Outcome of selective root canal retreatment-A retrospective study.

AIM: Selective root canal retreatment is when the treatment is limited to root(s) with radiographic evidence of periapical pathosis. The goals of this retrospective study were as follows: (i) evaluate the clinical and radiographic (periapical radiographs [PR] or cone-beam computerized tomographs [CBCT]) outcome of selective root canal retreatment after ≥12 months follow-up; (ii) evaluate the periapical status of the unretreated roots; and (iii) assess tooth survival. METHODOLOGY: A retrospective study (January 2018 to April 2021) was conducted to identify permanent multirooted teeth that underwent selective root canal retreatment. Clinical records, PR and CBCT were examined to ascertain variables of interest. Outcomes (per root and per tooth) were classified into 'favourable' or 'unfavourable' using well-established clinical and radiographic healing criteria. Treatment outcomes for the whole tooth and per root were compared as well as bivariate associations between the treatment outcome of the retreated roots and the treatment-related parameters (quality of root filling, sealer extrusion, iatrogenic mishaps and type of restoration) were analysed using Fisher's exact test (α = .05). Survival was recorded in months. RESULTS: A total of 75 teeth (195 roots) in 75 subjects were available for outcome analysis. The favourable outcome per tooth was 86.7%. At follow-up, 92.6% of the retreated roots had a favourable outcome. From the unretreated roots, 3.5% showed radiographic signs of an emerging periapical lesion. No statistical difference was shown between the outcomes per root and per tooth between both groups. None of the treatment-related parameters had a direct influence on the outcome of the retreated roots. The survival rate at 12-48 months after retreatment was 91.5%. CONCLUSIONS: Selective root canal retreatment is associated with a favourable outcome in a majority of cases. Unretreated roots rarely developed radiographic signs of a new periapical lesion at follow-up. Future high-quality clinical trials with larger sample sizes and longer follow-up periods are required to confirm these findings.

Type I Diabetes in Zebrafish Reduces Sperm Quality and Increases Insulin and Glucose Transporter Transcripts.

Type I diabetes is a prominent human pathology with increasing incidence in the population; however, its cause is still unknown. This disease promotes detrimental effects on reproduction, such as lower sperm motility and DNA integrity. Hence, the investigation of the underlying mechanisms of this metabolic disturbance in reproduction and its transgenerational consequences is of the utmost importance. The zebrafish is a useful model for this research considering its high homology with human genes as well as its fast generation and regeneration abilities. Therefore, we aimed to investigate sperm quality and genes relevant to diabetes in the spermatozoa of Tg(ins:nfsb-mCherry) zebrafish, a model for type I diabetes. Diabetic Tg(ins:nfsb-mCherry) males showed significantly higher expression of transcripts for insulin a (insa) and glucose transporter (slc2a2) compared to controls. Sperm obtained from the same treatment group showed significantly lower sperm motility, plasma membrane viability, and DNA integrity compared to that from the control group. Upon sperm cryopreservation, sperm freezability was reduced, which could be a consequence of poor initial sperm quality. Altogether, the data showed similar detrimental effects related to type I diabetes in zebrafish spermatozoa at the cellular and molecular levels. Therefore, our study validates the zebrafish model for type I diabetes research in germ cells.

Scaffolds for Dentin-Pulp Complex Regeneration.

