One-session root canal treatment with antimicrobial photodynamic therapy (aPDT): anin vivostudy

Triton X-100 enhanced antibacterial effect of photodynamic therapy against Enterococcus faecalis infection: an in vitro study

Photodynamic therapy (PDT) is an effective method for bacterial infection control in root canals of teeth with a broad-spectrum antibacterial activity. However, its application in root canal treatment is limited due to its inefficiency under hypoxic conditions and dentin staining. Triton X-100 (TX) shows great potential in enhancing the efficiency of antimicrobial agents through improving bacterial membrane permeability. The present study employed a combination of toluidine blue O (TB)-mediated PDT with TX to target the Enterococcus faecalis (E. faecalis), a bacterium with strong resistance to various antibacterial agents and mostly detected in infected root canals. PDT combined with TX showed enhanced antibacterial efficiency against both planktonic cells and biofilms of E. faecalis. At the same time, TX enhanced the antibacterial effect in dentinal tubules and reduced the incubation time. Mechanism studies revealed that TX improved reactive oxygen species (ROS) production through increasing the proportion of TB monomers. Additionally, increased membrane permeability and wettability were also observed. The findings demonstrated the PDT combined with TX could be used as a highly effective method for the root canal disinfection of teeth.

Effect of photodynamic therapy on the healing of periapical lesions after root canal retreatment: 1-year follow up randomized clinical trial

BACKGROUND

The aim of this randomized clinical trial was to evaluate the effects of photodynamic therapy (PDT) after traditional activated final irrigation protocol (ultrasonically activated irrigation, UAI) on periapical lesion healing after single-visit root canal retreatment.

METHODS

We included 36 patients with asymptomatic chronic apical periodontitis with periapical lesions larger than 5 mm and teeth sensitive to percussion and palpation, who had previous root canal treatment. All patients who signed informed consent underwent cone-beam computed tomography (CBCT) to determine and calculate the preoperative volume of the periapical lesion. Patients were randomly distributed into two groups according to the final disinfection protocol: Group 1; UAI (NaOCl, EDTA, and NaOCl), Group 2; UAI + PDT. All patients underwent single-visit root canal retreatment using rotary instrumentation and standardized irrigation (3 %NaOCl) by the same endodontist. The root canals were filled with epoxy resin-based sealer and single-cone gutta-percha, followed by control radiography. After one year, a new CBCT scan of the teeth was performed to calculate the reduction in the initial periapical lesion as a measure of periapical healing. For the statistical analysis, the chi-square test variants, Fisher's exact test and the Fisher-Freeman-Halton test were used at the level of significance set at 5 %.

RESULTS

There were no significant differences between the groups in terms of age, sex, preoperative and postoperative lesion volume (p > 0.05), and reduction of periapical lesion volume (median, 86.98 % for UAI and 79.72 % for UAI+PDT) (p = 0.970). Additional use of PDT after UAI did not contribute to the healing of periapical lesions.

CONCLUSION

The UAI and UAI+PDT protocols had equal effects on healing of periapical lesion.

The effect of photodynamic therapy in controlling the oral biofilm: A comprehensive overview

Several resistance mechanisms are involved in dental caries, including oral biofilms. An accumulation of bacteria on the surface of teeth is called plaque. Periodontitis and gingivitis are caused by dental plaque. In this review article, we aimed to review the studies associated with the application of photodynamic therapy (PDT) to prevent and treat various microbial biofilm-caused oral diseases in recent decades. There are several studies published in PubMed that have described antimicrobial photodynamic therapy (APDT) effects on microorganisms. Several in vitro and in vivo studies have demonstrated the potential of APDT for treating endodontic, periodontal, and mucosal infections caused by bacteria as biofilms. Reactive oxygen species (ROS) are activated in the presence of oxygen by integrating a nontoxic photosensitizer (PS) with appropriate wavelength visible light. By causing irreversible damage to microorganisms, ROS induces some biological and photochemical events. Testing several wavelengths has been conducted to identify potential PS for APDT. A standard protocol is not yet available, and the current review summarizes findings from dental studies on APDT.

