Bonding of an ion-releasing restorative material to caries-affected dentin disinfected with photodynamic therapy, Er,Cr:YSGG laser, and chemical disinfectants

Effect of photodynamic therapy with two photosensitizers on the microtensile bond strength of a universal adhesive to affected dentin

BACKGROUND

This study aimed to evaluate the impact of photodynamic therapy (PDT) using two photosensitizers, methylene blue and indocyanine green, on the microtensile bond strength of a universal adhesive to caries-affected dentin.

METHODS

The occlusal enamel of 60 third molars was cut to expose the inner one-third of the dentin. Artificial caries were induced through a pH cycling process. The samples were divided into three groups: M (Methylene blue+ diode laser), I (Indocyanine green agents+ diode laser irradiation), and control. Each group was further divided into two subgroups according to the adhesive protocol (self-etch, total-etch). After restoring with Gradia composite resin, teeth were sectioned and exposed to 5000 thermal cycles. Microtensile bond strength was measured using a universal testing machine. The data were subjected to two- and one-way ANOVA and paired comparisons were performed by the Tamhane and Tukey tests.

RESULTS

The study found significant effects of the photosensitizer, etching pattern, and their interactions on the microtensile bond strength of composite resin to caries-affected dentin (P < 0.001). In the self-etching mode, PDT with indocyanine green exhibited significantly higher bond strength values compared to PDT with methylene blue (P = 0.001) and the control groups (P < 0.001). However, no significant differences were observed in the total-etch mode. (P = 0.54).

CONCLUSIONS

The etching mode played a more significant role in the bond strength when using the universal adhesive alongside PDT with methylene blue and indocyanine green. Employing two photosensitizers in PDT during the self-etch mode significantly increased the bond strength values.

Adhesive Bond Strength of Restorative Materials to Caries-Affected Dentin Treated with Antimicrobial Photodynamic Therapy: A Systematic Review and Meta-Analysis

Objective: This systematic review aimed to evaluate the adhesive bond strength of restorative materials to caries-affected dentin (CAD) treated with antimicrobial photodynamic therapy (aPDT) in comparison with conventional chemical disinfectants. Methods: Three databases, including the Web of Science, Scopus, and PubMed, were searched to address the focused question: "What is the effect of aPDT compared to conventional chemical disinfection techniques on the adhesive bond strength of restorative materials to CAD?." Search keywords included "dentin*" "adhes bond*" "caries-affected dentin" "photodynamic "photochemotherapy" "photosensitizing agent" "phototherapy" "photoradiation" "laser" "light activated" "photoactivated." A fixed-effects model was used in each meta-analysis and the inverse variance was used to calculate the standard mean difference (SMD). For evaluating the statistical heterogeneity, the Cochrane's Q test and the I2 statistics were used. The risk of bias was evaluated based on the Cochrane Collaboration's tool. Results: Fourteen studies were included in the qualitative as well as quantitative analysis. The results of the meta-analyses exhibited an SMD of 2.38% [95% confidence interval (CI): 2.03-2.73; p < 0.00001], indicating a statistically significant difference in the shear bond strength scores between the tested group (samples treated with aPDT) and the control group (i.e., favoring the sound dentin and/or conventional chemical disinfectants). Contrarily, an SMD of -1.46% (95% CI: -2.04 to -0.88; p < 0.00001) and -0.37% (95% CI: -0.70 to -0.03; p = 0.03) was observed, indicating a statistically significant difference in the microtensile bond strength (μTBS), as well as microleakage scores between the tested group (favoring the samples treated with aPDT) and the control group (i.e., sound dentin and/or conventional chemical disinfectants). Conclusions: Adhesive bond strength of restorative materials to CAD treated with conventional chemical disinfectants showed superior outcomes compared to photodynamic therapy (aPDT).

Efficacy of methylene blue and curcumin mediated antimicrobial photodynamic therapy in the treatment of indirect pulp capping in permanent molar teeth

PURPOSE

This study aimed to evaluate the adhesive bond strength and antibacterial efficacy of methylene blue (MB)-mediated antimicrobial photodynamic therapy (aPDT) and curcumin (CUR)-mediated aPDT versus the conventional disinfectants, such as chlorhexidine gluconate (CHX) gel and sodium hypochlorite (NaOCl), for indirect pulp capping (IPC) treatment of permanent molars.

