In vitro evaluation of EDTA combined with photodynamic therapy to reduce Streptococcus mutans in carious dentin

BackgroundThis in vitro study aimed to evaluate the use of EDTA combined with photodynamic therapy to reduce Streptococcus mutans in carious dentin.MethodsSixty third molars were sectioned to obtain flat dentin surfaces. All specimens were waterproofed, except for the coronal dentin, and subjected to cariogenic challenge in brain-heart infusion (BHI) broth supplemented with 0.5% yeast extract, 1% glucose, 1% sucrose, and standard strain of S. mutans (ATCC 25175). The specimens were divided into 6 groups (n = 10 each): (1) control – caries collection; (2) EDTA - 17% EDTA was actively applied with a microbrush for 1 min; (3) aPDT – antimicrobial photodynamic therapy with 0.01% methylene blue photosensitizer (wavelength of 660 nm, energy of 4 J, power of 100 mW, spot size of 0.028 cm², energy density of 142 J/cm² for 40 s); (4) EDTA+aPDT – 17% EDTA actively applied for 1 min plus aPDT; (5) (EDTA+PT) + L – application of EDTA compounded with photosensitizer plus laser irradiation; and (6) PT – photosensitizer alone. Collection of caries was performed after the different cavity disinfection protocols. Aliquots from each dilution were seeded for colony-forming unit (CFU) counts. The results were log₁₀-transformed and analyzed by the Kruskal-Wallis test (Student-Newman-Keuls).ResultsThere was a significant reduction in S. mutans after aPDT (p<0.05), EDTA+aPDT (p<0.001), and (EDTA+PT) + L (p<0.001). The percentage of microbial reduction in ascending order was as follows: EDTA: 1.65%; PT: 15.51%; aPDT: 38.28%; EDTA+aPDT: 75.24%; and (EDTA+PT) + L: 97.35%.ConclusionApplication of 17% EDTA prior to photosensitization or compounded with a photosensitizer increased the antimicrobial effect of aPDT on S. mutans in carious dentin.     

Hydrogen peroxide potentiates antimicrobial photodynamic therapy in eliminating Candida albicans and Streptococcus mutans dual-species biofilm from denture base

BackgroundCandida albicans (C.albicans) is the primary pathogen of denture biofilm. Moreover, it could establish a cross-kingdom relationship with bacteria to enhance its virulence and resistance to antifungal drugs. This study aimed to investigate the efficacy of antimicrobial photodynamic therapy (aPDT) in combination with hydrogen peroxide (H₂O₂) against C.albicans and Streptococcus mutans (S.mutans) dual-species biofilm formed on polymethyl methacrylate (PMMA) disk, and explore its involved mechanisms.MethodsC.albicans and S.mutans were grown on PMMA disk for 48 h to form biofilm and received different treatments. The treatments included:1) phosphate-buffered saline (PBS) group,2) 100 mM H₂O₂ group,3) aPDT group,4) aPDT+ H₂O₂ and 5) H₂O₂+aPDT group. Colony forming units (CFU), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), and scanning electron microscope (SEM) were used to evaluate the antimicrobial effects. Extracellular polysaccharide substance (EPS) production and observation, cell permeability of biofilm, and uptake of toluidine blue O (TBO) by biofilm were assessed to investigate the involved mechanism.ResultsThere was no significant difference between PBS group and H₂O₂ group in viable microorganisms and metabolic activity of biofilm. The treatment protocols containing aPDT group reduced microorganism numbers and metabolic activity when compared to PBS group or H₂O₂ group (P<0.05). H₂O₂+aPDT treatment showed the highest antimicrobial efficacy in comparison with other treatments (P<0.05). Pretreatment with H₂O₂ could decrease EPS production and enhance cell permeability, leading to increased TBO uptake in biofilm.ConclusionPretreatment with H₂O₂ improved aPDT efficiency in eliminating dual-species biofilm from PMMA disk by reducing EPS amount, enhancing cell permeability, and increasing TBO uptake.     

