Efficacy of root canal treatment in c-shaped canals with adjunctive photodynamic therapy using micro-CT

Superiority of Warm Vertical Condensation in C-shaped root canals: improved periodontal health, enhanced fracture resistance, with reduced pain and secondary caries incidence

OBJECTIVE

To compare the clinical efficacy between the methods of Cold Lateral Compaction (CLC) and Warm Vertical Condensation (WVC) in treating C-shaped root canals, focusing on periodontal health, fracture resistance, postoperative pain, and the incidence of secondary caries.

METHODS

This retrospective cohort study involved 229 patients treated with either CLC (n=106) or WVC (n=123) from January 2022 to December 2023. Baseline characteristics were comparable between the two groups. Clinical data on clinical efficacy, periodontal indices, fracture resistance, pain scores, and secondary caries incidence were collected and analyzed.

RESULTS

The WVC technique demonstrated superior clinical outcomes, with an effectiveness rate of 95.93% compared to 87.74% for CLC (P=0.022). Patients treated with WVC showed significantly greater improvements in periodontal indices, including reduced plaque and gingival indices, probing depth, and tooth mobility one month post-treatment (all P<0.05). Additionally, the WVC group exhibited enhanced fracture resistance, with shorter dye penetration lengths and higher compressive load capacity (P=0.004 and P=0.006, respectively). Postoperative pain was reduced in the WVC group, as indicated by lower Visual Analog Scale (VAS) scores (P=0.027). Furthermore, the incidence of secondary caries at 24 months was significantly lower in the WVC group (11.38% vs 23.58% for CLC, P=0.014). The WVC group also showed marked reductions in inflammatory markers postoperatively, including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and C-reactive protein (CRP) (P<0.05).

CONCLUSION

The WVC technique is more effective than CLC for C-shaped root canals. It not only provides superior sealing capabilities but also improves periodontal health, increases fracture resistance, reduces postoperative pain, and lowers the incidence of secondary caries.

Updates on the Virulence Factors Produced by Multidrug-Resistant Enterobacterales and Strategies to Control Their Infections

The Enterobacterales order is a massive group of Gram-negative bacteria comprised of pathogenic and nonpathogenic members, including beneficial commensal gut microbiota. The pathogenic members produce several pathogenic or virulence factors that enhance their pathogenic properties and increase the severity of the infection. The members of Enterobacterales can also develop resistance against the common antimicrobial agents, a phenomenon called antimicrobial resistance (AMR). Many pathogenic Enterobacterales members are known to possess antimicrobial resistance. This review discusses the virulence factors, pathogenicity, and infections caused by multidrug-resistant Enterobacterales, especially E. coli and some other bacterial species sharing similarities with the Enterobacterales members. We also discuss both conventional and modern approaches used to combat the infections caused by them. Understanding the virulence factors produced by the pathogenic bacteria will help develop novel strategies and methods to treat infections caused by them.

Ex vivo evaluation of the efficacy of photodynamic therapy in eliminating Enterococcus faecalis from dentinal tubules by confocal laser scanning microscopy

INTRODUCTION

The aim of the present study was to investigate ex vivo by confocal laser scanning microscopy (CLSM) the antibacterial effect of photodynamic therapy (PDT) on dentinal tubules in the apical 5 mm of human mandibular premolars contaminated with Enterococcus faecalis.

METHODS

Thirty-four teeth were standardized to 20 mm and foraminal anatomic diameters using instrument K#20. Samples were contaminated for 21 days and divided into three experimental groups (n=10): PDT group - instrumented canals and PDT; PUI group - instrumented canals and passive ultrasonic irrigation (PUI); PUI-PDT group - instrumented canals, PUI and PDT; and a control group (n=4): non-instrumented canals. The canals in the experimental groups were instrumented with ProTaper Next up to X3 and rinsed with EDTA-sodium hypochlorite. The photosensitizer used was 0.01% methylene blue with a pre-irradiation time of 5 minutes and a diode laser with 4J energy and 660 nm wavelength. Cross sections were made 5 mm from the apex of all samples, which were taken for analysis by CLSM. The results were analyzed using the Shapiro-Wilk and Kruskal-Wallis (Dunn) tests.

