Photodynamic therapy in combating the causative microorganisms from endodontic infections

Bioburden assessment of necrotic teeth disinfected with sodium hypochlorite, diode laser, and photodynamic therapy using flow cytometry-a randomized double-blinded clinical trial

This study aimed to comparatively evaluate the disinfecting potential of sodium hypochlorite, diode laser, and photodynamic therapy in non-vital teeth with or without periapical rarefaction. Forty-five patients with the diagnosis of pulp necrosis with apical rarefaction were randomly assigned to three groups (n = 15) based on the disinfection protocol. Access cavities were prepared and pre-instrumentation microbial samples were taken using a paper point. Working length determination followed by cleaning and shaping with rotary files was performed. The canals were lubricated with ethylenediaminetetraacetic acid (EDTA) during instrumentation and finally rinsed with copious amounts of saline. Canals in group 1 were irrigated with 5 mL of 5.25% NaOCl, those in group 2 received irradiation with 808-nm diode laser (30 s, 7W), and those in group 3 were soaked with methylene blue photosensitizer (5 min) before irradiation with 660-nm diode laser (3 min). Post-disinfection microbial samples were collected using a paper point. Pre- and post-disinfection live bacterial counts were analyzed using a flow cytometer. The data were statistically analyzed using one-way ANOVA and Student's t-test. Comparison of pre-instrumentation mean live bacterial count showed no significant difference between the groups (p > 0.05). The mean live bacterial count post-disinfection was 41.07%, 46.99%, and 34.45% in groups 1-3 respectively. A significant reduction in the bacterial count was seen following disinfection in all the groups (p < 0.05). It can be concluded that both diode laser and photodynamic therapy were equally effective as 5.25% NaOCl in reducing the bioburden in root canals. TRIAL REGISTRATION: CTRI/2018/03/012667.

Nanotechnology for Dentistry: Prospects and Applications

In the XXI century, application of nanostructures in oral medicine has become common. In oral medicine, using nanostructures for the treatment of dental caries constitutes a great challenge. There are extensive studies on the implementation of nanomaterials to dental composites in order to improve their properties, e.g., their adhesive strength. Moreover, nanostructures are helpful in dental implant applications as well as in maxillofacial surgery for accelerated healing, promoting osseointegration, and others. Dental personal care products are an important part of oral medicine where nanomaterials are increasingly used, e.g., toothpaste for hypersensitivity. Nowadays, nanoparticles such as macrocycles are used in different formulations for early cancer diagnosis in the oral area. Cancer of the oral cavity-human squamous carcinoma-is the sixth leading cause of death. Detection in the early stage offers the best chance at total cure. Along with diagnosis, macrocycles are used for photodynamic mechanism-based treatments, which possess many advantages, such as protecting healthy tissues and producing good cosmetic results. Application of nanostructures in medicine carries potential risks, like long-term influence of toxicity on body, which need to be studied further. The introduction and development of nanotechnologies and nanomaterials are no longer part of a hypothetical future, but an increasingly important element of today's medicine.

Protocol for the clinical practice of photodynamic therapy in endodontics: assessment of guideline quality using the AGREE II instrument

BACKGROUND

The choice of parameters in Photodynamic Therapy for endodontic treatment, such as wavelength, energy, application time, and number of sessions can vary based on the characteristics of the procedure and the patient. Providing information supported by scientific evidence in an accessible way to clinicians who are unfamiliar with the literature is necessary. Thus, this study aimed to synthesize a clinical protocol for the use of photodynamic therapy in endodontics in permanent teeth.

METHODS

Protocols with high methodological quality were identified using a literature search and the Appraisal of Guidelines Research and Evaluation Instrument (AGREE II), a validated tool for assessing quality. The recommendations of these studies were synthesized and submitted to a group of experts for evaluation and adaptation, and consensus was assessed using the Delphi methodology.

RESULTS

The analysis of the literature on the application of antimicrobial photodynamic therapy in endodontics showed that clinical trials with good levels of evidence and clinical recommendations have been reported previously, with two studies identified as having a clinical recommendation level of A1A and an evidence level of A.

CONCLUSION

The written protocol was considered to be satisfactory and as having appropriate content validity during the second round of evaluation by the experts. The studies included in this research were predominantly explanatory in nature, highlighting the need for pragmatic designs to increase the degree of clinical applicability.