Assessment of dental caries lesion activity status using quantitative parameters obtained from the quantitative light-induced fluorescence method and difference of microbial distribution in primary molars

BackgroundThis study aimed to assess differences in quantitative measures obtained from the quantitative light-induced fluorescence method and microbial composition of carious dentin and saliva according to the activity status of caries lesions in primary molars.MethodsA total of 34 teeth from 34 children were evaluated in this study. The activity status of carious lesions was classified using the International Caries Classification and Management System criteria (active or inactive). Images of the carious lesions were captured using a quantitative light-induced fluorescence device for quantitative analyses. Carious dentin and saliva were collected to detect and quantify selected bacterial species (S. mutans, S. sobrinus, Lactobacillus species, F. nucleatum, P. nigrescence, P. intermedia) and C. albicans by quantitative polymerase chain reaction. Mann–Whitney U tests were performed to evaluate differences in quantitative measures from quantitative light-induced fluorescence, the microbial composition of carious dentin, and saliva according to the activity status of carious lesions.ResultsRed fluorescence values (∆R, ∆Rmax) from the quantitative light-induced fluorescence method were significantly higher in active lesions (∆R, p = 0.009; ∆Rmax, p = 0.014). The quantitative mean levels of Lactobacillus species (p = 0.010) in carious dentin and S. sobrinus (p = 0.017) in saliva were significantly higher in the active-lesion group.ConclusionsQuantitative measures related to red fluorescence from the quantitative light-induced fluorescence method, levels of Lactobacillus species from carious dentin, and levels of S. sobrinus from saliva were associated with caries lesion activity.     

The in vitro effect of antimicrobial photodynamic therapy with toluidine blue and indocyanine green on microleakage of class V cavities

IntroductionConsidering the importance of disinfecting dentin and enamel after cavity preparation and the possible effect of disinfection methods on induction of various reactions in the tooth structure the aim of the present study was to evaluate microleakage of composite resin restoration after disinfecting the prepared dentin and enamel surface with antimicrobial photodynamic therapy (aPDT) with toluidine blue (TBO) and indocyanine green (ICG).Materials and methodsStandard class V cavities were prepared on buccal surface of 71 human premolar teeth. The samples were randomly divided into 3 groups based on disinfection method: Group 1: conventional disinfection method with Phosphoric acid 37% as the control; Group 2: aPDT with TBO and diode laser with wavelength of 635 nm; Group 3: aPDT with ICG and diode laser with wavelength of 808 nm. All the cavities were restored with composite resin (3M™ Filtek™ Z250). After thermocycling and immersing in 0.5% basic fuchsin, the samples were prepared for microleakage evaluation under a stereomicroscope. Data was analyzed with Kruskal-Wallis and Wilcoxon signed-rank tests at P < 0.05.ResultsThere were no significant differences in the microleakage of occlusal and gingival margins between the TBO and control groups (P > 0.05). Also, the microleackage of occlusal margins between groups was not significantly different (P > 0.05) but microleackage of gingival margins of ICG group was lower than two other groups in a meaningful way (P < 0.05).ConclusionPhotodynamic therapy with ICG as disinfecting agent in cavity preparations before composite resin restorations decreases the microleackage of gingival margins.     

Antimicrobial efficacy,optical properties and flexural strength following antimicrobial photodynamic therapy over vacuum-formed orthodontic retainers

Background and aimsVacuum-formed retainers (VFRs) are widely used in dental practices because of their superior esthetics. However, simultaneous maintenance of their hygiene, mechanical and optical properties is challenging. This study aimed to evaluate and compare the disinfection efficacy of antimicrobial photodynamic therapy (aPDT), chlorhexidine (CHX), sodium hypochlorite (NaOCl) and water over VFRs specimens, along with their effect on flexural strength and color stability.Materials and methodsFabricated VFRs of thicknesses 1 mm and 2 mm were contaminated with S. mutans and C. albicans. Brain Heart Infusion agar was used to seed Streptococcus Mutans whereas Candida Albicans was seeded in Sabourand Dextrose Agar. The contaminated retainers were divided into four groups and decontaminated using four different treatment protocols: aPDT, CHX, NaOCl and water, with 10 specimens per group. Microbial viability following decontamination, was assayed using MTT. To assess the color stability, pre and post decontamination color difference of 10 specimens was recorded using a spectrophotometer by blinding technique. The flexural strength of 10 specimens was measured using a universal testing machine by a standardized 3-point flexural strength (FS) test.ResultaPDT showed the highest reduction in the viability of S. mutans (28%) and C. albicans (20%) species in 1 mm thickness group while the second highest reduction following disinfection with CHX (40%) in followed by NaOCl disinfection (50%). On comparison between 1 mm and 2 mm, a statistically significant difference was noted for S. mutans in aPDT (p = 0.033) and NaOCl (p = 0.028) groups, and for C. albicans, a significant difference was noted within NaOCl (p = 0.001) and CHX (p = 0.043) groups. For FS, a statistically significant difference (p < 0.05) was observed between aPDT and the rest of the groups, whereas there was no statistically significant difference in the flexural strength between the CHX, NaOCl and water groups (p > 0.05) in both 1 mm and 2 mm specimens. Between 1 mm and 2 mm specimens, no statistically significant difference in the mean color difference was noted after any disinfection protocol (p > 0.05).ConclusionAntimicrobial photodynamic therapy showed a remarkable reduction in candidal and bacterial viability over VFRs. aPDT treated VFR specimens showed increased flexural strength and a higher color difference post treatment compared to other reagents.     