Background and Objectives: Regenerative dentistry aims to regenerate the pulp-dentin complex and restore those of its functions that have become compromised by pulp injury and/or inflammation. Scaffold-based techniques are a regeneration strategy that replicate a biological environment by utilizing a suitable scaffold, which is considered crucial for the successful regeneration of dental pulp. The aim of the present review is to address the main characteristics of the different scaffolds, as well as their application in dentin-pulp complex regeneration. Materials and Methods: A narrative review was conducted by two independent reviewers to answer the research question: What type of scaffolds can be used in dentin-pulp complex regeneration? An electronic search of PubMed, EMBASE and Cochrane library databases was undertaken. Keywords including "pulp-dentin regeneration scaffold" and "pulp-dentin complex regeneration" were used. To locate additional reports, reference mining of the identified papers was undertaken. Results: A wide variety of biomaterials is already available for tissue engineering and can be broadly categorized into two groups: (i) natural, and (ii) synthetic, scaffolds. Natural scaffolds often contain bioactive molecules, growth factors, and signaling cues that can positively influence cell behavior. These signaling molecules can promote specific cellular responses, such as cell proliferation and differentiation, crucial for effective tissue regeneration. Synthetic scaffolds offer flexibility in design and can be tailored to meet specific requirements, such as size, shape, and mechanical properties. Moreover, they can be functionalized with bioactive molecules, growth factors, or signaling cues to enhance their biological properties and the manufacturing process can be standardized, ensuring consistent quality for widespread clinical use. Conclusions: There is still a lack of evidence to determine the optimal scaffold composition that meets the specific requirements and complexities needed for effectively promoting dental pulp tissue engineering and achieving successful clinical outcomes.

Assessment of larval quality of two bivalve species, Crassostrea angulata and Chamelea gallina, exposed and cryopreserved with different cryoprotectant solutions.

Marine bivalves are valuable resources, however, some shellfish populations are endangered due to factors such as anthropogenic pressure, pathologies or lack of reproduction synchrony. Portuguese oyster (Crassostrea angulata) and striped venus clam (Chamelea gallina) have high socio-economic value and their endangered natural populations require rehabilitation. Cryopreservation is a valuable method for the preservation and management of genetic resources for aquaculture and restocking. Larvae cryopreservation is particularly valuable since diploid organisms are obtained upon thawing. The objective of this work was the establishment of C. angulata and C. gallina D-larvae cryopreservation through the selection of permeant cryoprotectant in the freezing solution, namely ethylene glycol (EG) and dimethyl sulfoxide (Me2SO). Cryoprotectants exposure showed that, in C. angulata, Me2SO promoted significantly higher incidence of abnormalities and enhanced glutathione reductase activity when compared to control (larvae without cryoprotectant exposure) or even to EG treatment. However, for both species, EG significantly reduced D-larvae average path velocity (VAP). In C. angulata post-thaw D-larvae, EG treatment promoted significantly lower motility and velocity when compared to control and Me2SO treatment. Superoxide dismutase (SOD) activity showed a reduction in C. angulata post-thaw D-larvae when compared to control, which was compensated by the enhancement of glutathione peroxidase (GPX) activity. In C. gallina post-thaw D-larvae, only motility, velocity and SOD activity were significantly lower than control. Therefore, the best treatment to cryopreserve C. angulata D-larvae was EG while for C. gallina Me2SO produced better results. This work established for the first time D-larvae cryopreservation protocols for C. angulata and C. gallina.

Health behaviours as predictors of the Mediterranean diet adherence: a decision tree approach.

OBJECTIVE: This study aimed to identify health behaviours that determine adolescent's adherence to the Mediterranean diet (MD) through a decision tree statistical approach. DESIGN: Cross-sectional study, with data collected through a self-fulfilment questionnaire with five sections: (1) eating habits; (2) adherence to the MD (KIDMED index); (3) physical activity; (4) health habits and (5) socio-demographic characteristics. Anthropometric and blood pressure data were collected by a trained research team. The Automatic Chi-square Interaction Detection (CHAID) method was used to identify health behaviours that contribute to a better adherence to the MD. SETTING: Eight public secondary schools, in Algarve, Portugal. PARTICIPANTS: Adolescents with ages between 15 and 19 years (n 325). RESULTS: According to the KIDMED index, we found a low adherence to MD in 9·0 % of the participants, an intermediate adherence in 45·5 % and a high adherence in 45·5 %. Participants that regularly have breakfast, eat vegetable soup, have a second piece of fruit/d, eat fresh or cooked vegetables 1 or more times a day, eat oleaginous fruits at least 2 to 3 times a week, and practice sports and leisure physical activities outside school show higher adherence to the MD (P < 0·001). CONCLUSIONS: The daily intake of two pieces of fruit and vegetables proved to be a determinant health behaviour for high adherence to MD. Strategies to promote the intake of these foods among adolescents must be developed and implemented.