Membrane damage as mechanism of photodynamic inactivation using Methylene blue and TMPyP in Escherichia coli and Staphylococcus aureus

The worldwide threat of antibiotic resistance requires alternative strategies to fight bacterial infections. A promising approach to support conventional antibiotic therapy is the antimicrobial photodynamic inactivation (aPDI). The aim of this work was to show further insights into the antimicrobial photodynamic principle using two photosensitizers (PS) of different chemical classes, Methylene Blue (MB) and TMPyP, and the organisms Escherichia coli and Staphylococcus aureus as Gram-negative and Gram-positive representatives. Planktonic cultures of both species were cultured under aerobic conditions for 24 h followed by treatment with MB or TMPyP at various concentrations for an incubation period of 10 min and subsequent irradiation for 10 min. Ability to replicate was evaluated by CFU assay. Accumulation of PS was measured using a spectrophotometer. The cytoplasmic membrane integrity was investigated by flow cytometry using SYBR Green and propidium iodide. In experiments on the replication ability of bacteria after photodynamic treatment with TMPyP or MB, a killing rate of 5 log₁₀ steps of the bacteria was achieved. Concentration-dependent accumulation of both PS was shown by spectrophotometric measurements whereby a higher accumulation of TMPyP and less accumulation of MB was found for S. aureus as compared to E. coli. For the first time, a membrane-damaging effect of TMPyP and MB in both bacterial strains could be shown using flow cytometry analyses. Furthermore, we found that reduction of the replication ability occurs with lower concentrations than needed for membrane damage upon MB suggesting that membrane damage is not the only mechanism of aPDI using MB.

Antimicrobial action of photodynamic therapy on Enterococcus faecalis biofilm using curing light, curcumin and riboflavin

The aim of this study was to assess the effect of antimicrobial photodynamic therapy (aPDT) with curcumin and riboflavin on three-week Enterococcus faecalis biofilm. At first the 15-mm root canals of 65 single rooted extracted human teeth (including maxillary incisors, mandibular and maxillary canines and mandibular premolars) were separated from the crown and were prepared with ProTaper instruments. After autoclave sterilisation, samples were inoculated with E. faecalis suspension, and incubated for three weeks. After ensuring biofilm formation by scanning electron microscopy (SEM) in two teeth, the remaining 63 teeth were randomly divided into seven groups (n = 9): aPDT + curcumin, aPDT + riboflavin, LED, curcumin, riboflavin, 5.25% NaOCl (positive control) and no intervention (negative control). For light source a LED unit with 390-480 nm wavelength (peak of 460 nm), power density of 1000 ± 100 mW cm^-2 and mean energy density of 60 J cm^-2 was used. The roots were horizontally sectioned into coronal, middle and apical thirds each with 5 mm thicknesses. Dentin chips with equal weight (1 ± 0.005 g) were collected from the root canal walls with Gates Glidden drills and were transferred into microtubes containing 1 mL of sterile saline and vortexed for 30 s. Next, 10 µL of the contents of each tube was serially diluted and eventually, 10 µL of each solution was cultured on BHI agar. The number of colony-forming units was determined. Data were analysed using the Kruskal-Wallis and Friedman tests. The colony reduction was not significantly different between NaOCl and either riboflavin + LED or Curcumin + LED. The 5.25% NaOCl group showed maximum reduction in colony count, compared with the negative control (P = 0.00). Groups with aPDT with Curcumin + LED (P = 0.005), and with riboflavin + LED (P = 0.011) showed significant reduction in colony count in all three canal thirds (P < 0.05) without any difference with one another. With significant reduction of E. faecalis colony count, aPDT with Curcumin and riboflavin can serve as an adjunct to routine root canal disinfection method.

Fabrication of Photoactive Electrospun Cellulose Acetate Nanofibers for Antibacterial Applications

The aim of the study was to investigate the process of electrostatic fabrication of cellulose acetate (CA) nanofibers containing methylene blue (MB) as a photosensitizer. The electrical, physicochemical, and biocidal properties of the prepared material were given. CA nanofibers were prepared by electrospinning method using a solvent mixture of acetone and distilled water (9:1 vv−1) and different concentrations of CA (i.e., 10–21%). Additionally, methylene blue was implemented into the polymer solution with a CA concentration of 17% to obtain fibers with photo-bactericidal properties. Pure electrospun CA fibers were more uniform than fibers with MB (i.e., ribbon shape). Fiber diameters did not exceed 900 nm for the tested polymer solutions and flow rate below 1.0 mL h−1. The polymer properties (i.e., concentration, resistivity) and other parameters of the process (i.e., flow rate, an applied voltage) strongly influenced the size of the fibers. Plasma treatment of nanofibers resulted in reduced biofilm formation on their surface. The results of photo-bactericidal activity (i.e., up to 180 min) confirmed the high efficiency of inactivation of Staphylococcus aureus cells using fibers containing methylene blue (i.e., with and without plasma treatment). The most effective reduction in the number of biofilm cells was equal to 99.99 ± 0.3%.