Does aPDT reduce bacterial load in endodontic infected teeth? A systematic review and meta-analysis

This systematic review investigated whether antimicrobial photodynamic therapy (aPDT) after chemomechanical root canal disinfection (CD) yields a greater microbial load reduction than only CD. An electronic literature search was conducted on four databases up to November 2022, with no language or publication date restrictions. Randomized and non-randomized clinical trials were included if participants had a primary endodontic infection in permanent teeth, and if microbial loads before and after using aPDT were compared. Two researchers independently screened titles and abstracts to determine study eligibility. Assessments included risk of bias and methodological quality. This review was registered in PROSPERO (CRD42020181783). Eight studies were included in the qualitative analysis, and six were eligible for meta-analysis. In the random effects model, aPDT significantly improved the results of root canal disinfection when compared with standard protocols for cleaning and shaping (p = 0.04, 95% CI -1.72, -0.05). Subgroup analysis suggested that aPDT has a better effect on reducing the load of anaerobic microorganisms (p = 0.003, 95% CI -3.36, -0.69). The use of aPDT as an adjunct to chemomechanical disinfection promotes additional reduction of the microbial load and, therefore, seems to improve the results of root canal treatments in permanent teeth with a primary endodontic infection. However, certainty of evidence should be improved.

Morphological Assessment of the Effect of Nanosecond Diode Laser Radiation With a Wavelength of 1265 nm on Periodontal Tissue in the Treatment of Apical Periodontitis: An Experimental Study

Introduction: There is a morphological assessment of the damaged area and the inflammatory response of periodontal tissues after therapy. It seems relevant to evaluate the reaction of the periapical tissues of the teeth of experimental animals after the treatment of simulated apical periodontitis using laser photodynamic therapy (PDT) and non-pigment laser transcanal microablation using morphological research. Methods: The lower incisors of 15 rabbits were used to simulate acute apical periodontitis of pulpal origin. Subsequently, the traditional treatment of teeth canals using mechanical cleaning and irrigation with antiseptic solution started. Then, three groups underwent different therapies - using PDT (n = 5; photosensitizer chlorin e6, [l = 660 nm, 60 mW/cm² ] for 2 minutes), using a new technology of transcanal laser ablation (n = 5; diode laser [l = 1265 nm, 180 mW/cm² ] for 3 minutes), and without additional treatment (n = 5). Laser therapy in two groups was carried out for 10 days once in 2 days. The animals were euthanized 10 days after the treatment started, decapitation was performed, and morphological specimens were studied under a microscope. Descriptive analysis (study of inflammatory apical infiltrate, bone regeneration of the alveoli and periodontal ligament) and quantitative analysis were performed. The data were statistically processed using the Kruskal-Wallis test. Results: The group treated with the new laser technology showed the best results with moderate lymph-macrophage infiltration and congested vessels, moderate neoangiogenesis and fibrogenesis. The size of the lesion was 506.4 mm², compared with the PDT group - 872.0 mm² (P ≤ 0.05). Conclusion: A decrease in the focus of inflammation, moderate neoangiogenesis and fibrogenesis in the periapical region when using transcanal laser microablation indicate the prospects of using the new technology in clinical practice in the complex therapy of apical periodontitis.

Specialized pro-resolving lipid mediators in endodontics: a narrative review

Endodontics is the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. Human dental pulp is a highly dynamic tissue equipped with a network of resident immunocompetent cells that play major roles in the defense against pathogens and during tissue injury. However, the efficiency of these mechanisms during dental pulp inflammation (pulpitis) varies due to anatomical and physiological restrictions. Uncontrolled, excessive, or unresolved inflammation can lead to pulp tissue necrosis and subsequent bone infections called apical periodontitis. In most cases, pulpitis treatment consists of total pulp removal. Although this strategy has a good success rate, this treatment has some drawbacks (lack of defense mechanisms, loss of healing capacities, incomplete formation of the root in young patients). In a sizeable number of clinical situations, the decision to perform pulp extirpation and endodontic treatment is justifiable by the lack of therapeutic tools that could otherwise limit the immune/inflammatory process. In the past few decades, many studies have demonstrated that the resolution of acute inflammation is necessary to avoid the development of chronic inflammation and to promote repair or regeneration. This active process is orchestrated by Specialized Pro-resolving lipid Mediators (SPMs), including lipoxins, resolvins, protectins and maresins. Interestingly, SPMs do not have direct anti-inflammatory effects by inhibiting or directly blocking this process but can actively reduce neutrophil infiltration into inflamed tissues, enhance efferocytosis and bacterial phagocytosis by monocytes and macrophages and simultaneously inhibit inflammatory cytokine production. Experimental clinical application of SPMs has shown promising result in a wide range of inflammatory diseases, such as renal fibrosis, cerebral ischemia, marginal periodontitis, and cancer; the potential of SPMs in endodontic therapy has recently been explored. In this review, our objective was to analyze the involvement and potential use of SPMs in endodontic therapies with an emphasis on SPM delivery systems to effectively administer SPMs into the dental pulp space.