Effect of methylene blue-induced photodynamic therapy on a Streptococcus mutans biofilm model

BackgroundSeveral studies have reported the use of antimicrobial photodynamic therapy (aPDT) to control biofilm but its efficacy depends on several factors, such as biofilm model used. This study aims to examine whether exposure to diode laser combined with methylene blue affects the bacterial viability and polysaccharide content in a Streptococcus mutans cariogenic biofilm model, which simulated ‘feast-famine’ episodes of exposure to sucrose that occur in the oral cavity.Materials and methodsS. mutans biofilms were formed on acrylic resin discs and exposed to a 10% sucrose solution for 1 min, eight times/day. After growing for 48 h, the biofilms were submitted to the following treatments, twice daily (n = 4): (i) 0.9% NaCl (NaCl) as the negative control; (ii) 0.12% chlorhexidine digluconate (CHX) as the positive antibacterial control; (iii) diode laser combined with methylene blue, using an energy density of 320 J/cm² (aPDT). After 120 h of growth, the biofilm formed on each disc was collected to determine the viable bacterial counts and concentration of insoluble exopolysaccharides (IEPS) and intracellular polysaccharides (IPS).ResultsBacterial counts in the biofilms formed differed among the treatments. Compared with NaCl, aPDT significantly destabilized biofilm (p < 0.0001). aPDT and CHX equally lowered the concentration of IEPS and IPS in biofilms.ConclusionUnder the experimental conditions assessed, our findings indicate that a twice-daily treatment with diode laser combined with methylene blue effectively decreased bacterial viability and the intra- and extracellular polysaccharide concentration in biofilms of S. mutans, a cariogenic bacterium.     

Rutin-gallium complex mediated antimicrobial photodynamic therapy: An in vitro studies against Streptococcus mutans biofilms

BackgroundDiscoloration of teeth following antimicrobial photodynamic therapy (aPDT) is a serious concern. Common photosensitizers are colored, and access to a photosensitizer that does not leave color on the teeth or is the same color as the enamel and dentin is highly demanded. The physicochemical characterization, anti-virulence, and antimicrobial effects of a novel rutin-gallium (III) (Rt-Ga) complex as novel photosensitizer are presented herein.Materials and MethodsPhotophysical properties and cytotoxicity of the Rt-Ga complex were evaluated in comparison with the parental rutin. Intracellular reactive oxygen species (ROS) generation following Rt-Ga complex-mediated aPDT was measured using the fluorescent 2′,7′-dichlorofluorescein diacetate (H2DCF-DA) method. The anti-biofilm effects of Rt-Ga complex-mediated aPDT on Streptococcus mutans were assessed using a colorimetric assay. The virulence‑associated gtfB gene expression was assessed following Rt-Ga complex-mediated aPDT by quantitative real‑time PCR.ResultsThe photophysical properties of the Rt-Ga complex revealed a significant blue-shift in absorption (60 nm shift) and increased extinction coefficient (4100 M −1 cm −1; at λmax = 450 nm). Average (± SEM) DCF fluorescence intensities in an arbitrary unit (A.U.) were 7.1 ± 0.9, 4.1 ± 0.5, and 1.7 ± 0.3 for 10.0 μM of Rt-Ga complex-mediated aPDT, 7.5 μM of Rt-Ga complex-mediated aPDT, and 10.0 μM of Rt-Ga complex alone, respectively. The corresponding DCF fluorescence intensities were 710% (P = 0.001), 410% (P = 0.001), and 170% (P = 0.02) of the untreated S. mutans as the control group (1.0 ± 0.1 A.U.), respectively. The novel Rt-Ga complex-mediated aPDT exhibited no toxicity against primary human gingival fibroblast cells, a dose dependent decrease in S. mutans biofilm cell survival and virulence were observed (91.4% and 11.7-fold, respectively).ConclusionThe Rt-Ga complex-mediated anti-virulence and antimicrobial photodynamic effects were superior to the one caused by rutin alone making the Rt-Ga complex a more promising photosensitizer than the parent material.     