Bacterial phototoxicity of biomimetic CdTe-GSH quantum dots

AIM

Fluorescent semiconductor nanoparticles or quantum dots (QDs) have excellent properties as photosensitizers in photodynamic therapy. This is mainly a consequence of their nanometric size and the generation of light-activated redox species. In previous works, we have reported the low-cost biomimetic synthesis of glutathione (GSH) capped QDs (CdTe-GSH QDs) with high biocompatibility. However, no studies have been performed to determine their phototoxic effect. The aim of this work was to characterize the light-induced toxicity of green (QDs₅₀₀ ) and red (QDs₆₀₀ ) QDs in Escherichia coli, and to study the molecular mechanism involved.

METHODS AND RESULTS

Photodegradation and reduction power of biomimetic QDs was determined to analyse their potential for radical generation. Escherichia coli cells were exposed to photoactivated QDs and viability was evaluated at different times. High toxicity was determined in E. coli cells exposed to photoactivated QDs, particularly QDs₅₀₀ . The molecular mechanism involved in QDs phototoxicity was studied by determining Cd²⁺ -release and intracellular reactive oxygen species (ROS). Cells exposed to photoactivated QDs₅₀₀ presented high levels of ROS. Cells exposed to photoactivated QDs₅₀₀ presented high levels of ROS. Finally, to understand this phenomenon and the importance of oxidative and cadmium-stress in QDs-mediated phototoxicity, experiments were performed in E. coli mutants in ROS and Cd²⁺ response genes. As expected, E. coli mutants in ROS response genes were more sensitive than the wt strain to photoactivated QDs, with a higher effect in green-QDs₅₀₀ . No increase in phototoxicity was observed in cadmium-related mutants.

CONCLUSION

Obtained results indicate that light exposure increases the toxicity of biomimetic QDs on E. coli cells. The mechanism of bacterial phototoxicity of biomimetic CdTe-GSH QDs is mostly associated with ROS generation.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results presented establish biomimetic CdTe-GSH QDs as a promising cost-effective alternative against microbial infections, particularly QDs₅₀₀ .

Comparison of Antibacterial Effects of Photodynamic Therapy and an Irrigation Activation System on Root Canals Infected With Enterococcus faecalis: An In Vitro Study

Introduction: Enterococcus faecalis is a resistant bacterium which is the most abundant species in infected root canals. Photodynamic therapy (PDT) is a method for killing the bacteria with active Oxygen radicals generated in a photosensitizer when exposed to centralized light. Furthermore, as a new method of canal disinfection, a variety of irrigation activation systems have been introduced, one of which is GentleFile (GF) with rotary movements and spiral effects for antibacterial action. This study aimed to compare the effectiveness of the two mentioned methods when used with and without Sodium Hypochlorite in eliminating E. faecalis from infected root canals. Methods: Fifty-eight uniradicular teeth were randomly divided into 4 experimental groups of 14. Two specimens were selected for later scanning electron microscopy in order to screen the procedure steps. In each experimental group, 10 samples were selected to be treated with GF or PDT; 3 of them were selected as positive controls and the other one sample was chosen as a negative control. Experimental groups were as follows: (1) Irrigation activation system, (2) Irrigation activation system + sodium hypochlorite, (3) PDT, and (4) PDT+ sodium hypochlorite. The specimens were then cultured for a bacterial colony count. Results: The decrease in the bacterial count after the treatment with the irrigation activation system was 99.8% (P =0.011) and when the system was used with sodium hypochlorite, it was 100% (P =0.001). The antibacterial effect of PDT was 90.08% (P =0.011) and it was 99.7% when PDT was combined with sodium hypochlorite (P =0.011). Conclusion: All four methods can be administered as complementary methods in root canal disinfection. According to the results of disinfection in the experimental groups of current study it is concluded that integration of new technologies such as activation irrigation system or PDT in Combination with NaOCl ameliorates disinfection of root canal and can provide several advantages in the endodontic outcome.

