Photodynamic Therapy in Endodontics: A Helpful Tool to Combat Antibiotic Resistance? A Literature Review

Abstract

Background: Antibiotic resistance has become a growing global problem where overprescription is a contributing factor for its development. In the endodontics field, complementary treatments, such as antimicrobial photodynamic therapy (aPDT), have been described to eliminate residual bacteria from the root canal space and reduce complications. The aim of this review is to describe the literature evidence up to now regarding the advantages, efficiency, and clinical outcomes of this therapy in endodontics as a possible tool to combat antibiotic resistance. Methods: A review of the literature from 2010 to 2021 was carried out using the PubMed and Web of Science databases. Two steps were taken: First, articles were compiled through the terms and MeSH terms “Photochesdmotherapy” and “endodontics.” Then, a second search was conducted using “photodynamic therapy” and “antibiotic resistance” or “drug resistance, microbial.” Results: A total of 51 articles were included for evaluation: 27 laboratory studies, 14 reviews, and 10 clinical studies. Laboratory studies show that aPDT achieves significant bacterial elimination, even against antibiotic-resistant species, and is also effective in biofilm disruption. Clinical studies suggest that aPDT can be considered a promising technique to reduce bacterial complications, and reviews about the issue confirm its advantages. Conclusion: The benefits of aPDT in reducing complications due to its antibacterial effects means a possible decrease in systemic antibiotic prescription in endodontics. In addition, it could be an alternative to local intracanal antibiotic therapy, avoiding the appearance of possible antibiotic resistance, as no bacterial resistance with aPDT has been described to date.

Clinical applications of antimicrobial photodynamic therapy in dentistry

“…Thus, mechanical decontamination and chemical irrigation methods cannot eradicate bacterial contamination, especially considering limitations such as accessory canals, anastomoses, and the root canal complex anatomy. Using PS molecules with aPDT has shown to be a promising alternative for endodontic disinfection ( Abdelkarim-Elafifi et al, 2021 ). Commonly used PSs in treating endodontic infections are hematoporphyrin derivatives, toluidine blue O, methylene blue, cyanine, phthalocyanine, and phototherapeutic agents ( Meisel and Kocher, 2005 ; Sigusch et al, 2005 ; Pinheiro et al, 2009 ).…”

“…aPDT may be considered an antibacterial alternative to systemic and local antibiotics in endodontics due to the lack of bacterial resistance reported with aPDT so far ( Abdelkarim-Elafifi et al, 2021 ).…”

Current Applications and Future Directions of Lasers in Endodontics: A Narrative Review

“…Photodynamic therapy, also known as antimicrobial photodynamic therapy, performs using antimicrobial properties via an interaction between a light source at a specific wavelength and a photosensitizer [ 93 ]. Furthermore, through a clinical study focused on the influence of photodynamic therapy on pain after the treatment of teeth with necrotic pulps, there was a conclusion that aligned with this notion.…”

5-Aminolevulinic Acid and Red Led in Endodontics: A Narrative Review and Case Report

“…Photodynamic therapy in endodontics is a topic widely studied in the literature, but it is very varied. The effectiveness of photodynamic therapy in endodontics is still a debated topic, but it has emerged that certainly in addition to the conventional chemo-mechanical treatment accompanied with sodium hypochlorite and EDTA irrigation, the effectiveness of bacterial decontamination of root canals has increased [ 144 , 145 ].…”