Root Canal Disinfection Using Highly Effective Aggregation-Induced Emission Photosensitizer

Root canal (RC) therapy is the primary treatment of dental-pulp and periapical diseases. The mechanical method and chemical irrigation have limitations in RC therapy. Much attention has focused on exploring more controllable and efficacious antimicrobial methods. Although the introduction of photodynamic therapy (PDT) has provided the ideas for RC debridement, the problems of low photosensitive efficiency and nonsignificant germicidal potency of traditional photosensitizers (e.g., methylene blue) have not been solved. Since the concept of "aggregation-induced emission" (AIE) was proposed, optimization of photosensitizers has been boosted considerably. Herein, an AIE photosensitizer, DPA-SCP, with a strong ability to generate singlet oxygen, is proposed for use as an antibacterial application in infected RCs. The antimicrobial activity of DPA-SCP against Enterococcus faecalis suspensions was tested. To explore the antibacterial ability of this photosensitizer against bacterial-biofilm colonization on the inner walls of RCs, we established a model of bacterial biofilm infection. PDT mediated by DPA-SCP had a significant germicidal effect on E. faecalis suspensions and 21-day biofilms in human RCs. PDT mediated by DPA-SCP could achieve efficiency equivalent to that observed using 1% NaOCl, and lead to no significant change in the dentin surface, chemical corrosion, or cytotoxicity.

Retrospective clinical evaluation of root canal treatment with or without photodynamic therapy for necrotic teeth and teeth subjected to retreatment

PURPOSE

To compare the effect of photodynamic therapy (PDT) as a procedure to complement root canal treatment (RCT), for both primary treatment and retreatment.

METHODS

This was a retrospective study based on analysis of clinical records. A total of 214 teeth that had undergone RCT on either a primary or retreatment basis, with or without complementary PDT, were evaluated. For 118 teeth that met the previously established inclusion criteria, the time until healing was evaluated. Complementarily, the need for application of calcium hydroxide (CaHy) between visits and the number of visits necessary for completing the treatment were assessed. Data were analyzed using the Mann-Whitney and χ² tests with a significance level of P < 0.05.

RESULTS

Periapical radiolucency resolution was achieved at 15 ± 9.33 months in the RCT + PDT group and 20.35 ± 22.1 months in the RCT group (P = 0.07). For primary treatment, CaHy was necessary in 72.4% of the RCT cases and 16.4% of the RCT + PDT cases (P < 0.01). For retreatment cases, CaHy was used in 82.7% of the RCT cases and 17% of the RCT + PDT cases (P < 0.01). In the RCT group, more than two visits were necessary for primary treatment in 18.6% of the cases, compared with 13.10% in the RCT + PDT group (P = 0.31), whereas for retreatment, more than two visits were necessary for 64.9% and 49.1% of cases, respectively (P = 0.05).

CONCLUSION

In comparison with RCT alone, teeth receiving RCT + PDT showed less variation in the time needed for periapical lesion healing, fewer cases required CaHy, and fewer cases required more than two visits to complete the treatment.

Effects of Rose Bengal- and Methylene Blue-Mediated Potassium Iodide-Potentiated Photodynamic Therapy on Enterococcus faecalis: A Comparative Study

BACKGROUND AND OBJECTIVES

This study was performed to compare the use of methylene blue (MB) and rose bengal (RB) in antimicrobial photodynamic therapy (PDT) targeting Enterococcus faecalis (E. faecalis) bacteria in planktonic and biofilm forms with potassium iodide (KI) potentiation.

STUDY DESIGN/MATERIALS AND METHODS

E. faecalis bacteria in planktonic form were exposed to antimicrobial PDT protocols activating MB and RB, with or without KI potentiation, following laser irradiation with different exposure times, 60 mW/cm² laser power, and different photosensitizer agent (PS)/potentiator concentrations to observe relationships among the variables. Two continuous-wave diode lasers were used for irradiation (red light: λ = 660 nm and green light: λ = 565 nm). The pre-irradiation time was 10 minutes. The vitality of E. faecalis biofilm was assessed by confocal laser scanning microscopy, and the morphology was determined by scanning electron microscopy. The effects on the proliferation of stem cells from the apical papilla (SCAPs) were analyzed by cell counting kit-8 assay. The staining effect of antimicrobial PDT on dentin slices was investigated. Statistical analysis using a one-way analysis of variance was done.

