Comparison of the Antimicrobial Efficacy of Calcium Hydroxide and Photodynamic Therapy Against Enterococcus faecalis and Candida albicans in Teeth With Periapical Lesions; An In Vivo Study

Abstract

IntroductionMicrobial infection plays an important role in the development of periapical (PA) lesions.1 Elimination of the pathological microflora of the root canal system is a major goal in endodontic treatment. Inadequate disinfection of the root canal system may lead to treatment failure and development of PA lesions.2 Killing the bacteria of root canal system is not always achievable with current root canal treatment (RCT) techniques (mechanical debridement associated with chemical irrigation).3,4 The anatomical complexity of the root canal system makes it almost impossible to completely eliminate the bacteria using conventional mechanical and chemical techniques, even with the highest technical standards. 5A 94% treatment success rate has been reported in cases with a negative culture before the obturation of root canal system. This rate decreases to 68% in cases undergoing root canal filling despite the cultures being positive. There is a challenge for the clinician in treatment of teeth with PA lesions, all efforts and attempts have been made to eliminate irritating agents from the root canal system in order to provide healing in the periradicular tissues. Methods: This in vivo study was conducted on 20 patients with single-rooted mandibular premolar with previously failed endodontic treatment. This study was performed as a clinical trial (IRCTID: IRCT2016090429686N1). After conventional chemo-mechanical root canal preparation (hand and rotary instruments and 2.5% NaOCl), microbiological samples were obtained using sterile paper points, then stored in thioglycolate solution and transferred to a microbiology laboratory. Group 1 (n = 10) specimens underwent aPDT (diode laser 808 nm + 50 mg/mL methylene blue), while creamy calcium hydroxide paste was used in group 2 for a duration of 1 week. A control sample was taken with sterile paper points and F3 Protaper rotary file. The samples were dispersed in transport medium, serially diluted, and cultured on selective mediums to determine the number of colony forming units (CFUs). Data were analyzed by Mann-Whitney U test at 5% significance level. The significance level for all analyses was set at P < 0.05. Results: Number of CFU significantly decreased in both groups after the interventions (P < 0.001); however, there was no significant difference in the colony count between the 2 groups. Conclusion: aPDT and calcium hydroxide therapy showed the same antimicrobial efficacy on E. faecalis and C. albicans.

The Efficacy of Photodynamic Inactivation of the Diode Laser in Inactivation of the Candida albicans Biofilms With Exogenous Photosensitizer of Papaya Leaf Chlorophyll

“…25 In an in vivo study, photoinactivation of C. albicans at the periapical region of the tooth, with added photosensitizer calcium hydroxide, was proven to be more effective in reducing bacterial colonies by 58% compared to the treatment of calcium hydroxide without illumination, which reduced bacterial colonies only 13%. 26 The results of the photoinactivation studies on the form of planktonic and biofilm cells of Candida albicans indicated that the more complex and thicker structure of C. albicans cell membrane could decrease the inactivation effect. The hype form tends to occur when C. albicans envelops its cells into the biofilm layer.…”

Antimicrobial Photodynamic Therapy: An Effective Alternative Approach to Control Bacterial Infections

“…However, there was no important difference in the number of colonies among the two groups. 44 The study by Wu et al evaluated the effect of photodynamic therapy via using chlorin e6 against P. aeruginosa keratitis in mice under in vivo conditions. With the scratch on the mouse corneal epithelial tissue, the mouse corneal was infected with P. aeruginosa (strain PA54).…”

Terapia fotodinâmica na endodontia: revisão de literatura

“…A eliminação da microflora patológica do sistema radicular é um dos principais objetivos no tratamento endodôntico. A desinfecção inadequada do sistema de canais radiculares pode levar ao insucesso do tratamento e nem sempre as técnicas atuais de tratamento do canal radicular permitem esta desinfecção (21,24). De acordo com Trindade et al, em sua revisão de literatura, os estudos em vivo concluíram que a combinação da terapia fotodinâmica com a terapia convencional de preparo químico mecânico apresentam intervalos de redução microbiana de 96,7% a 98,5%, já apenas para a terapia convencional de preparo químico mecânico este intervalo passa para 87,7% a 91% (14).…”

“…Sendo que o uso de hidróxido de cálcio mostrou-se mais efetivo na diminuição da progressão da lesão (26). Já Ahangari et al em seu estudo mostraram a mesma eficácia antimicrobiana contra E. faecalis e C. albicans utilizando tanto a terapia fotodinâmica quanto o hidróxido de cálcio (24).…”