Cryoprotectants synergy improve zebrafish sperm cryopreservation and offspring skeletogenesis.

The synergy obtained by the combination of cryoprotectants is a successful strategy that can be beneficial on the optimization of zebrafish sperm cryopreservation. Recently, a protocol was established for this species using an electric ultrafreezer (-150 °C) performing cooling rate (-66 °C/min) and storage within one step. The ultimate objective of sperm cryopreservation is to generate healthy offspring. Therefore, the objective of this study was to select the most adequate cryoprotectant combination, for the previously established protocol, that generate high quality offspring with normal skeletogenesis. Among the permeating cryoprotectant concentrations studied 12.5% and 15% of N,N-dimethylformamide (DMF) yielded high post-thaw sperm quality and hatching rates. For these two concentrations, the presence of bovine serum albumin (10 mg/mL), egg yolk (10%), glycine (30 mM) and bicine (50 mM) was evaluated for post-thaw sperm motility, viability, in vitro fertilization success and offspring skeletal development (30 days post fertilization). Higher concentration of permeating cryoprotectant (15%) decreased the incidence of deformed arches and severe skeletal malformations, which suggests higher capacity to protect the cell against cold stress and DNA damage. Extender containing 15% DMF with Ctrl, Bicine and egg yolk were the non-permeating cryoprotectants with higher post-thaw quality. The use of these compounds results in a reduction in vertebral fusions, compressions and severity of skeletal malformations in the offspring. Therefore, these extender compositions are beneficial for the quality of zebrafish offspring sired by cryopreserved sperm with -66 °C/min freezing rate. To the best of our knowledge, this is the first report on skeletal development of the offspring sired by cryopreserved sperm performed with different freezing media compositions in zebrafish.

Electric ultrafreezer (- 150 °C) as an alternative for zebrafish sperm cryopreservation and storage.

Zebrafish sperm cryopreservation is a fundamental methodology to manage and back-up valuable genetic resources like transgenic and mutant strains. Cryopreservation usually requires liquid nitrogen for storage, which is expensive and hazardous. Our objective was to evaluate if electric ultrafreezers (- 150 °C) are a viable alternative for zebrafish sperm storage. Zebrafish sperm was cryopreserved in the same conditions (- 20 °C/min), stored either in liquid nitrogen or in an ultrafreezer, and thawed after 1 week, 1 month, and 3 months. Sperm motility, membrane integrity, and fertilization ability were assessed. There were no significant differences in motility and hatching rate throughout storage time. Additionally, we aimed at understanding if cryopreservation directly in an ultrafreezer (- 66 °C/min) could improve post-thaw sperm quality. Freezing at - 20 °C/min was performed as before, and compared to samples cryopreserved with a fast cooling rate by placing directly in an ultrafreezer (- 66 °C/min). Sperm quality was assessed according to motility, viability, DNA fragmentation, and apoptosis (annexin V). The - 66 °C/min cooling rate showed significantly higher membrane and DNA integrity, and lower number of cells in late apoptosis in comparison to the other treatments. This study showed that zebrafish sperm cryopreservation and storage in an ultrafreezer system is possible and a fast cooling rate directly in ultrafreezer improves post-thaw sperm quality.

May carriers at nanoscale improve the Endodontic's future?

Nanocarriers (NCs) are dynamic nanovehicles used to transport bioactive derivatives like therapeutical formulations, drugs and/or dyes. The current review assists in understanding the mechanism of action of several recent developed NCs with antimicrobial purposes. Here, nine NCs varieties are portrayed with focus on nineteen approaches that are fulfil described based on outcomes obtained from in vitro antimicrobial assays. All approaches have previously been verified and we underline the biochemical challenges of all NCs, expecting that the present data may encourage the application of NCs in endodontic antimicrobial basic research. Methodological limitations and the evident base gaps made not possible to draw a definite conclusion about the best NCs for achieving efficient antimicrobial outcomes in endodontic studies. Due to the lack of pre-clinical trials and the scarce number of clinical trials in this emergent area, there is still much room for improvement on several fronts.