The Combination of Diode Laser and Ozonated Water in the Treatment of Complicated Pulp Gangrene

The study aimed to investigate the effects of endodontic space decontamination using a laser combined with ozonated water in the therapy of complicated pulp gangrene. The subject of this in vivo study was a 12-year-old patient diagnosed with extensive periapical periodontitis on the mandibular right first molar. Biological samples were initially collected to identify the active pathogen—Enterococcus faecalis, then the nonsurgical endodontic treatment was performed in a single visit, according to the active disinfection guidelines of the identified pathogen. Two-month postoperative, clinical and radiological examination revealed a complete healing of the periapical lesion. The correct diagnosis of this endodontic–periodontal pathology, and the unconventional treatment of the complex system of infected root canals, allowed a favorable treatment result without any surgical intervention. This unconventional approach, which combines a laser technique with ozonated water, allows for predictable results in periapical lesion treatment.

Comparison of Antibacterial Effects of Photodynamic Therapy, Modified Triple Antibiotic Paste and Calcium Hydroxide on Root Canals Infected With Enterococcus faecalis: An In Vitro Study

Introduction: A pivotal issue to achieve success in the treatment of the root canal is root canal disinfection. One of the most important bacteria that infect the root canal is Enterococcus faecalis. This study seeks to examine the effectiveness of 3 methods for disinfecting the root canal: photodynamic therapy, modified triple antibiotic paste (MTAP), and calcium hydroxide. Methods: Sixty-two single-rooted extracted anterior teeth were collected. After cleaning and disinfecting the teeth, their crowns were cut at the CEJ point. The root canals were shaped to the working length up to file F3 ProTaper (F1, F2, F3). EDTA 17% and sodium hypochlorite 2.5% were used for 5 minutes to wash and remove the smear layer, and then the apical foramen was sealed using composite. After that, the teeth were sterilized in an autoclave at 121°C for 15 minutes. Then 10 samples were taken randomly as the negative control. The remaining samples were immersed and cultivated in a suspension containing E. faecalis for 21 days. Then the samples were divided into 5 groups: 2 positive control groups, 1 group treated with the antibiotic paste with the concentration of 1 mg/mL, 1 group treated with calcium hydroxide, and 1 group treated with photodynamic therapy. Then, to collect the biofilm, the ProTaper file F4 was used. After that, the microbial suspension was provided and counting the colonies was carried out to compare the groups. Results: The findings indicated that the amount of CFU/mg of MTAP samples, including clindamycin, metronidazole, ciprofloxacin in the concentration of 1 mg/mL and photodynamic therapy and calcium hydroxide was lower than that in the control group. Antibiotic paste cleansed the root canal up to 99.9%. Photodynamic therapy reduced the amount of CFU/mg to 98.8%, and calcium hydroxide reduced the amount of CFU/mg to 94.13%. Conclusion: Using photodynamic therapy causes a reduction in the biofilm and inhibits the growth of the E. faecalis bacterium. In addition, in this study, MTAP with a concentration of 1 mg/mL was used, which expunged the bacteria completely. Meanwhile, calcium hydroxide had the weakest effect of all on the E. faecalis bacterium.

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.

Photodynamic Therapy: A Novel Ally for Surgical Endodontic Treatment? Case Report

Introduction: Photodynamic therapy (PDT) has emerged as a powerful tool for conventional endodontic treatment, capable of eradicating microorganisms present in endodontic infections. Despite this, the use of PDT in the surgical endodontic treatment is not well-known. Case Report: This paper describes the case of a patient with asymptomatic apical periodontitis in a mandibular incisor submitted to surgical endodontic treatment associated with PDT. After conventional procedures, photosensitizer methylene blue (0.01%) was applied to the retrograde cavity for 3 minutes, followed by irradiation with diode laser (100 mW and 660 nm) for 3 minutes. Six months after the procedure, the patient was asymptomatic, and the radiographic examination showed healthy periradicular tissues. Conclusion: The association of PDT with surgical endodontic treatment was effective, suggesting that this therapy may provide additional benefits to patients when compared to the conventional surgical technique.

