Outcome of curcumin-based photodynamic therapy in endodontic microsurgery: A case report.

INTRODUCTION: Persistent apical periodontitis after root canal treatment may require surgical retreatment when non-surgical options are ineffective or impractical due to anatomical challenges or iatrogenic errors. Endodontic microsurgery (EMS) is a precise technique that aims to overcome extraradicular biofilm and root morphology issues. Photodynamic therapy (PDT) is an emerging supplementary disinfection approach that utilizes a photosensitizer agent and light to eliminate microorganisms through oxidative reactions. REPORT: A 60-year-old male with persistent apical periodontitis in a left maxillary first molar underwent non-surgical root canal retreatment followed by surgical reintervention due to anatomical complexities. During surgery, PDT was performed using a novel curcumin-based photosensitizer agent. After the procedure, the tooth was retrofilled with bioceramic cement, and photobiomodulation was applied to enhance tissue healing. One year post-surgery, the patient exhibited complete periradicular repair and remained asymptomatic. DISCUSSION: EMS is considered a last resort to salvage an endodontically treated tooth and has shown moderate success rates. PDT has demonstrated promise in improving periapical healing and reducing microorganisms. In this case, curcumin, diluted with 2 % chlorhexidine gel, served as an effective photosensitizer agent with antimicrobial properties. Moreover, performing photobiomodulation aided in cell recovery and reduced postoperative discomfort. CONCLUSION: The proposed EMS treatment protocol with PDT using curcumin yielded positive outcomes in this case report. Further randomized clinical trials are necessary to assess the efficacy of this approach in EMS. Additionally, further research on curcumin-based photosensitizer agents encapsulated in nanoparticles and enhanced antimicrobial agents is recommended to refine this treatment protocol for routine use.

Tooth color change after photodynamic therapy in endodontics: A systematic review.

BACKGROUND: A smile is considered one of the most important soft skills in social interaction. And discolored teeth may effect this. It is known that some photosensitizer agents (PS) used in photodynamic therapy (PDT) during root canal treatment could play a significant role in tooth color change, and thus the main objective of this systematic review is to address whether performing PDT can influence tooth color change and to synthesize the most effective methods to remove PS from the root canal system. METHODS: This study followed the PRISMA 2020 statement, and the protocol was registered at the Open Science Framework. Two blinded reviewers searched five databases up to November 20th, 2022: Web of Science, PubMed, Scopus, Embase, and the Cochrane Library. The eligibility criteria were studies that investigated tooth color change after PDT in endodontics. RESULTS: A total of 1695 studies were retrieved, and 7 were included in the qualitative analysis. All the included studies were in vitro evidence and investigated five different PS: methylene blue, toluidine blue O, malachite green, indocyanine green, and curcumin. Besides curcumin and indocyanine green, the remaining agents all caused tooth color change, and no method employed was effective in fully removing these PS from inside the root canal system CONCLUSIONS: Even though the findings showed that curcumin and indocyanine green did not influence tooth color change, the present evidence should be interpreted with caution since it is based on laboratory studies with questionable methods, and all efforts should be employed to avoid this undesirable side effect during clinical practice.

Sodium Thiosulfate for Recovery of Bond Strength to Dentin Treated with Sodium Hypochlorite.

INTRODUCTION: The aim of this study was to evaluate the efficacy of sodium thiosulfate (Na2S2O3) for restoring adhesion to pulp chamber dentin treated with sodium hypochlorite (NaOCl) and EDTA. METHODS: Sixty-three crowns of bovine incisors were cut to expose the dentin pulp chamber. The specimens were polished and randomly distributed into 9 groups (n = 7) according to the following protocols used: 0.9% sodium chloride for 30 minutes (negative control), 5.25% NaOCl for 30 minutes, 17% EDTA for 3 minutes, and 5.25% NaOCl for 1 minute (positive control). The other groups, after treatments with NaOCl and EDTA, were immersed in 0.5% or 5% Na2S2O3 for 1, 5, and 10 minutes or just immersed in an inert solution for 10 minutes (0.9% sodium chloride). After drying the specimens, Scotchbond Multi-Purpose (3M ESPE, St Paul, MN) was applied to the pulp chamber dentin followed by Filtek Z250 composite (3M ESPE). Six rectangular slabs were obtained from each specimen, and the dentin/resin interface was tested by using a universal testing machine. The resulting data were submitted to 1-way analysis of variance and the Duncan test (P = .05). RESULTS: There was a significant decrease in bond strength regarding NaOCl and EDTA (P < .05). When 5% Na2S2O3 was used for 10 minutes, the bond strength was found to be statistically equal to the negative control and higher than the positive control (P < .05). CONCLUSIONS: The use of Na2S2O3 can significantly increase the bond strength of composite resin to NaOCl/EDTA-treated dentin, allowing adhesive restorations to be immediately applied after endodontic treatment.