METHODS

One Hundred grossly carious human permanent molars were collected through non-traumatic extraction. All specimens were embedded in polyvinyl cross-sections to the cemento-enamel junction. The cavity preparation was conducted by grinding the samples using silicon carbide discs. After culturing Streptococcus mutans (S. mutans), a 10 µL of S. mutans suspension (10⁶ colony forming units/mL) was transferred in each tooth cavity and anaerobically incubated for 48 hours at 37°C. All specimens were randomly divided into 5 groups: Group-I: samples treated IPC; Group-II: samples treated with 2% CHX gel; Group-III: samples treated with 6% NaOCl; Group-IV: irradiation of prepared cavity with MB-mediated aPDT; and Group-V: irradiation of prepared cavity with CUR-mediated aPDT. After disinfection methods, the universal adhesive was used, and all specimens were restored using giomer. Eventually, confocal laser scanning microscopy, shear bond strength (SBS), micro-tensile bond strength (μTBS), four-point bending strength (4P-BS) analyses were performed, and the data were analyzed statistically.

RESULTS

At baseline, the highest SBS (48.8 ± 6.5 MPa), μTBS (54.3 ± 3.9 MPa), and 4P-BS (123 ± 32 MPa) scores were demonstrated by the samples treated with MB-mediated aPDT. However, after 12 months of storage, the highest SBS (42.3 ± 3.9 MPa) and μTBS (45.2 ± 6.6 MPa) scores were shown by samples treated with MB-mediated aPDT, while CUR-mediated aPDT treated samples demonstrated the highest 4P-BS scores (70 ± 18 MPa). Moreover, the highest antibacterial activity against S. mutans was shown by the samples treated with MB-mediated aPDT.

CONCLUSIONS

The application of aPDT, especially MB-mediated, demonstrated superior SBS, μTBS, and 4P-BS values as well as antibacterial activity against S. mutans as compared to 2% CHX gel and 6% NaOCl as cavity disinfectants for IPC treatment of permanent molars.

Clinical applications of antimicrobial photodynamic therapy in dentistry

Given the emergence of resistant bacterial strains and novel microorganisms that globally threaten human life, moving toward new treatment modalities for microbial infections has become a priority more than ever. Antimicrobial photodynamic therapy (aPDT) has been introduced as a promising and non-invasive local and adjuvant treatment in several oral infectious diseases. Its efficacy for elimination of bacterial, fungal, and viral infections and key pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Candida albicans, and Enterococcus faecalis have been investigated by many invitro and clinical studies. Researchers have also investigated methods of increasing the efficacy of such treatment modalities by amazing developments in the production of natural, nano based, and targeted photosensitizers. As clinical studies have an important role in paving the way towards evidence-based applications in oral infection treatment by this method, the current review aimed to provide an overall view of potential clinical applications in this field and summarize the data of available randomized controlled clinical studies conducted on the applications of aPDT in dentistry and investigate its future horizons in the dental practice. Four databases including PubMed (Medline), Web of Science, Scopus and Embase were searched up to September 2022 to retrieve related clinical studies. There are several clinical studies reporting aPDT as an effective adjunctive treatment modality capable of reducing pathogenic bacterial loads in periodontal and peri-implant, and persistent endodontic infections. Clinical evidence also reveals a therapeutic potential for aPDT in prevention and reduction of cariogenic organisms and treatment of infections with fungal or viral origins, however, the number of randomized clinical studies in these groups are much less. Altogether, various photosensitizers have been used and it is still not possible to recommend specific irradiation parameters due to heterogenicity among studies. Reaching effective clinical protocols and parameters of this treatment is difficult and requires further high quality randomized controlled trials focusing on specific PS and irradiation parameters that have shown to have clinical efficacy and are able to reduce pathogenic bacterial loads with sufficient follow-up periods.

Nanoparticle incorporated dentin bonding agent to caries effected dentin treated by photodynamic therapy, laser or chlorhexidine

PURPOSE

This study aims to evaluate the microtensile bond strength (µTBS) and failure modes of graphene nanoplatelets doped with hydroxyapatite (GNP-HA) modified self-etch dentin bonding agent (DBA) to caries effected dentin (CAD) after various conventional and laser disinfection protocols.