Photodynamic therapy in endodontics

Photodynamic therapy (PDT) is a treatment modality that was initiated in 1900; however, it was not until the last decade that PDT regained attention for its several favourable features during the treatment of microbial infections in endodontics. Recently, several papers advocated its use for root canal treatment. The concept of photodynamic inactivation requires microbial exposure to either exogenous or endogenous photosensitizer molecules, followed by visible light energy, typically wavelengths in the red/near-infrared region that cause the excitation of the photosensitizers resulting in the production of singlet oxygen and other reactive oxygen species that react with intracellular components and consequently produce cell inactivation and death. Recently, PDT has been suggested as a promising effective adjunct to standard antimicrobial intracanal cleaning and shaping for the treatment of periapical lesions. Current publications tested PDT in terms of bacterial load reduction in vivo, in vitro and ex vivo, showing promising results. The purpose of this article was to review the existing literature on PDT in the endodontic field regarding its mechanism of action, photosensitizers and light sources, limitations and clinical procedures. Although positive results have been demonstrated in vitro, there are considerably fewer in vivo investigations. In conclusion, more in vivo studies are needed on the use of antimicrobial PDT in root canal treatment.

Efficacy of photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review

BACKGROUND

The aim of this study was to systematically review the efficacy of photodynamic therapy (PDT) in the management of symptomatic oral lichen planus (OLP).

MATERIALS AND METHODS

PubMed/MEDLINE, Scopus, and ISI Web of knowledge were searched until July 2017, using the following keywords: OLP, erosive lichen planus, lichen planus, and PDT.

RESULTS

Five clinical studies were included. The risk of bias was considered high in 4 studies and moderate in 1 study. The efficacy of PDT was compared with topical corticosteroids in all included studies. Laser wavelengths, duration of irradiation, and power density ranged between 420-660 nm, 30 seconds to 10 minutes, and 10-500 mW/cm² , respectively. All studies reported PDT to be effective in the management of symptomatic OLP. Two studies reported PDT to be as effective as corticosteroids, 1 study reported a better efficacy of PDT compared to corticosteroids, whereas 2 studies found PDT to be inferior to corticosteroids.

CONCLUSIONS

The limited available evidence suggests that PDT is an effective treatment option for the management of OLP. However, due to the limited number of studies included in this review and heterogeneity among these studies, more well-designed clinical trials with adequate sample sizes are highly warranted.

Effect of ultrasonic activation of photosensitizer dye temoporfin (Foscan) on antimicrobial photodynamic therapy: An ex vivo study

Aim:

The aim of this study is to evaluate the effectiveness of ultrasonic activation of photosensitizer (PS) drug Foscan in the elimination of endodontic pathogen from root canal system.

Materials and Methods:

The minimal bactericidal concentration of “Foscan” was determined using disc diffusion and broth dilution method. Forty-eight extracted single-rooted premolars with periapical pathology were used for the study. After access opening, the first microbial sample was taken. The teeth were then randomly divided into four groups: Group 1: Chemomechanical debridement (CMD), Group 2: CMD and passive ultrasonic irrigation (CMD + PUI), Group 3: CMD and antimicrobial photodynamic therapy (aPDT), and Group 4: CMD and aPDT with activation by ultrasonics. After antimicrobial protocols, the second microbiological sample was collected. The samples were analyzed by multiplex polymerase chain reaction for the effectiveness of four antimicrobial protocols on Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis, and Treponema denticola.

Statistical Analysis Used:

Wilcoxon signed-rank test and Mann–Whitney U-test with the significant level P < 0.05, using IBM SPSS statistics 20 version software.

Results:

Foscan at concentration of 3.125 μg/ml was chosen for antimicrobial analysis. The prevalence of T. denticola, F. nucleatum, P. gingivalis, and P. intermedia was 79.17%, 70.84%, 70.83%, and 58.33%, respectively. Group 4 showed highest bacterial reduction of 99.51%, followed by Group 1 which showed bacterial reduction of 97.35%.

Conclusions:

Foscan can be used as an effective PS dye at low concentration with minimal tendency for tooth discoloration. Ultrasonic activation of PS dye facilitated better diffusion into dentinal tubules and biofilm obtaining greater bacterial reduction.

Antimicrobial Photodynamic Therapy as a Co-adjuvant in Endodontic Treatment of Deciduous Teeth: Case Series

To assure the success of endodontic treatment, the root canal must be completely decontaminated. Thus, some methods have been researched in an attempt to effectively eliminate microorganisms from the interior of the root canal system. Among them is conventional endodontic therapy in conjunction with photodynamic therapy (PDT). Five anterior deciduous teeth were treated endodontically with the conventional technique and PDT. For PDT, 0.005% methylene blue was used as a photosensitizer and a 660 nm laser. After the conventional endodontic therapy, the photosensitizer was applied inside the root canal, 3 min of pre-irradiation time, and then, the laser was applied for 40s with an energy of 4J. Afterward, the canal was irrigated with saline solution and the sealing material of the root canal was placed. The microbiological analysis of the samples was collected before and after the treatments were performed. Observing the results obtained in this case series, which showed a bacterial reduction from 37.57% to 100%, and the clear difficulty in the success of endodontic treatment of deciduous teeth, antimicrobial photodynamic therapy can be considered an alternative of easy application that does not generate microbial resistance, to act as a support in the decontamination of the root canals.

