Review Article

Photodynamic Antimicrobial Chemotherapy for Root Canal System Asepsis: A Narrative Literature Review

Table 1

In vitro studies compilation.

Study typeGroups% NaOCl SubstractePhotosensitizerLaserParameters evaluatedConclusion

In vitro, 16 studies
Seal et al. 2002 [63]Test groups:
Group #1: PDT with 20 combinations of 4 TBO concentrations and 5 laser energy doses ().
TBO (12.5, 25, 50, and 100 mg mL−1) incubated for 30 s.
Laser (60, 90, 120, 300, and 600 s).
Energy dose (2.1, 3.2, 4.2, 10.5, and 21 J).
Group #2: NaOCl ().
Control group:
Light source: Canals () were filled with reduced transport fluid (RTF) for 30 s followed by application of various laser light doses (60, 90, 120, 300, or 600 s).
TBO only: Canals () were filled with TBO at various concentrations (12.5, 25, 50, or 100 mg mL−1) and incubated for 30 s.
No treatment: Canals () were filled with RTF and incubated for 30 s.
3S. intermedius (strain NS)TBO
12.5, 25, 50, 100 g mL−1
Preincubation time (PIT): 30 s
Helium-neon
632.8 nm]
Irradiation time (IT): 60 s, 90 s, 120 s, 300 s, and 600 s
Cell viability
Colony-forming-unit – CFU (log10)
PDT is bactericidal to S. intermedius biofilms in root canals but is not as effective as irrigation with 3% NaOCl.
Sample: 35 root canals from human uniradicular teeth

Silva Garcez et al. 2006 [57]Test groups:
Group #1:
Group #2:
Group #3:
Group #4:
Group #5: NaOCl
Control group:
Canals filled with BHI broth and incubated for 24 h.
0.5Enterococcus faecalis (ATCC1494)AZ paste
0.01%]
PIT: 300 s
Paste composition: urea peroxide 10%, detergent 15% (Tween 80) and vehicle 75% (carbowax).
GaAlAs diode
685 nm]
IT: 180 s
Cell viability
CFU (log10)
In root canals, PDT showed 99.2% E. faecalis reduction, whereas 0.5% NaOCl achieved 93.25%.
Sample: 30 root canals from human uniradicular teeth (upper central incisors and upper canines)

Garcez et al. 2007 [34]Test groups:
Group #1: PDT
Group #2: RCT (root canal treatment) with NaOCl
Group #3: Combined treatment (PDT + ET with NaOCl)
Control group:
Teeth with 3-day biofilms + BHI for 24 h
2.5Proteus mirabilis (XEN44)
Pseudomonas aeruginosa (XEN5)
PEI/e6 
NS] 
PIT: 600 s
MMOptics
660 nm]
IT: NS
Bioluminescence imaging
Cell viability
CFU (log10)
NaOCl reduced bacteria by 90% while PDT alone reduced bioluminescence by 95%.
Sample: 10 root canals from uniradicular human teeth (upper central incisors and upper canines)

George and Kishen 2008 [59, 103]
In vitro
Ex vivo
Test groups:
Group #1: RCT with NaOCl
Group #2: PDT
Group #3: RCT + PDT in an emulsion of H2O2 : triton-X100 in the ratio 75 : 24.5 : 0.5
Group #4: RCT + an emulsion of H2O2 : triton-X100 in the ratio 75 : 24.5 : 0.5
Control group:
Root canal not subject to any treatment
IV: 1
EV: 5.2
E. faecalis (strain NS)MB
1, 5, 10, 15, 20, 25 M]
PIT: 600 s (in the dark)
Dark toxicity was evaluated
Perfluorodecahydronaphthalene
(oxygen carrier)
H2O2(oxider)
Triton-X100
(nonionic detergent)
Power Technology Inc.
664 nm]
IT: NS
CSLM
Photooxidation activity
Singlet oxygen generation
Cell viability
CFU (log10)
NaOCl showed no viable bacteria after 4 h, but 60% of the root canal shavings confirmed bacterial growth after 24 h.
PDT alone or + NaOCl showed the absence of bacteria even after 24 h.
Sample: in vitro: E. faecalis biofilms grown on a glass coverslip that was fixed covering a grove (6 mm diameter) made at the bottom part of a Petri dish
Ex vivo (16–24 years): 30 root canals from human uniradicular teeth (anterior teeth)

