Clinical and microbiological effectiveness of photodynamic therapy on primary endodontic infections: a 6-month randomized clinical trial
- 301 Downloads
This short-term randomized controlled trial evaluated the effectiveness of photodynamic therapy (PDT) on clinical success (periapical healing) and on the microbiota of primary endodontic infections.
Thirty-two patients presenting mandibular molars with apical periodontitis (one tooth/patient) were selected and randomly allocated into two therapeutic groups: control (chemo-mechanical debridement [CMD]; n = 16) and PDT (CMD + PDT; n = 16). All teeth in both groups had intracanal medication with calcium hydroxide for 7 days before final obturation. Follow-up radiographs were made at 3 and 6 months. Periapical healing was evaluated by the periapical index (PAI). Samples were obtained at baseline, after CMD with or without PDT, and just before root filling to determine the frequency and levels of 37 taxa by checkerboard.
Significant decreases in PAI scores were observed in both groups over time, although at 6 months, the PDT group presented a significantly better healing score than the control (p < 0.05). At baseline, the most prevalent species in all samples were Candida albicans (46.9%), Dialister pneumosintes (31.2%), Prevotella nigrescens (28.2%), Prevotella tannerae (28.1%), and Peptostreptococcus anaerobius (25%). Most species reduced over time in both groups, and no significant differences in frequency and levels of the tested species were observed between groups in any time point evaluated. C. albicans and D. pneumosintes were still detected in high frequency in both groups at 3 months post-therapy.
Conventional endodontic therapy with or without PDT is effective in reducing microbial load, resulting in periapical healing. Nevertheless, adjunctive PDT provides better periapical healing at 6-month follow-up.
Teeth with apical periodontitis treated with PDT adjunct to conventional treatment would demonstrate superior healing and reduction of microorganisms.
KeywordsApical periodontitis Checkerboard DNA-DNA hybridization Randomized clinical trial Success and failure rate
This study was supported in part by National Council for Scientific and Technological Development (CNPq), Coordination of Improvement of Higher Education Personnel (CAPES), and Foundation for Research Financial Support in the State of Rio de Janeiro (FAPERJ), Brazil.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed involving human participants were in accordance and approved with the ethical standards by the Human Research Ethics Committee of the University Hospital, Federal University of Rio de Janeiro (UFRJ), protocol #707.472, and conducted in accordance with the CONSORT 2010 Statement.
For this type of study, informed consent was obtained from all individual participants included in the study.
- 3.Molander A, Warfvinge J, Reit C, Kvist T (2007) Clinical and radiographic evaluation of one- and two-visit endodontic treatment of asymptomatic necrotic teeth with apical periodontitis: a randomized clinical trial. J Endod 33:1145–1148. https://doi.org/10.1016/j.joen.2007.07.005 CrossRefPubMedGoogle Scholar
- 6.Miranda RG, Santos EB, Souto RM, Gusman H, Colombo APV (2013) Ex vivo antimicrobial efficacy of the EndoVac® system plus photodynamic therapy associated with calcium hydroxide against intracanal Enterococcus faecalis. Int Endod J 46:499–505. https://doi.org/10.1111/iej.12016 CrossRefPubMedGoogle Scholar
- 10.Brito LCN, Teles FR, Teles RP, França EC, Ribeiro-Sobrinho AP, Haffajee AD, Socransky SS (2007) Use of multiple-displacement amplification and checkerboard DNA-DNA hybridization to examine the microbiota of endodontic infections. J Clin Microbiol 45:3039–3049. https://doi.org/10.1128/JCM.02618-06 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Tzanetakis GN, Azcarate-Peril MA, Zachaki S, Panopoulos P, Kontakiotis EG, Madianos PN, Divaris K (2015) Comparison of bacterial community composition of primary and persistent endodontic infections using pyrosequencing. J Endod 41:1226–1233. https://doi.org/10.1016/j.joen.2015.03.010 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Heller D, Varela DM, Silva-Senem MX, Torres MCB, Feres-Filho EJ, Colombo APV (2011) Impact of systemic antimicrobials combined with antiinfective mechanical debridement on the microbiota of generalized aggressive periodontitis: a 6-month RCT. J Clin Periodontol 38:355–364. https://doi.org/10.1111/j.1600-051X.2011.01707.x CrossRefPubMedGoogle Scholar
- 28.Oliveira BP, Aguiar CM, Câmara AC, Albuquerque MM, Correia ACRB, Soares MFLR (2015) The efficacy of photodynamic therapy and sodium hypochlorite in root canal disinfection by a single-file instrumentation technique. Photodiagn Photodyn Ther 12:436–443. https://doi.org/10.1016/j.pdpdt.2015.05.004 CrossRefGoogle Scholar
- 32.Fonseca MB, Junior POT, Pallota RC, Filho HF, Denardin OVP, Rapoport A, Dedivitis RA, Veronezi JF, Genovese WJ, Ricardo AL (2008) Photodynamic therapy for root canals infected with Enterococcus faecalis. Photomed Laser Surg 26:209–213. https://doi.org/10.1089/pho.2007.2124 CrossRefPubMedGoogle Scholar
- 33.Garcez AS, Nunez SC, Lage-Marques JL, Cardoso Jorge AO, Ribeiro MS (2006) Efficiency of NaOCl and laser-assisted photosensitization on the reduction of Enterococcus faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:93–98. https://doi.org/10.1016/j.tripleo.2006.02.015 CrossRefGoogle Scholar