RESULTS

KI-potentiated RB and MB antimicrobial PDT both effectively eradicated E. faecalis bacteria in planktonic and biofilm forms. The minimum bactericidal concentrations of PSs (±100 mM KI) were obtained through PDT on planktonic E. faecalis, and the optimal light parameters were 60 mW/cm² , 6 J/cm² for 100 seconds. KI-potentiated PDT effectively strengthened the ability to inhibit E. faecalis biofilm with 86.50 ± 5.78% for MB (P = 0.0015 < 0.01) and 91.50 ± 1.75% for RB (P = 0.0418 < 0.05) of bactericidal rate, with less toxicity for SCAPs (P < 0.001) and less staining. KI could reduce the staining induced by antimicrobial PDT on dentin slices.

CONCLUSION

A combination of KI and antimicrobial PDT may be a useful alternative to conventional disinfection methods in endodontic treatment. MB and RB antimicrobial PDT at much lower concentrations with KI could hopefully achieve disinfection effects comparable with those of 1.5% NaClO while causing few adverse effects on SCAPs. KI helps to avoid staining problems associated with high concentrations of photosensitizer agents. Lasers Surg. Med. © 2020 Wiley Periodicals, LLC.

Comparison of apical periodontitis repair in endodontic treatment with calcium hydroxide-dressing and aPDT

This study evaluated the effect of antimicrobial photodynamic therapy (aPDT) on the endodontic treatment of apical periodontitis (AP). AP was induced in 48 premolars of 6 dogs. After biomechanical preparation, the teeth were divided into 4 groups: Calcium-Hydroxide (CH)/120d and CH/180d: root canals filled with CH-based dressing for 15 days before obturation; aPDT/120d and aPDT/180d: conditioning with phenothiazine photosensitizer (10 mg/mL) for 1 minute and irradiation with diode laser in the same session as obturation. Root filling was performed with AH Plus sealer. After the experimental periods, animals were euthanized and teeth were submitted for histology. HE staining was performed for descriptive analysis of the periapical region, measurement of apical periodontitis and for inflammatory cells, and blood vessels count. Immunohistochemistry was performed for osteopontin (OPN) and alkaline phosphatase (ALP). Data were analyzed statistically by two-way ANOVA and chi-square test (α = 5%). Teeth in Group CH/120d presented only a slightly enlarged periodontal ligament (PL) with advanced repair. Group aPDT/120d presented the PL moderately enlarged, with moderate inflammatory infiltrate and few collagen fibers. The same pattern was observed at 180 days. AP lesions in CH-treated groups were smaller than those in aPDT-treated groups (p < 0.001) with more blood vessels (p < 0.0001), regardless of the evaluation period, without significant differences in the number of inflammatory cells (p > 0.05). CH-treated groups showed significantly more intense immunostaining for ALP and OPN (p < 0.001) in both periods. Although aPDT stimulated angiogenesis and expression of bone formation markers, the two-session endodontic treatment with CH-based dressing promoted better apical periodontitis repair.

Terapia fotodinâmica na endodontia: revisão de literatura

A terapia endodôntica busca prevenir e quando necessário eliminar infecções endodônticas. A persistência de microrganismos ao preparo químico mecânico ou a medicação intracanal é considerada a principal causa dos insucessos do tratamento endodôntico. Sendo nestes casos o Enterococcus faecalis o microrganismo mais comumente encontrado. A terapia fotodinâmica (PDT) desponta desta maneira como uma promissora terapia coadjuvante ao tratamento endodôntico convencional para eliminar estes microrganismos persistentes. Esta terapia consiste na associação de uma fonte de luz específica a um fotossensibilizador na presença de oxigênio, produzindo assim espécies citotóxicas aos microrganismos. Assim, o presente artigo tem como objetivo realizar uma revisão de literatura sobre o uso da terapia fotodinâmica na endodontia, a qual demonstra-se efetiva como auxiliar durante o preparo do canal radicular.