Meire et al. 2009 [64]
In vitro
Ex vivo
Test groups:
Group #1: Nd:YAG laser ()
Group #2: KTP laser ()
Group #3: PDT ()
Group #4: NaOCl ()
Control group:
Group #5: teeth with no treatment () – positive control
Group #6: uninoculated teeth
() – negative control
2.5E. faecalis (ATCC10541)TBO
12.7 mg mL−1]
PIT: 120 s
Denfotex
635 nm]
IT: 150 s
Cell viability
CFU (log10)
Solid phase cytometry
Epifluorescence microscopy
PDT was less effective than NaOCl (15 min) in reducing E. faecalis, both in aqueous suspension and in the infected tooth model.
Sample: 60 uniradicular human teeth

Souza et al.2010 [65]Test groups:
Group #1: PDT with MB + NaOCl ()
Group #2: PDT with TBO + NaOCl ()
Group #3: PDT with MB + NaCl ()
Group #4: PDT with TBO + NaCl ()
Control groups:
2.5E. faecalis (MB35)MB/TBO 
15/15 g mL−1
PIT: 120 s
MMOptics
660 nm]
IT: 240 s
SEM
Cell viability
CFU (log10)
PDT did not significantly enhance disinfection after chemomechanical preparation using NaOCl as irrigant.
Sample: 70 uniradicular human teeth

Nagayoshi et al. 2011 [62]Test groups:
Group #1: 5 W, 30 s, PS (+)
Group #2: 5 W, 60 s, PS (+)
Group #3: 5 W, 120 s, PS (+)
Group #4: 5 W, 120 s, PS (−)
Control groups:
Group #5: NaCL: negative control
Group #6: NaOCl: positive control
2.5E. faecalis (ATCC29212)Indocyanine green
12. mg mL−1]
PIT: 60 s
P-Laser
805 nm]
IT: 30, 60, 120 s
Cell viability
CFU (log10)
Temperature
PDT had nearly the same antimicrobial effect as 2.5% NaOCl.
Sample: in vitro model of apical periodontitis in resin blocks

Nunes et al. 2011 [66]Test groups:
Group #1: OF/IT90 ()
Group #2: OF/IT180 ()
Group #3: NOF/IT90 ()
Group #4: NOF/IT180 ()
Control groups:
Group #5: untreated ()
Group #6: NaOCl: positive control ()
1E. faecalis (ATCC29212)MB
100 g mL−1]
PIT: 300 s
Thera Lase
660 nm]
IT: 90, 180 s
Cell viability
CFU (log10)
The highest percentage of E. faecalis reduction was achieved with NaOCl. The use of intracanal fiber during PDT does not reveal improvement.
Sample: 60 uniradicular human teeth

Poggio et al. 2011 [67]Test groups:
Group #1: PDT ()
Group #2: PDT + NaOCl ()
Group #3: TBO ()
Group #4: PDT () – more time than in group 1
Control groups:
Group #5: NaOCl: positive control ()
0.5
5
Streptococcus mutans (CCUG35176)
E. faecalis (ATCC19433) Streptococcus sanguis (CCUG17826)
TBO
100 g mL−1]
PIT: 60 s
FotoSan
628 nm]
IT: 30, 60 s
Cell viability In vitro antimicrobial efficacy of 5% NaOCl is higher than PDT.
Sample: 100 root canals from human uniradicular teeth

Rios et al. 2011 [68]Test groups:
Group #1: NaOCl
Group #2: TBO
Group #3: Light
Group #4: PDT
Group #5: PDT + NaOCl
Control groups:
The experimental conditions were repeated seven independent times with 15 total experimental samples. Both negative (no growth) and positive (growth without any treatment) controls were done for each independent experiment.
6E. faecalis (OG1X)
A derivative of an oral isolate that has been shown to be cariogenic
TBO
NS]
PIT: 30 s
FotoSan
628 nm]
IT: 30 s
SEM
Cell viability
CFU (log10)
The bacterial survival rate of the NaOCl/PDT group (0.1%) was significantly lower than the NaOCl (0.66%) and PDT groups (2.9%).
Sample: uniradicular human teeth (total number of teeth unknown)

Cheng et al. 2012 [69]Test groups:
Group #1: Nd:YAG
Group #2: Er:YAG/NaOCl/NS/DW 
Group #3: Er:YAG/NS/DW
Group #4: Er,Cr:YSGG
Group #5: PDT
Control groups:
Group #6: NaOCl:
positive control
Group #7: normal saline: negative control
5.25E. faecalis (ATCC4083)MB
50 g mL−1]
PIT: 60 s
Nd:YAG
1064 nm]
IT: 16 s
Er:YAG
2940 nm]
IT: 20 s
Er,Cr:YSGG
2780 nm]
IT: 4 s
Lit-601
660 nm]
IT: 60 s
SEM
Cell viability
CFU (log10)
PDT was less effective than NaOCl at surface of the root and 100, 200, and 300 m inside the dentinal tubule.
Sample: 220 uniradicular human teeth