Long-Term Outcome of Nonvital Immature Permanent Teeth Treated With Apexification and Corono-Radicular Adhesive Restoration: A Case Series.

INTRODUCTION: This study aimed to evaluate the long-term outcome of 16 permanent maxillary central incisors with nonvital pulps and open apices treated with apexification and corono-radicular adhesive restorations, within a follow-up span of 5 to 22 years. METHODS: Fourteen patients providing a total of 16 teeth treated with mineral trioxide aggregate (n = 12), Biodentine (n = 3), or ß-tricalcium phosphate (n = 1) apical barrier and corono-radicular restoration, with or without fiberglass post, were included. Clinical and radiographic criteria were defined for assessment at recall. Restoration and periapical tissue status evaluation were performed according to FDI World Dental Federation's esthetic, functional, and biological criteria and Ørstavik Periapical Index (PAI). Outcome was dichotomized as "healed" (PAI ≤ 2, asymptomatic with absence of signs of infection) or "not healed" (PAI ≥ 3, presence of clinical signs and/or symptoms). RESULTS: Fourteen of 24 patients were available for the present study (recall rate = 58%). Within a follow-up of 5 to 22 years, 10 (62.5%) teeth were considered "healed," fulfilling both strict clinical and radiographic success criteria. Only 1 tooth was missing due to root resorption and 1 patient was presenting with clinical signs and symptoms at recall, resulting in a survival rate of 93.8%. CONCLUSIONS: Adhesive corono-radicular restoration in nonvital permanent immature teeth treated with apexification allows for favorable long-term outcomes, by ensuring structural reinforcement and coronal microleakage prevention. Teeth sustaining a substantial loss of coronal structure may require post/core placement. In the case of failure, this endodontic-restorative combination ensured teeth survival until growth phase conclusion, thus allowing for proper prosthetic rehabilitation approaches.

Delayed Cutaneous Adverse Reaction of the AstraZeneca COVID-19 Vaccine in a Breastfed Female Infant: A Coincidence or a Rare Effect?

The ChAdOx1 nCoV-19 vector vaccine (Vaxzevria, AstraZeneca, Cambridge, UK) was developed at Oxford University and is considered safe for the administration in lactating mothers. Nevertheless, as a novel vaccine, there are gaps in the knowledge regarding possible adverse events in breastfeeding infants of vaccinated mothers. This case report provides first-time data on a possible delayed, cutaneous, adverse reaction in a breastfed, 16-month-old female infant after the first administration of the AstraZeneca vaccine to her 33-year-old mother. Even though, no clinical adverse effects were observed in the mother, her daughter had a 2-day rash in the lower extremities and face. The infant's cutaneous rashes might be a coincidental event. However, all skin lesions were analogous to previous descriptions and photographs of dermatologic reactions, which resolved spontaneously with no medical intervention, in people who had been vaccinated with other COVID-19 vaccines. Our aim is that this short report contributes to the enhancement of parental awareness about the possibility of similar skin rashes in breastfed children when the mothers receive a vaccination and the importance of reporting those adverse reactions to the competent authorities.

Influence of Preoperative Pulp Inflammation in the Outcome of Full Pulpotomy Using a Dog Model.

