photodynamic therapy (PDT) is an adjunctive treatment that aims to inactivate microorganisms through an oxidative reaction produced by irradiating a photosensitizing agent. The quest for improved root canal disinfection has sought supplementary methods when performing chemomechanical procedures. From this perspective, PDT protocols were proposed as an auxiliary approach in endodontics. Thus, the aim of this study was to investigate publication metrics and research trends related to this scope.
This review is reported in accordance with the PRISMA 2020 recommendations. Two blinded and independent reviewers systematically searched five electronic databases until December 2021. The acquired bibliometric parameters were analyzed through descriptive statistics and graphical mappings with VOSViewer software.
The search retrieved 342 studies from 84 journals originating from 33 countries. About 85% of the included studies were published over the last decade. Most of the available evidence is laboratory-based (74.5%), and the main clinical outcomes evaluated were microbiological load reduction and postoperative pain. Mayram Pourhajibagher is the researcher with the most publications as the first author (n = 16). Tehran University of Medical Sciences carried out the highest number of studies (n = 29), and Photodiagnosis and Photodynamic Therapy is the journal that most published on the theme (n = 111).
This bibliometric analysis mapped and discussed the scientific progress and publication metrics in PDT in endodontic research. Additionally, future perspectives were highlighted and should focus on discovering new photosensitizer agents, standardizing optimal photoactivation protocols, and conducting more clinical-oriented research.
Management of teeth with dens invaginatus and apical periodontitis: A case series
2022, Journal of the American Dental Association
Citation Excerpt :
Proper disinfection of the complex anatomy of the invagination may require supplementary steps, such as NaOCl agitation using mechanical (for example, XP-endo Finisher or EndoActivator) or ultrasonic (PUI) means.20 Photodynamic therapy was also used in 2 of our cases, although its effectiveness in enhancing root canal disinfection still needs to be supported by means of clinical studies.21 Another approach to improving disinfection is intracanal medication with calcium hydroxide,22-25 which was used in 5 of the 6 cases.
Dens invaginatus is a dental anomaly that can predispose the tooth to pulp and periapical pathology.
Different endodontists treated 6 maxillary incisors with dens invaginatus associated with apical periodontitis. Cone-beam computed tomography was used to help with diagnosis and treatment planning in most patients. Four patients received diagnoses of Oehlers type II dens invaginatus and the other 2 as type III. In some patients with type II, the invagination had to be perforated to permit access to the apical part of the true root canal. Both the true canal and the invagination (pseudocanal) were treated in all cases using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation and supplementary disinfection approaches. Calcium hydroxide medication was used in all but 1 case. The root canal and invagination were often filled using thermoplasticized gutta-percha techniques, sometimes using an apical plug with a bioceramic material in teeth with large apical openings. All treated patients had favorable clinical and radiographic outcomes.
Regardless of the complex anatomic variations, common strategic therapeutic approaches were identified that might serve as recommendations for proper management of teeth with dens invaginatus and apical periodontitis. These approaches include cone-beam computed tomographic planning, aggressive disinfection using sodium hypochlorite ultrasonic or sonic activation and calcium hydroxide intracanal medication, and thermoplasticized gutta-percha obturation of both the root canal and invagination.

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Review ArticleThe Effect of Photodynamic Therapy in Root Canal Disinfection: A Systematic Review

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Population Intervention Control Outcome Question

Search Strategy

Results

Discussion

Conclusion

Acknowledgments

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

Photodiagnosis Photodyn Ther

J Endod

J Photochem Photobiol B

Drug Discov Today

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

Quality of preparation of oval distal root canals in mandibular molars using nickel-titanium instruments

Int Endod J

Clinical antimicrobial efficacy of NiTi rotary instrumentation with NaOCl irrigation, final rinse with chlorhexidine and interappointment medication: a molecular study

Int Endod J

Review Article
The Effect of Photodynamic Therapy in Root Canal Disinfection: A Systematic Review