Vaziri et al. 2012 [70]Test groups:
Group #1: NaOCl ()
Group #2: Laser + NaOCl ()
Group #3: PDT ()
Group #4: PDT + NaOCl ()
Group #5: chlorhexidine ()
Control groups:
Group #6: no treatment: positive control
Group #7: without inoculation of bacterium: negative control
2.5E. faecalis (ATCC29212)TBO
15 g mL−1]
PIT: 300 s
FotoSan
625 nm]
IT: 60 s
Cell viability
CFU (log10)
NaOCl showed better results than PDT. However, PDT + NaOCl showed the best result.
Sample: 90 root canals from 90 uniradicular human teeth

Pileggi et al. 2013 [60]Test groups:
Group #1: PDT (Eosin-Y) with Light+ and L−
Group #2: PDT (Rose bengal) with Light+ and L−
Group #3: PDT (Curcumin)
with Light+ and L−
Control groups:
Group #4: NaOCl
positive control
3E. faecalis (135737)Eosyn-Y/RB/curcumin
50 g mL−1]
PIT: 1800 s
Optilux 501
380–500 nm]
IT: 240 s
Cell viability
CFU (log10)
In BS, PDT significantly reduced E. faecalis viability. For biofilm, PDT completely suppressed E. faecalis.
Sample: E. faecalis 135737 culture collection of the University Hospitals of Geneva; CH was used for the inactivation assays because of its prominent role in endodontic infections

Bumb et al. 2014 [61]Test groups:Group #1: PDT (MB) with Light+
Control groups:
Group #2: no treatment ()
Positive control
3E. faecalis (ATCC29212)MB
25 mg mL−1]
PIT: 600 s
Diode laser
910 nm]
IT: NS
SEM
Cell viability
CFU (log10)
Bacterial reduction in PDT group was 96.70%. PDT potential to be used as an adjunctive antimicrobial procedure.
Sample: 20 uniradicular human teeth

Gergova et al. 2015 [71]Test groups:Group #1: lasers ()
#1.1: Nd:YAG ()
#1.2: diode ()
Group #2: PDT ()
#2.1: FotoSan ()
#2.2: without laser – dark control ()
#2.3: without PS – light control ()
Group #3: iontophoresis ()
#3.1: Cupral ()
#3.2: Ca(OH)2 ()
#3.3: I2/KI2 ()
Group #4 ()
#4.1: 2% Chx ()
#4.2: 2.5% NaOCl ()
#4.3: 30% H2O2 ()
Control groups:
Group #5: PBS ()
Positive control
2.5Two control strains from the American Type Culture Collection (ATCC):
Methicillin sensitive Staphylococcus aureus (ATCC29213)
E. faecalis (ATCC29212)
Clinical isolates served as multidrug-resistant:
S. pyogenes
S. intermedius
E. coli K. pneumonia
E. cloacae
S. marcescens
M. morganii
P. aeruginosa
A. baumannii
C. albicans
TBO
15 g mL−1]
PIT: NS
FotoSan
625 nm]
IT: 300 s
SEM
Cell viability
CFU (log10)
X-ray laser particle sizer
2.5% NaOCl is the most satisfactory result; however, PDT with FotoSan, H2O2, and all tested types of iontophoresis all showed strong disinfection potential without statistical significance.
Sample: 300 uniradicular human teeth

Wang et al. 2015 [72]Test groups:Group #1: PDT ()
Group #2: ultrasonic irrigation + NaOCl
#2.1: US + 0.5% NaOCl ()
#2.2: US + 1% NaOCl ()
#2.3: US + 2% NaOCl ()
#2.4: US + 2.5% NaOCl ()
#2.5: US + 5.25% NaOCl ()
Group #3: ultrasonic irrigation + PDT + NaOCl
#3.1: US + PDT + 0.5% NaOCl ()
#3.2: US + PDT + 1% NaOCl ()
#3.3: US + PDT + 2% NaOCl ()
#3.4: US + PDT + 2.5% NaOCl ()
#3.5: US + PDT + 5.25% NaOCl ()
Control groups:
Group #4: ultrasonic irrigation with 0.9% NaCl ()
Negative control
0.5
1
2
2.5
5.25
E. faecalis (ATCC33186)MB
100 M
PIT: 600 s
Diode laser 
670 nm]
IT: 300 s
SEM
Cell viability
CFU (log10)
PDT alone is less efficient than even the 0.5% NaOCl ultrasonic irrigation under the condition of this experiment.
Sample: 120 intact bovine incisors