A systematic review and meta-analysis on the effects of phototherapy on postoperative pain in conventional endodontic reintervention.

OBJECTIVES: This systematic review and meta-analysis (SRM) aimed to evaluate the efficacy of laser phototherapy (LPT) on the reduction in postoperative pain (PP) of endodontic origin after conventional/non-surgical reintervention of root canals. METHODS: This SRM was registered with PROSPERO (CRD42021243500) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess the risk of bias and the GRADE tool to assess the quality of evidence. RESULTS: Initially, 1028 articles were found, and five articles were included. Most studies were classified as "low" risk of bias. Of the five clinical studies, four showed a significant decrease in PP after endodontic reintervention in the LPT groups compared to the control group, especially in the first four days after the intervention. In symptomatic teeth with multiple roots, LPT led to less PP at 24 h (MD -0.52 [-1.03; -0.02] p = .04). However, no significant difference between the groups was found at 48 and 72 h (p > .05). The certainty of the evidence was classified as low. CONCLUSION: Despite the limitations of this SRM, LPT was shown to be a promising alternative for reducing and controlling PP in conventional endodontic reintervention. CLINICAL SIGNIFICANCE: The use of LPT in endodontic reintervention may be a safe and promising alternative to clinically efficacious agent for use in the management of PP in this procedure.

Influence of two photodynamic therapy sessions and different photosensitizers on the bond strength of glass-fiber posts in different regions of intraradicular dentin.

BACKGROUND: Although photodynamic therapy associated with photosensitizers can promote microbial reduction, studies evaluating the consequences of two photodynamic therapy sessions associated with different photosensitizers on the bond strength of glass-fiber posts to endodontically treated intraradicular dentin are scarce. This in vitro study aimed to investigate the influence of two photodynamic therapy sessions using methylene blue or curcumin photosensitizers on the bond strength of glass-fiber posts to intraradicular dentin in different root thirds. METHODS: Seventy-two teeth were divided into 9 experimental groups according to photosensitizer type, concentration and light-activation: Control - deionized water; Methylene blue 50 mg/L; Methylene blue 50 mg/L + laser; Methylene blue 100 mg/L; Methylene blue 100 mg/L + laser; Curcumin 500 mg/L; Curcumin 500 mg/L + LED; Curcumin 1000 mg/L; and Curcumin 1000 mg/L + LED. Push-out bond strength of the fiber posts to endodontically treated dentin was evaluated using a universal test machine (n = 8). Bond strength data underwent Kruskal-Wallis test, followed by Dunn test for comparison between treatments, and Friedman test for comparison between thirds (α = 0.05). Illustrative scanning electron microscopy images were obtained to qualify the failure mode. RESULTS: Curcumin at higher concentration, activated or not by blue LED, decreased the bond strength values in the apical region when compared with the control group (P < 0.05). There was no difference between two photodynamic therapy sessions using methylene blue photosensitizer (activated or not) and the control group regardless of concentrations and root canal depth evaluated (P > 0.05). Regarding intraradicular depth, the different thirds showed no statistical difference on bond strength values (P > 0.05). All experimental groups presented predominance of mixed-type failure, excepting the methylene blue group at higher concentration activated by red laser, and the curcumin photosensitizer at both concentrations activated by blue LED. CONCLUSIONS: Methylene blue at a 50 mg/L concentration can be applied in two PDT sessions, after biomechanical preparation and before glass-fiber post luting, as it presents no influence on root dentin bond strength in in vitro conditions.

Influence of curcumin photosensitizer in photodynamic therapy on the mechanical properties and push-out bond strength of glass-fiber posts to intraradicular dentin.

BACKGROUND: The effects of using curcumin as photosensitizer on the mechanical properties of intraradicular dentin and on the bond strength of glass-fiber posts are unknown. Thus, this in vitro study evaluated the influence of using curcumin as photosensitizer during photodynamic therapy on the Martens hardness, elastic modulus, and bond strength of glass-fiber posts luted to intraradicular dentin, in different tooth root thirds. METHODS: Eighty bovine teeth were divided into 5 groups according to the concentration of curcumin applied, with or without blue LED light activation: Control-deionized water; Curcumin 500 mg/L; Curcumin 500 mg/L + blue LED; Curcumin 1000 mg/L; and Curcumin 1000 mg/L + blue LED. Mechanical properties were measured in different thirds of the radicular dentin using an ultramicrohardness tester (n = 8). A universal testing machine was used to evaluate the push-out bond strength (n = 8). Mechanical properties were compared across groups with the Kruskal-Wallis test, and across regions with the Friedman test. Bond strength data were subjected to ANOVA, followed by Tukey's test (α = 0.05). Scanning electron microscopy was used to analyze the failure mode of the specimens. RESULTS: The use of curcumin photosensitizer, with or without blue LED light, improved mechanical properties compared to those of the control group (P < 0.05), and promote no statistically significant difference in bond strength values (P > 0.05). Overall, there was no difference among the intraradicular thirds for Martens hardness and push-out bond strength values (P > 0.05). CONCLUSIONS: Curcumin photosensitizer, with or without photodynamic therapy, changed the mechanical properties of intraradicular dentin; however, the Martens hardness and bond strength values did not differ with the depth of the dentin.

Effect of photodynamic therapy on the mechanical properties and bond strength of glass-fiber posts to endodontically treated intraradicular dentin.

STATEMENT OF PROBLEM: The use of photosensitizers in photodynamic therapy promotes intraradicular microbial reduction during nonsurgical endodontic therapy. However, studies are lacking on the consequences of the application of these agents on the mechanical properties of intraradicular dentin and on the bond strength of glass-fiber posts. PURPOSE: The purpose of this in vitro study was to evaluate the influence of photodynamic therapy on the bond strength of glass-fiber posts using a push-out test and, additionally, to measure the Martens hardness (MH) and elastic indentation modulus (Eit) of intraradicular dentin when different photosensitizers are used. MATERIAL AND METHODS: Eighty bovine teeth were used to simulate experimental endodontic treatments. Biomechanical instrumentation was performed for all root canals, and the teeth were distributed into 5 groups: control-deionized water; methylene blue 50 mg/L + red laser; methylene blue 100 mg/L + red laser; curcumin 500 mg/L + blue LED; and curcumin 1000 mg/L + blue LED. The MH and Eit of intraradicular dentin were measured using an ultramicrohardness tester under a load of 3 mN (n=8). The push-out bond strength of glass-fiber posts to dentin was measured using a universal testing machine (n=8). Mechanical properties and bond strength data were subjected to the Kruskal-Wallis test, ANOVA, and Fisher least significant difference test (α=.05). Images of representative specimens were obtained using a scanning electron microscope. RESULTS: The MH, Eit, and bond strength of intraradicular dentin were influenced by the photosensitizer used. In general, curcumin promoted lower mechanical properties values but higher bond strength values. CONCLUSIONS: Photosensitizers influenced the mechanical properties of intraradicular dentin and the bond strength of glass-fiber posts, and methylene blue at 50 mg/L had no marked effect on the mechanical properties of the dentin or the bond strength values.