RESULTS

There was a lower percentage of live bacteria in the PUI-PDT group, with a statistical difference compared with the control and PDT groups (p< 0.05). There was no statistical difference in the percentage of live bacteria between PUI-PDT and PUI (p > 0.05).

CONCLUSION

It is concluded that the PUI-PDT association was most effective in disinfecting root canals compared to the control group and PDT.

Influence of antimicrobial photodynamic therapy on the bond strength of endodontic sealers to intraradicular dentin: A systematic review and meta-analysis

BACKGROUND

The objective of this systematic review and meta-analysis (SRMA) was to investigate the influence of antimicrobial photodynamic therapy (aPDT) on the bond strength of endodontic sealers to intraradicular dentin.

METHODS

This SRMA followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) (CRD42022319856). A population, intervention, control, and outcome (PICO) question was formulated: "Does antimicrobial photodynamic therapy decrease the bond strength of root canal sealers?". A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases until July 2022. Joanna Briggs Institute Critical Assessment Guidelines for Quasi-Experimental Studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (p<0.05).

RESULTS

Out of an initial 345 articles, 8 in vitro studies were included, published between 2013 and 2022. The studies were qualitatively analyzed; two studies showed a positive effect, two studies a negative effect, and the other studies showed no effect on bond strength of endodontic sealers to intraradicular dentin. Seven of the studies were included in the SRMA, which indicated that there was no significant difference in bond strength when using aPDT (P = 0.90; MD: -0.03; 95% CI: -0.46 to -0.41). There was a high level of evidence for each meta-analysis outcome.

CONCLUSION

It can be concluded that the use of aPDT as a method of root canal disinfection does not negatively influence the bond strength of endodontic sealers in the root canal.

Photodynamic Therapy in Root Canal Disinfection: A Case Series and Mini-Review

Introduction: Photodynamic therapy (PDT) is now a widely used treatment modality in many fields of dentistry, including endodontics. The most common application of PDT in endodontics is to disinfect root canals. The purpose of this study was to present the experience of using PDT in root canal disinfection of three patients. Case Presentation: Three patients referred to the Endodontics Department of Shahid Beheshti University of Medical Sciences were treated using 0.1 mg/mL Toluidine Blue (FotoSan® agent; CMS Dental, Denmark) irradiated with a light-emitting diode (LED) lamp (FotoSan®; CMS Dental, Denmark) with a mean wavelength of 630 nm and a mean power density of 3 W/cm2 over two 30-second periods. Conclusion: PDT using LED lighting can be used in conjunction with conventional root canal treatment (RCT) to achieve great results.

Effectiveness of antimicrobial photodynamic therapy as an adjunct to mechanical instrumentation in reducing counts of Enterococcus faecalis and Candida albicans from C-shaped root canals

BACKGROUND/PURPOSE

The aim was to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical instrumentation (MI) in reducing Enterococcus faecalis (E faecalis) and Candida albicans (C albicans) counts from C-shaped root-canals.

METHODS

Teeth with C-shaped canals as identified on cone beam computed tomographic images were included. Following incubation with E faecalis and C albicans, samples were divided into 4 groups a four follows: Group-1: MI with adjunct aPDT; Group-2: aPDT alone; Group-3: MI alone; and Group-4: no treatment. The pulp chambers of these teeth were exposed and coronal pulp was mechanically derided using sterile endodontic excavators. Using flexible files, all canals were debrided up to size #30 K-files with intermittent irrigation with 2.5% sodium hypochlorite irrigation. In Groups 1 and 3, methylene-blue was injected in all canals and aPDT was performed using a 600 nm diode laser. Sample-size estimation was done on data from a pilot investigation and group-comparisons were done using one way analysis of variance and Bonferroni post-hoc adjustment tests. P < .05 was considered statistically significant.