Antimicrobial photodynamic therapy as an adjunct for treatment of deep carious lesions—A systematic review

For deep carious lesions, a more conservative treatment modality (“selective caries removal”) has been proposed, where only the heavily contaminated dentine is removed. In this regard, effective adjuncts for cavity disinfection such as the antimicrobial photodynamic therapy (aPDT) can be valuable clinically prior to definitive restoration. Therefore, the aim of this study was to systematically assess clinical studies on the effectiveness of aPDT as a supplementary tool in the treatment of deep caries lesions. Searches were performed in four databases (PubMed, EMBASE, ISI Web of Science, ClinicalTrials.gov) from 1st January, 2011 until 21st June, 2016 for search terms relevant to the observed parameters, pathological condition, intervention and anatomic entity. The pooled information was evaluated according to PRISMA guidelines. At first, 1651 articles were recovered, of which 1249 full-text articles were evaluated, 270 articles thereof were reviewed for eligibility and finally 6 articles met all inclusion criteria. The aPDT protocols involved Methylene Blue, Toluidine Blue and aluminium-chloride-phthalocyanine as photosensitizers and diode lasers, light-emitting diodes and halogen light-sources. The data from five reports, utilizing both culture-dependent and −independent methods, disclosed significant reduction of cariogenic bacterial load after mechanical caries removal with adjunct aPDT. As these studies exhibit some methodological limitations, e.g. lack of positive controls, this systematic review can support the application of aPDT to a limited extent only in terms of reducing the microbial load in deep carious lesions before restorative treatment.     

Does potassium iodide help in the microbial reduction of oral microcosm biofilms after photodynamic therapy with methylene blue and red laser?

ObjectiveTo evaluate the efficacy of methylene blue (MB)-mediated antimicrobial photodynamic therapy (aPDT) doped with potassium iodide (KI) against oral microcosms biofilms cultured in dentin.MethodsA saliva-glycerol stock formed from pooled human saliva was diluted in McBain artificial saliva with 1% sucrose (1:1), inoculated on bovine dentin blocks, and refreshed daily for 5 days. The biofilms were divided (n = 9/group) and treated with 0.9% NaCl (C), 0.2% chlorhexidine (CX), 0.01% MB + low-power laser 15 J, 88 mW, 180 s (PL), and 0.01% MB + 50 mM KI + laser (PKIL). Serial dilution was performed, and cellular viability (CFU/mL) was evaluated for total microorganisms, total lactobacilli, total streptococci, and S. mutans. Additional biofilms were cultured and treated (n = 4) for biomass determination (%BMR). The microscopic structure of the biofilms was observed by SEM. One-way ANOVA and Tukey tests were conducted (α=5%).ResultsTotal microorganisms and total streptococci significantly reduced in biofilms treated with CX and PKIL when compared to C, but the CX, PKIL, and PL treatments did not differ from each other. Total lactobacilli and S. mutans showed a significant reduction in the CX, PL, and PKIL groups when compared to C, but with no difference between them. Biomass analysis showed a significantly reduction for CX and PKIL compared to C. SEM micrographs showed noticeable changes in bacterial membrane integrity for the PKIL and CX groups.ConclusionThe addition of KI to methylene blue-mediated aPDT in microcosm biofilms was effective in reducing oral microorganisms, but the effect was group dependent.     