Methylene Blue and Hydrogen Peroxide for Photodynamic Inactivation in Root Canal - A New Protocol for Use in Endodontics

Objective

Antimicrobial photodynamic therapy (aPDT) is a controversial approach for endodontic disinfection. The objective of this study was to test the photosensitiser (PS) concentration and assess the optical shielding phenomenon, the use of hydrogen peroxide (H₂O₂) and minimal energy irradiation to optimise endodontic aPDT for suggesting a protocol for clinical use.

Methods

Different parameters for aPDT were tested. Aqueous solutions of methylene blue (MB) at 50, 100, 150 and 300 μM were tested in vitro for optical shield and reactive oxygen species (ROS) production by the reduction of N,N-dimethyl-4-notrosoaniline (RNO) at 440 nm absorbance when irradiated using a diode laser (660 nm). Ten single-rooted teeth were inoculated with bioluminescent bacteria Pseudomonas aeruginosa for 72 hours to form biofilms. Bioluminescence imaging was used to serially evaluate the minimum energy necessary during endodontic aPDT using MB and a diode laser coupled to an optical fibre for intracanal microbial reduction. In addition, teeth (n=21) infected with Enterococcus faecalis were treated with sequential combinations of endodontic aPDT and H₂O₂ and the colony-forming unit (CFU) was determined.

Results

ROS production was inversely proportional to the MB concentration in the solution due to quenching of MB. Optical shielding limited light penetration at high MB concentrations. The use of H₂O₂ before aPDT achieved higher disinfection compared to conventional aPDT or when MB was irradiated in an H₂O₂ solution. Energy irradiation of 9.6 J achieved a significant reduction and further light delivery did not produce further reduction.

Conclusion

PS concentration of about 50 μM, biofilm pre-treatment with H₂O₂ for 1 min and energy irradiation around 10 J appear to be an effective protocol for endodontic aPDT.

Methylene Blue and Hydrogen Peroxide for Photodynamic Inactivation in Root Canal - A New Protocol for Use in Endodontics

OBJECTIVE

Antimicrobial photodynamic therapy (aPDT) is a controversial approach for endodontic disinfection. The objective of this study was to test the photosensitiser (PS) concentration and assess the optical shielding phenomenon, the use of hydrogen peroxide (H₂O₂) and minimal energy irradiation to optimise endodontic aPDT for suggesting a protocol for clinical use.

METHODS

Different parameters for aPDT were tested. Aqueous solutions of methylene blue (MB) at 50, 100, 150 and 300 μM were tested in vitro for optical shield and reactive oxygen species (ROS) production by the reduction of N,N-dimethyl-4-notrosoaniline (RNO) at 440 nm absorbance when irradiated using a diode laser (660 nm). Ten single-rooted teeth were inoculated with bioluminescent bacteria Pseudomonas aeruginosa for 72 hours to form biofilms. Bioluminescence imaging was used to serially evaluate the minimum energy necessary during endodontic aPDT using MB and a diode laser coupled to an optical fibre for intracanal microbial reduction. In addition, teeth (n=21) infected with Enterococcus faecalis were treated with sequential combinations of endodontic aPDT and H₂O₂ and the colony-forming unit (CFU) was determined.

RESULTS

ROS production was inversely proportional to the MB concentration in the solution due to quenching of MB. Optical shielding limited light penetration at high MB concentrations. The use of H₂O₂ before aPDT achieved higher disinfection compared to conventional aPDT or when MB was irradiated in an H₂O₂ solution. Energy irradiation of 9.6 J achieved a significant reduction and further light delivery did not produce further reduction.

CONCLUSION

PS concentration of about 50 μM, biofilm pre-treatment with H₂O₂ for 1 min and energy irradiation around 10 J appear to be an effective protocol for endodontic aPDT.