MATERIALS AND METHODS

Graphene nanoplatelets and HA nanoparticles were doped and incorporated in DBA. Fifty carious human molar teeth were used for the experiment. CAD specimens were divided into five groups (n=10/group) into CAD undergoing no disinfection treatment (Group-CAD), 2% chlorhexidine disinfection (Group-CHX), 6% NaOCl disinfection (Group-NaOCl), methylene blue assisted PDT (Group-MB-PDT), and Er,Cr:YSGG laser application (Group-Er,Cr:YSGG). Following the respective disinfection techniques, the GNP-HA modified adhesive was applied to all treated CAD surface. Subsequently µTBS and failure modes were analyzed.

RESULTS

Representative scanning electron microscope images (SEM images) of the synthesized GNP-HA indicated flakes of graphene with varying size lengthwise (>500 nm) with 1-2 nm width. The doped HA showed round and spherical morphology conjugated over the surface of the GNP measuring 40 -100 nm in diameter. CAD group that underwent no treatment represented the highest µTBS (29.43 MPa). Within the tested specimens, MB-PDT (22.37 MPa) and Er,Cr:YSGG (21.85 MPa) showed the highest µTBS values than CHX (15.69 MPa) and NaOCl (11.46 MPa). However, there was no significant difference between MB-PDT and Er,Cr:YSGG (p>0.05) and a significant difference existed between CHX and NaOCl (p<0.05). Equal distribution of cohesive and adhesive failures was noted for CAD, CHX and NaOCl treated specimens. A majority of adhesive failures existed in the MB-PDT groups. While admixed and adhesive failures were higher in Er,Cr:YSGG treated samples.

CONCLUSIONS

The outcome of this study suggests that CAD restored by GNP-HA modified self-etch adhesive showed highest bond strength after MB-PDT and Er,Cr:YSGG protocols with low amount of adhesive failure.

Influence of adjunctive photodynamic therapy (curcumin) on the extrusion bond strength of radicular dentin to contemporary root canal sealers

OBJECTIVE

The aim was to compare Photodynamic therapy (PDT) as an adjunct to NaOCl and EDTA on the extrusion bond strength (EBS) of AH Plus (AH), Sealapex (SA) and MTA Fillapex (MF) root canal sealers.

MATERIALS AND METHOD

Root canal treatment for human teeth (n = 60) using protaper universal system was performed followed by irrigation with NaOCl/ EDTA. Samples were divided (n = 30) based on disinfection technique, NaOCl/EDTA and NaOCl/EDTA with PDT (Curcumin-PS-CP) as an adjunct. Specimens were divided in three subgroups (n = 10) based on sealers used (Gp 1-Na-E-AH, Gp 2-Na-E-PDT-AH, Gp 3-Na-E-SA, Gp 4-Na-E-PDT-SA, Gp 5-Na-E-MF & Gp 6-Na-E-PDT-MF). Canals were dried and obturated followed by sectioning at coronal and middle third. EBS testing was performed using a universal testing machine (UTM) and modes of failure were assessed. Analysis of variance (ANOVA) and Tukey multiple comparison tests were used to compare the means of EBS. (p < 0.05).

RESULTS

Sealers showed a significant influence on EBS, as Gp 1 (Co: 9.21 ± 0.62, Mid: 8.54 ± 0.55) and Gp 2 (Co: 7.11 ± 0.68, Mid: 7.30 ± 0.37) showed higher EBS than Gp 3 (Co: 5.21 ± 0.63, Mid: 4.36 ± 0.83) and Gp 4 (Co: 5.39 ± 0.72, Mid: 4.46 ± 0.74). Gp 5 (Co: 9.04 ± 0.13, Mid: 8.14 ± 0.91) and Gp 6 (Co: 8.67 ± 0.42, Mid: 8.07 ± 0.07) exhibited higher EBS than Gp 3 and Gp 4 specimens. Adjunctive use of PDT for AH sealer (Gp 2) showed decreased EBS compared to Gp 1 specimens. EBS remained comparable for both MTA-Fillapex and Sealapex with and without PDT.

CONCLUSION

AH Plus (Gp 1 and 2) and MTA-Fillapex (Gp 5 and 6) sealers displayed better EBS compared to Sealapex (Group 3 and 4). Adjunctive Application of PDT (CP) did not show a significant improvement in bond strength of sealers to root dentin.