The influence of implant surface roughness on decontamination by antimicrobial photodynamic therapy and chemical agents: A preliminary study in vitro

BackgroundThe aim of this preliminary study was to analyze the effectiveness of three different protocols of decontamination on five commercial moderate rough implants.Material and methodsThe types of implants investigated were: Neoporos Drive CM (CM; Neodent®), Drive CM Acqua (ACQ; Neodent®), SLActive (SLA; Straumann®), Osseotite (OT; Biomet 3i®) and Nanotite (NT; Biomet 3i®). Implant surface properties (n = 2/type of implant; control groups) were analyzed by scanning electron microscopy (SEM) images to determine surface roughness parameters (SRP) and energy disperse X-ray spectrometry to determine the chemical composition. Implants were then inoculated with Aggregatibacter actinomycetencomitans in vitro (n = 6/type of implant;experimental groups) and the contaminated areas were determined in SEM images (500x magnifications). Decontamination of implants was performed in duplicate by three protocols: antimicrobial photodynamic therapy (aPDT), EDTA associated with citric acid (EDTA + CA) and 0.12 % chlorhexidine (CHX). The remaining contaminated area (rCtA) was determined in SEM images (500x magnifications). All quantitative analysis through SEM images were analyzed in ImageJ® software for two-dimensional parameters.ResultsNo significant differences were found in SRP among implants (control group), except for Rv (lowest valley) between SLA vs. OT (p=0.0031; Kruskal Wallis post hoc Dunn). NT implants showed highest contaminated area vs. ACQ implants (68.19 % ± 8.63 % and 57.32 % ± 5.38 %, respectively; p = 0.0016, Tukey's test). SRP after decontamination showed statistical difference for Ra (arithmetical mean deviation) for all decontamination groups when compared to control (p < 0.05; ANOVA with post-hoc Tukey's multiple comparisons test), only CM implants showed statistical difference when compared decontamination protocols to control with highest modification of SRP for EDTA + AC group. For decontamination analysis, for applicability of different protocols in the same type of implant, only SLA showed statistical significant difference for aPDT vs. EDTA + CA (p = 0.0114; ANOVA with post-hoc Tukey's multiple comparisons test) with lowest rCTA for aPDT, however for ACQ implants the aPDT showed lowest rCTA with no statistical difference (p > 0.05; ANOVA with post-hoc Tukey's multiple comparisons test). No statistical difference was observed between the decontamination protocols at other implant types.ConclusionIt can be suggested that the chemical-physical characteristics of dental implants can be effected by the process of contamination and decontamination by aPDT and chemical agents.     

In vitro antibacterial activity and durability of a nano-curcumin-containing pulp capping agent combined with antimicrobial photodynamic therapy

BackgroundConsidering the antibacterial properties of nano-curcumin (nCur) reinforced with antimicrobial photodynamic therapy (aPDT), this study aimed to assess the antibacterial activity and durability of Activa BioActive Base/Liner (ABBL) containing nCur (nCur-ABBL) as a pulp capping agent against Streptococcus mutans, the most common cause of secondary caries.Materials and methodsIn this in vitro experimental study, ABBL discs containing 0.5 %, 1%, 2%, and 5% (w/w) concentrations of nCur were fabricated. After aPDT using light emitting diode (LED) at 435 ± 20 nm wavelength for 5 min, the discs were undergone aging in artificial saliva for 90 days. The antibacterial activity of the discs against S. mutans was evaluated by the disc agar diffusion test, and the number of bacterial colonies present in the biofilm formed on the disc surfaces was counted after 0, 15, 30, and 60 days of aging.ResultsThe maximum growth inhibition zone was noted around the 5% nCur-ABBL discs. Increasing the concentration of nCur from 0.5 % to 5% combined with aPDT significantly decreased the number of S. mutans colonies in the biofilm over time (P < 0.05). nCur-ABBL discs containing 2% and 5% nCur had no difference in antibacterial activity at any time point up to 60 days (P > 0.05).ConclusionAccording to our data, 5% nCur-ABBL revealed the largest growth inhibition zone in S. mutans culture. Moreover, 5% nCur can serve as an excellent ABBL additive in aPDT producer against S. mutans biofilms up to 60 days of aging period.     