Antimicrobial photodynamic therapy - what we know and what we don't

Considering increasing number of pathogens resistant towards commonly used antibiotics as well as antiseptics, there is a pressing need for antimicrobial approaches that are capable of inactivating pathogens efficiently without the risk of inducing resistances. In this regard, an alternative approach is the antimicrobial photodynamic therapy (aPDT). The antimicrobial effect of aPDT is based on the principle that visible light activates a per se non-toxic molecule, the so-called photosensitizer (PS), resulting in generation of reactive oxygen species that kill bacteria unselectively via an oxidative burst. During the last 10-20 years, there has been extensive in vitro research on novel PS as well as light sources, which is now to be translated into clinics. In this review, we aim to provide an overview about the history of aPDT, its fundamental photochemical and photophysical mechanisms as well as photosensitizers and light sources that are currently applied for aPDT in vitro. Furthermore, the potential of resistances towards aPDT is extensively discussed and implications for proper comparison of in vitro studies regarding aPDT as well as for potential application fields in clinical practice are given. Overall, this review shall provide an outlook on future research directions needed for successful translation of promising in vitro results in aPDT towards clinical practice.

Effect of aPDT on Streptococcus mutans and Candida albicans present in the dental biofilm: Systematic review

To evaluate the effect of aPDT on S. mutans and C. albicans present in the dental biofilm, using methylene blue as a photosensitizer in different pre-irradiation times. The searches were made on Pubmed, Web of Science, Bireme, Scopus and Cochrane Library, and were complemented by screening the references of selected articles in the attempt to find any article that did not appear in the database search. The searches were performed by two researchers and limited to studies involving human subjects published in the English language. Inclusion criteria included in vitro studies with aPDT; studies that used methylene blue as a photosensitizer; studies that used low power laser; studies that evaluated S. mutans or C. albicans. Studies published in a non-English language, patents, in vivo or in situ studies; case reports, serial case, reviews and animal studies were not included. Studies published before 1996 were also not included. Initially, the search resulted in 68 published studies. 16 records were excluded because they were duplicated. The analysis of titles and abstracts resulted in the exclusion of 48 of the published studies, resulting in 4 studies included in the systematic review. The aPDT was effective in three of the four papers selected for the systematic review and the pre-irradiation time used was 5 or 15 min. This therapy had satisfactory results in both C. albicans and S. mutans when using methylene blue as a photosensitizer.

Factors affecting the periapical healing process of endodontically treated teeth

Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.

The Antibacterial Effect of Additional Photodynamic Therapy in Failed Endodontically Treated Teeth: A Pilot Study

Introduction: Root canal therapy as a routine dental procedure has resulted in retention of millions of teeth that would otherwise be lost. Unfortunately, successful outcomes are not always achievable within initial endodontic treatments, and that necessitates further treatment. Nonsurgical retreatment is the first choice in most clinical situations. The aim of this clinical pilot study was to assess the effect of additional photodynamic therapy (PDT) on intraradicular bacterial load following retreatment of failed previously root treated teeth. Methods: Thirty single-rooted/canalled endodontically treated matured teeth (in 27 healthy patients) accompanied by apical periodontitis (AP) were selected for this study. Standard protocol was followed for nonsurgical retreatment of each tooth. Microbiological samples were taken after establishment of apical patency, finished cleaning/shaping procedure, and PDT (665 nm, 1 W, 240 seconds). All samples were cultured for 72 hours and colony-forming unit (CFU) was counted. McNemar test was used for statistical analysis of the data. The level of significance was set at 0.001. Results: Routine cleaning and shaping resulted in twenty four negative (80%) out of 30 cultures. Four additional negative results were obtained after additional PDT (93.3%). The addition of PDT to routine procedures significantly enhanced the number of bacteria-free samples (P < 0.001). Conclusion: Regarding elimination of intraradicular microbiota, additional PDT may increase the effectiveness of conventional chemomechanical preparation in previously root filled teeth accompanied by AP. Well controlled randomized clinical trials should be planned for future.

Rat tissue reaction and cytokine production induced by antimicrobial photodynamic therapy

BACKGROUND

The antimicrobial photodynamic therapy (aPDT) inactivates the target cell via reactions among the photosensitizer (PS), Laser or Led and O₂. The aim of this study was to evaluate the tissue reaction and cytokine production promoted by aPDT with curcumin photosensitizer.