INTRODUCTION: This study aimed to evaluate the impact of preoperative pulp inflammation on the histologic outcome of full pulpotomy performed in mature permanent posterior teeth using 4 different biomaterials. METHODS: Five beagle dogs (providing a total of 120 roots) were selected. Dentin exposure was performed in teeth from the second and third quadrants. One week later, full pulpotomy procedures were performed using 4 different bioactive materials (ProRoot MTA [MTA], TotalFill BC Putty [BC], Biodentine [BIO], and an experimental cement [ie, pulp capping material]). The hemostasis time was registered. After 14 weeks, the animals were killed. Pulp-dentin tissues were histologically and radiographically assessed. The significance level was set at .05. RESULTS: Teeth with previously exposed dentin revealed a statistically significant increase in the time required to achieve hemostasis (P < .001), therefore confirming the pulp inflammation status induced by 1-week exposure of occlusal dentin before performing full pulpotomy. There was no radiographic evidence of root resorption, periapical radiolucency, or lamina dura alterations. No statistically significant differences were observed between normal and inflamed pulp regardless of the evaluated histologic parameters. Moreover, histologic data concerning calcified barrier formation and the pulp tissue response show better results for BIO without statistical differences compared with MTA or BC (P > .05). The pulp capping material presented a lower performance, with statistically significant differences being detected in regard to the remaining 3 tested materials (P < .001). CONCLUSIONS: Radiographic and histologic outcomes of full pulpotomy are not jeopardized by short-term preoperative pulp inflammation. Moreover, BIO, MTA, and BC cements present suitable alternatives to be used as pulp capping agents.

Microdiet Formulation with Phospholipid Modulate Zebrafish Skeletal Development and Reproduction.

Dietary phospholipids' (PLs) content, origin, and profile are known to affect fish development and reproductive performance, but their effects in zebrafish (Danio rerio) nutrition are still poorly investigated. Therefore, this study aimed to assess the effect of practical microdiets containing plant-based and marine PL sources in zebrafish growth, survival, skeletal development, and reproductive performance. Reproductive performance was evaluated according to sperm motility, number of eggs, egg morphometry, hatching rate, and offspring standard length at 5 days postfertilization (dpf). For this purpose, seven microdiets were used, where two control diets were tested along with a supplementation with soybean lecithin (SL) as a plant-based PL source, and krill oil (KO) and copepod oil (CO) as marine PL sources, or in combinations (SLCO and SLKO). KO supplementation decreased larval growth performance and induced severe skeletal anomalies. SL supplementation reduced sperm total motility but improved offspring length at 5 dpf. CO supplementation increased sperm motility and the number of spawned eggs. Our results showed that a careful selection of the origin of dietary PL sources for microdiet formulation is critical to ensure adequate skeletal development and reproductive success. This study contributes to the improvement of zebrafish microdiet formulation and optimization of zebrafish husbandry practices.

Early Transition to Microdiets Improves Growth, Reproductive Performance and Reduces Skeletal Anomalies in Zebrafish (Danio rerio).

Zebrafish is a model species with a high variability of feeding regimes among fish facilities. The use of live feeds for early life stages is a common practice, and few studies have focused early weaning into microdiets. The lack of standardized feeding protocols among research facilities promotes discrepancies in biological performances, and few studies relate dietary regimes to zebrafish development. The objective of this work was to assess the effect of an early transition into microdiets in zebrafish development by evaluating growth, survival, reproductive performance, and skeletal anomalies. These parameters were assessed in one group exclusively fed on Artemia nauplii and two groups fed on microdiets (commercial and experimental). Results showed that an early weaning with the two microdiets significantly improved zebrafish growth and reproductive performance, while a decrease in incidence of vertebral column anomalies was observed. A high survival was also maintained in fish fed microdiets at an early developmental stage when comparing to exclusive Artemia nauplii feeding. In conclusion, early weaning with high quality microdiets is beneficial for zebrafish growth, reproductive performance, and skeletal development, contributing to the standardization of zebrafish husbandry practices.

Selection Criteria of Zebrafish Male Donors for Sperm Cryopreservation.

Selection criteria for sperm cryopreservation are highly relevant in zebrafish since sperm quality is particularly variable in this species. Successful cryopreservation depends on high-quality sperm, which can only be ensured by the selection of breeders. Consequently, male selection and management are a priority to improve cryopreservation, and therefore, this study aimed to characterize optimal age and sperm collection frequency in zebrafish. For this purpose, males from wild type (AB) and from a transgenic line [Tg(runx2:eGFP)] were sampled at 6, 8, 12, and 14 months. For each age, sperm were collected at time 0 followed by samplings at 2, 7, and 14 days of rest. Sperm quality was assessed according to motility and membrane viability parameters. Quality assessment showed that Tg(runx2:eGFP) displayed significantly higher motility than AB and younger males showed higher motility in both lines. Sperm collection frequency affected membrane viability. While AB fish recovered sperm viability after 14 days of rest, Tg(runx2:eGFP) could not recover. Consequently, it may be important to study the sperm quality of each zebrafish line before sperm cryopreservation. Taking into consideration the results achieved in both lines, sperm collection should be performed between 6 and 8 months of age with a minimum collection interval of 14 days.