Evaluation of antimicrobial photodynamic therapy on wounds infected by Staphylococcus aureus in animal models

BackgroundAntibiotic-resistant Staphylococcus aureus bacteria are one of the expanding challenges. The purpose of current study is to evaluate the antimicrobial effect of photodynamic therapy (aPDT) on wounds infected to Staphylococcus aureus.MethodsIn this study, 40 six-month-old rats were divided into 4 groups: control, photosensitizer (PS), laser, and aPDT. A full-thickness wound was created on their skin and it was infected by Staphylococcus aureus. For aPDT, the Indocyanine Green (Germany, Nürnberg, A.R.C. Laser, EmunDo) photosensitive agent and laser diod 810 nm (Germany, Nürnberg, A.R.C. Laser) was utilized. The wound healing procedure was monitored every 24 h until the 12th day with photography. The number of the bacteria was counted on the 12th day also. All results were compared using ANOVA and Tukey post hoc tests. Significance level was considered P-Value < 0.05.ResultsThe average area of wound reduced in days 5–11th in photosensitizer, laser, and aPDT, respectively. The absolute colonization rate of bacteria in the wounds showed a significant decrease in two groups laser and aPDT compared to the control group. However, the lowest value was for the aPDT.ConclusionIn the conditions of this study, it emerged that aPDT and laser have an antimicrobial effect against antibiotic-resistant bacteria (particularly Staphylococcus aureus) and improve wound healing.     

Adhesive bond of Bioactive and bulk fill resin to disinfected caries affected dentin (lactobacillus specie) with laser and photodynamic therapy

AimsTo evaluate the antimicrobial effectiveness of cavity disinfectants chlorhexidine gluconate (CHX), Er, Cr, YSGG laser (ECL), and curcumin photosensitizer (CP) against Lactobacillus and shear bond strength (SBS) of Bioactive (BA) and bulk fill composite (BFC) restorative material bonded to carious affected dentin (CAD).Materials and MethodsSixty human mandibular molars scored 4 and 5 on the International Caries Detection and Assessment System (ICDAS) were included. After inoculating the specimens with lactobacillus specie all the samples were arbitrarily divided into three groups based on the disinfection regime used (n=20). Groups 1 and 2: CAD disinfection using ECL, Groups 3 and 4: CAD disinfection using CP, and Groups 5 and 6: CAD disinfection using CHX. After cavity sterilization, the survival rate was estimated and each group was further divided into two sub-groups based on the restorative material used. Groups 1, 3, and 5 (n = 10) were restored using BFC restorative material, and groups 2, 4, and 6 (n = 10) were restored using a conventional bulk-fill resin material. A universal testing machine (UTM) was used to determine the SBS and debonded surfaces were examined under a stereomicroscope to determine the modes of failure. Kruskal-Walis, ANOVA, and Post Hoc Tukey were applied to investigate the survival rate and bond strength values.ResultsECL group displayed the highest survival rate (0.73±0.13) of Lactobacillus. The least survival rate (0.17±0.09) was demonstrated by CP activated by PDT. Group 1 (ECL+ BA) treated specimens exhibited the maximum value of SBS (18.31 ± 0.22 MPa). However, group 3 (CP + BA) revealed the minimum values of bond strength (14.05 ± 1.02 MPa). The intergroup comparison revealed that group 1, group 2 (ECL+BFC) (18.11 ± 0.14 MPa), group 5 (CHX+ BA) (18.14 ± 0.36 MPa), and group 6 (CHX+BFC) (18.18 ± 0.35 MPa) displayed comparable outcomes of bond integrity (p>0.05).ConclusionCaries-affected dentin disinfected with Er, Cr: YSGG, and chlorhexidine improve bond scores of bioactive and conventional bulk-fill restorative material.     

Glass fiber post resistance to dislodgement from radicular dentin after using contemporary and conventional methods of disinfection