METHODS

Polyethylene tubes containing saline solution (control), 5% sodium hypochlorite (NaOCl) and aPDT with curcumin PS 500mg/L, were implanted into dorsal connective tissue of Wistar rats. After 7, 15, 30, 60 and 90days of implantation, the animals were euthanized and the tubes with surrounding tissues were removed. The specimens were divided in two part, one half was processed, fixed and prepared for histological analysis by staining with hematoxylin and eosin. The other half was collected for IL-1β and IL-6 cytokine production using ELISA assay. The results were statistically analyzed by Kruskal-Wallis test followed by Dunn test (p<0.05) for tissue reaction and ANOVA followed by Bonferroni's correction (p<0.05) for ELISA.

RESULTS

All groups showed severe tissue reactions at 7days, whilst a significantly decrease by time was observed. Regarding to cytokine production, aPDT increases the IL-1β levels in all periods of time (p<0.05). However, for IL-6 levels, the highest value was observed with aPDT on the 90th day (p<0.05).

CONCLUSIONS

aPDT with curcumin PS 500mg/L demonstrated biocompatibility similar to saline solution and induced the IL-1β and IL-6 cytokines production.

Histopathological, Microbiological, and Radiographic Analysis of Antimicrobial Photodynamic Therapy for the Treatment of Teeth with Apical Periodontitis: A Study in Rats' Molars

OBJECTIVE

The aim of this study was to evaluate in vivo, by histological and radiographic analysis, the response of apical tissues of rats' teeth with experimentally induced apical periodontitis, after one- and two-session endodontic treatment with and without photodynamic therapy (PDT). A microbiological analysis was also performed to verify bacterial reduction after each treatment.

BACKGROUND DATA

Studies carried out in recent years highlighted the antibacterial potential of PDT when associated with conventional endodontic therapy in vitro. Although the antimicrobial effect of PDT is well-established, tissue response to PDT in teeth with apical periodontitis lacks studies.

METHODS

Thirty-two rats' root canals were assigned to four groups: one session/PDT-[chemomechanical preparation (CMP)+root canal filling (RCF)]; two sessions/PDT- [CMP+calcium hydroxide (CH) for 14 days+RCF]; one session/PDT+ [CMP+PDT+RCF], and two sessions/PDT+ [CMP+PDT+CH for 14 days+RCF]. For microbiological evaluation, samples were collected before and after proposed treatments. For radiographic and histological analysis, the animals were euthanized after 28 days and the mandibles surgically removed.

RESULTS

PDT associated with conventional endodontic therapy was able to promote significant bacterial reduction in root canals with induced apical periodontitis, but this reduction was not significantly different to conventional endodontic therapy alone. Although radiographic evaluation showed no significant differences, histological analysis showed lower scores for neutrophils/eosinophils in PDT-treated groups and macrophages/giant cells in CH groups.

CONCLUSIONS

The use of low-level laser as light source did not promote major improvement on radiographic and histological repair, but since the number of inflammatory cells slightly decreased, it may optimize repair by modulating inflammatory process. PDT may be indicated as an adjunct to conventional endodontic therapy for teeth with apical periodontitis, in association with an interappointment dressing with CH, in an attempt to produce better conditions to stimulate repair.

Effect of the antimicrobial photodynamic therapy on microorganism reduction in deep caries lesions: a systematic review and meta-analysis

This study aimed to perform a systematic review to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) in the reduction of microorganisms in deep carious lesions. An electronic search was conducted in Pubmed, Web of Science, Scopus, Lilacs, and Cochrane Library, followed by a manual search. The MeSH terms, MeSH synonyms, related terms, and free terms were used in the search. As eligibility criteria, only clinical studies were included. Initially, 227 articles were identified in the electronic search, and 152 studies remained after analysis and exclusion of the duplicated studies; 6 remained after application of the eligibility criteria; and 3 additional studies were found in the manual search. After access to the full articles, three were excluded, leaving six for evaluation by the criteria of the Cochrane Collaboration’s tool for assessing risk of bias. Of these, five had some risk of punctuated bias. All results from the selected studies showed a significant reduction of microorganisms in deep carious lesions for both primary and permanent teeth. The meta-analysis demonstrated a significant reduction in microorganism counts in all analyses (p<0.00001). Based on these findings, there is scientific evidence emphasizing the effectiveness of aPDT in reducing microorganisms in deep carious lesions.