RESULTS

Sixty periodontally hopeless mandibular second molars with C-shaped canals were included. There was a statistically significant reduction CFU/mL of E faecalis (P < .001) and C albicans (P < .001). At post-operative microbial assessments in Group-1. There was no difference CFU/mL of E faecalis and C albicans at post-operative microbial assessments in Groups 2-4.

CONCLUSION

MI with adjunct aPDT is more effective in reducing count of E faecalis and C albicans from C-shaped root canals.

Effectiveness of photodynamic therapy on bonding strength and failure modes of fiber-posts in c-shaped treated root canals

AIM

The present study aimed to assess the push-out bond strength (PBS) and failure modes of fiber-posts after photodynamic therapy (PDT) and Erbium yttrium scandium gallium garnet (Er,Cr:YSGG) in c-shaped canals.

METHODS

Sixty molars with c-shaped root configuration were studied. The endodontic prepared teeth specimen were equally randomized into four groups: i) photodynamic therapy (PDT); ii) Er,Cr:YSGG; iii) chlorhexidine and; iv) control group. Post root filling, 10 mm space was prepared for insertion of post in the root canals. The push-out bond strength was evaluated using Universal testing machine. Modes of failure were evaluated as adhesive, cohesive and admixed. Mean values were computed between groups using Kruskal-Wallis test followed by Bonferroni post hoc test. Comparison between two thirds of root sections were analyzed using Friedman test. P-value was set at 0.05 or less.

RESULTS

Specimens treated with PDT reported the highest mean PBS (8.56 ± 2.12 MPa), while the lowest PBS was observed in NaOCl group (6.92 ± 2.21 MPa). Thirteen failures were observed at the adhesive post interface, whereas 22 failures were found at the interface forming between the dentin surface and adhesive. Similarly, 9 failures were categorized as mixed. For PDT group, a sum of 3 failures and 4 failures were noted at the apical and cervical points.

CONCLUSION

The specimens treated with PDT showed the highest push out bond strength with least number of failures.in c-shaped root canals.

Effect of Nd:YAG, Er,Cr:YSGG Laser Irradiation, and Adjunctive Photodynamic Therapy on Push-Out Bond Strength of Zirconia Posts to Radicular Dentin

This study is aimed at assessing the influence of Nd:YAG, Er,Cr:YSGG laser irradiation, and adjunctive photodynamic therapy (aPDT) on the bond strength of zirconia posts to radicular dentin. Eighty extracted anterior teeth were randomly categorized into 4 groups (n = 20) based on varying laser irradiation treatments, i.e., conventional cleaning and shaping (CCS), Nd:YAG, Er,Cr:YSGG, and aPDT group, respectively. Using a cutting machine, the samples were prepared for push-out bond strength analysis; 4 sections (2 on each apical and cervical) of around 1 mm thickness were sectioned for all roots at a right angle to the long axis of the post. After making the space for the post, they were incorporated into the root system and were subjected to different laser treatments. The universal testing machine was utilized to assess the push-out bond strength, which had a defined 1 mm/minute crosshead speed until the failure was encountered. Specimens in the aPDT group (8.20 ± 2.14 MPa) demonstrated the highest mean push-out bond strength, whereas the lowest was shown by samples in the CCS group (7.08 ± 1.11 MPa). According to the independent t-test, the mean push-out bond strength scores of the cervical segments were higher as compared to the apical segments in research groups (p < 0.05). Overall, the adhesive type was the most frequently encountered failure mode in all of the experimental groups, with the least number of failures observed in aPDT treated teeth samples. In conclusion, the push-out bond strength to radicular dentin was not much influenced by Nd:YAG, Er,Cr:YSGG laser, and aPDT in comparison with CCS. Although statistically not significant, however, the application of aPDT provided better outcomes as compared to other research groups.