AimThe present study aimed to assess the bond integrity of curcumin photosensitizer (CPS) Photodynamic therapy (PDT) on fiber post disinfection bonded to radicular dentin in comparison to the conventional fiber post sterilant used.Materials and methodsFifty human permanent single-rooted premolars were utilized with the crown part sectioned using up to the cementoenamel junction. Root canal preparation was performed followed by canal obturation with gutta-percha (GP) and resin-based sealer. The post space was prepared using peso reamers leaving 4 mm at the apical part of the post space. Fifty glass fiber posts (GFP) were divided into five groups based on the surface disinfectant (n = 10). group 1: Autoclave sterilization (AS) group 2: chlorhexidine digluconate (CHX dig), group 3: CPS solution, group 4: 35% phosphoric acid (PA) gel, and group 5: No disinfection. Cementation was performed using dual-cure self-etch resin cement. Each tooth was sectioned and placed on the universal testing machine. Failure mode was analyzed using a stereomicroscope at 40x magnification. Statistical analysis was performed using one-way analysis of variance (ANOVA) and Tukey multiple comparison tests. (p = 0.05).ResultsIntragroup comparison analysis demonstrated that group 2 in which 2% CHX dig was used as a post-surface disinfectant revealed the highest bond integrity at all three levels. Group 5 where no disinfectant was used to decontaminate the post surface exhibited the lowest bond values. In all the investigated groups, PBS values showed a downward trend from coronal to the apical third of the post space. Group 1 in which AS was used to sterilize the fiber post and group 3 in which CPS was smeared to decontaminate the GFPs surface-displayed comparable outcomes of PBS to group 5 specimens at all three levels. (p > 0.05).ConclusionCHX dig and PA post-surface disinfection displayed a positive impact on bond strength with the radicular dentin. However, CPS and AS do not reveal any effect on the PBS when used for post-decontamination.     

The effect of photodynamic therapy on postoperative pain in teeth with primary endodontic infection

Introduction: The objective of this study was to investigate the action of photodynamic therapy on pain control after endodontic treatment in asymptomatic teeth with a primary infection, within a single visit.Methods: Sixty (60) single-rooted teeth with pulp necrosis and periapical lesions were selected and randomly divided into two (2) groups (n = 30), according to the protocol; a control group (CG) and a group using photodynamic therapy (aPDT). The canals were instrumented with Reciproc files # 25 up to 40 along the entire length of the canal, using 2% chlorhexidine gel as the auxiliary chemical substance, followed by irrigation with sterile saline. aPDT consited of 0.005% methylene blue as photosensitizer, using AsGaAl diode laser, 660 nm wavelength, 100 mW of power and 9 J of energy, using optical fibers with 365 μm in diameter. The canals were filled with Endomethasone N cement.Results: Pain intensity was assessed at 8, 12, 24, 48, 72 h and 1 week after endodontic treatment using a visual analogue scale. The level of pain was classified as none (0), mild (1–3), moderate (4–7) or severe (8–10). The data were at a significance level of 5%. There was a statistically significant difference (p<0.05) in the periods of 8, 12, 24, 48 and 72 h between the control group and the aPDT group. After 1 week, there was no statistically significant difference.Conclusions: It is concluded that photodynamic therapy had a significant effect on decreasing post-endodontic treatment pain in teeth with necrotic pulp and asymptomatic periapical lesions.     

Aptamer decorated emodin nanoparticles-assisted delivery of dermcidin-derived peptide DCD-1L: Photoactive bio-theragnostic agent for Enterococcus faecalis biofilm destruction

BackgroundDespite the high success rate of root canal treatment, failures are observed in a broad range of cases. Therefore, the need for novel approaches with the development of new generations of antimicrobial agents and intracellular drug delivery systems as adjunctive therapy is undeniable. In this study, we investigated the antimicrobial effects of antimicrobial photodynamic therapy (aPDT) using dermcidin‑derived peptide DCD‑1L loaded onto aptamer-functionalized emodin nanoparticles (Apt@EmoNp-DCD-1L) against Enterococcus faecalis as one of the most common bacteria involved in recurrent root canal treatment failures.Materials and methodsFollowing preparation of EmoNp-DCD-1L, the binding of selected labeled Apt to EmoNp-DCD-1L was performed, followed by the specificity of Apt@EmoNp-DCD-1L to E. faecalis was determined. The antimicrobial potential of aPDT was then assessed after the determination of the minimum inhibitory concentration (MIC) of Apt@EmoNp-DCD-1L. The molecular docking analysis was conducted to evaluate the potential binding modes of EmoNp to the proteins involved in E. faecalis pathogenesis. Eventually, the anti-virulence capacity of Apt@EmoNp-DCD-1L-mediated aPDT was investigated via quantitative real-time PCR (qRT-PCR) assay following measurement of intracellular reactive oxygen species (ROS) generation.ResultsThe binding specificity of Apt@EmoNp-DCD-1L to E. faecalis was confirmed by flow cytometry. The results showed that the cell viability of E. faecalis exposed to aPDT groups employing the sub-MIC doses of Apt@EmoNp-DCD-1L (7.8 and 15.6 µM) was significantly reduced compared to the control group (P < 0.05). Also, Apt@EmoNp-DCD-1L in combination with a blue laser light was capable of enhancing the anti-biofilm activity of aPDT against E. faecalis biofilm. Data obtained from the qRT-PCR analysis showed significant downregulation in the expression level of genes involved in bacterial biofilm formation after exposure to aPDT (P < 0.05).Conclusions: This in vitro study highlights that aPDT with the minimum concentration of Apt@EmoNp-DCD-1L can be considered as a targeted bio-theragnostic agent for the detection and elimination of E. faecalis in the dispersed and biofilm states.     