Advances in antimicrobial photodynamic inactivation at the nanoscale

The alarming worldwide increase in antibiotic resistance amongst microbial pathogens necessitates a search for new antimicrobial techniques, which will not be affected by, or indeed cause resistance themselves. Light-mediated photoinactivation is one such technique that takes advantage of the whole spectrum of light to destroy a broad spectrum of pathogens. Many of these photoinactivation techniques rely on the participation of a diverse range of nanoparticles and nanostructures that have dimensions very similar to the wavelength of light. Photodynamic inactivation relies on the photochemical production of singlet oxygen from photosensitizing dyes (type II pathway) that can benefit remarkably from formulation in nanoparticle-based drug delivery vehicles. Fullerenes are a closed-cage carbon allotrope nanoparticle with a high absorption coefficient and triplet yield. Their photochemistry is highly dependent on microenvironment, and can be type II in organic solvents and type I (hydroxyl radicals) in a biological milieu. Titanium dioxide nanoparticles act as a large band-gap semiconductor that can carry out photo-induced electron transfer under ultraviolet A light and can also produce reactive oxygen species that kill microbial cells. We discuss some recent studies in which quite remarkable potentiation of microbial killing (up to six logs) can be obtained by the addition of simple inorganic salts such as the non-toxic sodium/potassium iodide, bromide, nitrite, and even the toxic sodium azide. Interesting mechanistic insights were obtained to explain this increased killing.

Effectiveness of repeated photodynamic therapy in the elimination of intracanal Enterococcus faecalis biofilm: an in vitro study

The study aimed to investigate the effectiveness of photodynamic therapy in the elimination of intracanal Enterococcus faecalis biofilm and to analyse how a repeated light irradiation, replenishment of oxygen and photosensitiser affect the results of the photodynamic disinfecting protocol. After chemomechanical preparation, 46 single-rooted human teeth were infected with a clinical strain of E. faecalis and incubated for a week in microaerobic conditions. The experimental procedures included groups of single application of photodynamic therapy, two cycles of PDT, irrigation with 5.25% NaOCl solution and negative and positive control. The number of residing bacterial colonies in the root canals was determined based on the CFU/ml method. In the group of preparations irrigated with NaOCl, bacterial colonies were not observed. A single PDT eliminated 45% of the initial CFU/ml. Repeated PDT eradicated 95% of the intracanal bacterial biofilm. Photodynamic therapy has a high potential for the elimination of E. faecalis biofilm. There is a safe therapeutic window where photoinduced disinfection can be used as an adjuvant to conventional endodontic treatment, which remains the most effective.

Improvement of Antibacterial Efficacy Through Synergistic Effect in Photodynamic Therapy Based on Thiazinium Chromophores Against Planktonic and Biofilm-Associated Periodontopathogens

OBJECTIVE

Aim of the study was to improve the antibacterial efficacy of toluidine blue (TBO)/methylene blue (MB)-mediated photodynamic systems with light-emitting diode (LED) or laser irradiation administered to planktonic and biofilm-associated periodontopathogens.

BACKGROUND DATA

Antibacterial photodynamic therapy (PDT) is a common, noninvasive adjunctive clinical method to inactivate microorganisms. So far, the disadvantage of this method has been its limited effectiveness in eliminating pathogens.

METHODS

An anaerobic cocktail consisting of six representative periodontal pathogens was prepared as initial culture for planktonic samples and biofilms grown on human tooth slides. Both types of microbial samples were exposed to three commercial photodynamic systems (PDT1: TBO, 630 nm LED, PDT2: TBO, 635 nm laser, PDT3: MB, 665 nm laser) in conventional and a new modified approach (PDT^plus) based on the use of an oxygen supplement (photosensitizer+hydrogen peroxide). The microbial viability was characterized by bacterial growth [colony forming units (CFU)], total bacterial cell counts, and microbial vitality. Statistical data analysis was performed using 95% confidence intervals (ANOVA) and post hoc Tukey's test (p < 0.05).

RESULTS

The modified PDT^plus showed the highest statistically significant synergistic antimicrobial activity for TBO-based systems evidenced by a CFU reduction of 9 log₁₀ units to 0 for planktonic pathogens and a 4 log₁₀ CFU reduction for biofilm bacteria. The MB-based PDT^plus was superior mainly against biofilm pathogens. By comparison, the default TBO-based PDT achieved colony growth reductions of 2 and 1 log₁₀ units concerning planktonic and biofilm cells.

CONCLUSIONS

Compared to conventional PDT, PDT^plus showed superior antibacterial efficacy based on its synergistic effect, promising vast application possibilities.