Efficacy of antimicrobial photodynamic therapy in disinfection of Candida biofilms on acrylic dentures: A systematic review

BackgroundThe aim of this systematic review was to critically analyze and summarize the currently available scientific evidence concerning antifungal efficacy of aPDT against Candida on acrylic surface.MethodsThe focused question was: ‘“Is aPDT effective in minimizing the counts of Candida on acrylic dentures”. A literature search was conducted interpedently on the following electronic research databases: PubMED/MEDLINE, Cochrane, Google Scholar and Embase. The MeSH terms used were: ((antimicrobial photodynamic therapy) OR (light) OR (laser) OR (photodynamic)) AND ((Candida) OR (denture stomatitis)) AND ((denture) OR (acrylic) OR (polymethylmethacrylate) OR (dental prosthesis)). Data was extracted from the studies and quality assessment was carried out using a modified version of the CONSORT checklist.ResultsEighteen in-vitro anti-microbial studies and 5 clinical studies were included. Twenty-two studies suggested that aPDT was effective in reducing the Candida count on acrylic dentures and one study did not have a significant effect. 19 out of 23 studies were graded as having ‘medium’ quality and 4 studies were graded as ‘high’. Several photosensitizers, including methylene blue, porphyrin derivatives, toluidine blue-O and others were used. LED was the most popular light source used for photo-activation of the photosensitizers.ConclusionWithin the limitations of this review, aPDT is effective in reducing Candida growth on acrylic dentures and may prove to be clinical effective in preventing or treating denture stomatitis. However, more long-term clinical research is required before its clinical efficacy can be determined.     

Disinfection of caries-affected dentin using potassium titanyl phosphate laser,Rose bengal and Ozonated water on shear bond strength of deciduous teeth

AimTo assess the efficacy of disinfection of caries-effected dentin (CAD) using KTP laser and different decontamination methods using ozonated water (OW), Rose Bengal photosensitizer (RBP), chlorhexidine (CHX), and Er, YAG laser on the shear bond strength (SBS) of adhesive resin bonded to deciduous teeth.Material and methodsA total of 50 extracted and radiographically verified carious primary molars were collected and scrutinized according to ICDAS criteria. Specimens were allocated randomly into five groups (n = 10) as per the type of CAD disinfectants. KTP laser, OW, RBP, CHX (control), and Er, YAG laser. After cavity sanitization, a resin adhesive (prime and bond NT) was smeared on the dentinal exterior followed by incremental composite filling. SBS evaluation was performed by employing specimens in the universal testing machine. The debonded surface was assessed under 40x magnification in a stereomicroscope to ascertain fracture mode. Statistical analysis was done by using the ANOVA and the Post Hoc Tukey multiple comparison tests (p < 0.05).ResultsThe highest SBS was exhibited by group 2 i.e., when OW was employed for CAD disinfection (10.25 ± 0.24 MPa). Whereas, the lowest SBS bond value was unveiled by samples in group 3 when RBP was applied for dentin surface sanitization (7.85 ± 0.59 MPa).CAD disinfection with KTP laser (8.25 ± 0.41 MPa), CHX (8.19 ± 0.73 MPa), and RBP displayed comparable bond values (p > 0.05).ConclusionOzonated water and Er, YAG laser could be employed as cavity disinfectants in primary teeth as they demonstrated better shear bond strength without jeopardizing the adhesive binding capacity of restorative resins bonded to caries-affected dentin.