Bacterial photodynamic inactivation mediated by methylene blue and red light is enhanced by synergistic effect of potassium iodide

The inexorable increase of antibiotic resistance occurring in different bacterial species is increasing the interest in developing new antimicrobial treatments that will be equally effective against multidrug-resistant strains and will not themselves induce resistance. One of these alternatives may be photodynamic inactivation (PDI), which uses a combination of nontoxic dyes, called photosensitizers (PS), excited by harmless visible light to generate reactive oxygen species (ROS) by type 1 (radical) and type 2 (singlet oxygen) pathways. In this study, we asked whether it was possible to improve the efficacy of PDI in vitro and in vivo by addition of the inert salt potassium iodide (KI) to a commonly investigated PS, the phenothiazinium dye methylene blue (MB). By adding KI, we observed a consistent increase of red light-mediated bacterial killing of Gram-positive and Gram-negative species in vitro and in vivo. In vivo, we also observed less bacterial recurrence in wounds in the days posttreatment. The mechanism of action is probably due to formation of reactive iodine species that are produced quickly with a short lifetime. This finding may have a relevant clinical impact by reducing the risk of amputation and, in some cases, the risk of death, leading to improvement in the care of patients affected by localized infections.

Comparative evaluation of photodynamic therapy using LASER or light emitting diode on cariogenic bacteria: An in vitro study

OBJECTIVE

The aim of this study was to evaluate in vitro the effect of photodynamic therapy (PDT) using LASER or light emitting diode (LED) on cariogenic bacteria (Streptococcus mutans [SM] and Lactobacillus casei [LC]) in bovine dentin.

MATERIALS AND METHODS

Twenty five fragments of dentin were contaminated with SM and LC strands and divided into five experimental groups according to the therapy they received (n = 5): C - control (no treatment), SCLED - no dye/LED application (94 J/cm(2)), SCLASER - no dye/LASER application (94 J/cm(2)), CCLED - dye/LED application (94 J/cm(2)) and CCLASER - dye/LASER application (94 J/cm(2)). The dye used was methylene blue at 10 mM. Dentin scrapes were harvested from each fragment and prepared for counts of colony forming units (CFU)/mL. The data were analyzed using Kruskal-Wallis, followed by Student-Newman-Keuls (α =0.05).

RESULTS

Regarding SM, groups CCLASER and CCLED showed a significant reduction in CFU/mL, which was statistically superior to the SCLASER, SCLED and C groups. Regarding LC, the groups CCLASER and CCLED caused a significant reduction in CFU/mL when compared with SCLASER, which showed intermediate values. SCLED and C had a lesser effect on reducing CFU/mL, where the former showed values similar to those of SCLASER.

CONCLUSIONS

In conclusion, PDT combined with LASER or LED and methylene blue had a significant antimicrobial effect on cariogenic bacteria in the dentin.

Photodynamic therapy in root canals contaminated with Enterococcus faecalis using curcumin as photosensitizer

The aim of the study was to evaluate the photodynamic therapy (PDT) effect on root canals contaminated with Enterococcus faecalis using a light emitting diode (LED) light and a curcumin solution (CUR) as photosensitizer (PS). Eighty root canals from uniradicular human teeth were prepared with Protaper Universal rotary system and contaminated with E. faecalis for 21 days. They were divided as: GIa-PDT (CUR, pre-irradiation for 5 + 5 min of irradiation); GIb-PDT (CUR, pre-irradiation for 5 + 10 min of irradiation); GIIa-(CUR, pre-irradiation for 5 + 5 min without irradiation); GIIb-(CUR pre-irradiation for 5 + 10 min of irradiation); GIIIa-(physiological solution and irradiation for 5 min); and GIIIb-(physiological solution and irradiation for 10 min); positive and negative control groups. Collections from root canals were made at time intervals of 21 days after contamination, immediately after treatment, and 7 days after treatment, and submitted to colony forming units per milliter (CFU mL(-1)) counts. The data were submitted to ANOVA and Tukey multiple comparison tests, at a level of significance of 5 %. In the immediate post-treatment collection, group GIa showed greater bacterial reduction in comparison with GIIa, GIIb, GIIIa, GIIIb, and positive control (P < 0.05). At 7 days post-treatment, GIa showed significant bacterial reduction only in comparison with GIIIa (P < 0.05). Curcumin as sensitizer was effective by 5 min LED irradiation but not by 10 min irradiation PDT using LED light, and curcumin as PS was not effective in eliminating E. faecalis. No difference was observed for periods of irradiation.