An Insight into Advanced Approaches for Photosensitizer Optimization in Endodontics-A Critical Review.

Apical periodontitis is a biofilm-mediated disease; therefore, an antimicrobial approach is essential to cure or prevent its development. In the quest for efficient strategies to achieve this objective, antimicrobial photodynamic therapy (aPDT) has emerged as an alternative to classical endodontic irrigation solutions and antibiotics. The aim of the present critical review is to summarize the available evidence on photosensitizers (PSs) which has been confirmed in numerous studies from diverse areas combined with several antimicrobial strategies, as well as emerging options in order to optimize their properties and effects that might be translational and useful in the near future in basic endodontic research. Published data notably support the need for continuing the search for an ideal endodontic photosensitizer, that is, one which acts as an excellent antimicrobial agent without causing toxicity to the human host cells or presenting the risk of tooth discoloration. The current literature on experimental studies mainly relies on assessment of mixed disinfection protocols, combining approaches which are already available with aPDT as an adjunct therapy. In this review, several approaches concerning aPDT efficiency are appraised, such as the use of bacteriophages, biopolymers, drug and light delivery systems, efflux pump inhibitors, negative pressure systems, and peptides. The authors also analyzed their combination with other approaches for aPDT improvement, such as sonodynamic therapy. All of the aforementioned techniques have already been tested, and we highlight the biological challenges of each formulation, predicting that the collected information may encourage the development of other effective photoactive materials, in addition to being useful in endodontic basic research. Moreover, special attention is dedicated to studies on detailed conditions, aPDT features with a focus on PS enhancer strategies, and the respective final antimicrobial outcomes. From all the mentioned approaches, the two which are most widely discussed and which show the most promising outcomes for endodontic purposes are drug delivery systems (with strong development in nanoparticles) and PS solubilizers.

Root Resorption Classifications: A Narrative Review and a Clinical Aid Proposal for Routine Assessment.

Root resorption (RR) refers to noninfectious damage related to the loss of hard and soft dental tissue that results from clastic cell activity. It is observed as a pathologic process that is predominantly asymptomatic in the permanent dentition and physiological during the shedding of primary teeth. Roots are protected by unmineralized organic cementoid and predentine. RR occurs because of the inability of the clastic cells to adhere to unmineralized surfaces. Since the first RR classification was described by Andreasen in the 1970s, several classifications have been proposed with diverse terminology. A narrative literature review was undertaken on the current classification, diagnosis, pathophysiology, and treatment of RR. A bibliographic search resulted in 434 titles and abstracts, and from those, 17 articles were obtained that alluded to 15 RR classifications. A total of 28 articles that met the inclusion criteria were included. Results showed that Andreasen's classification is the most widely used for classifying RR. In terms of epidemiologic data, studies are scarce, although RR pathophysiology is well described in the literature. Overall clinical guidelines are summarized in a new RR classification diagram. The choice of RR treatment application should be in line with the RR type and the dentist's experience. However, an earlier and correct diagnosis will significantly improve final outcomes and long-term prognosis, especially with the current evolution of advanced imaging techniques, such as cone-beam computed tomography and bioceramic-based endodontic sealers.

Is the chlorophyll derivative Zn(II)e6Me a good photosensitizer to be used in root canal disinfection?

BACKGROUND: The aim of this study was to assess antimicrobial efficacy and cytotoxic outcomes of a chlorophyll based photosensitizer (PS) Zn(II)chlorin e6 methyl ester (Zn(II)e6Me), when applied to human dentin discs and root blocks infected with 48 h biofilms. The results were compared with the ones obtained with FotoSan® (commercial Toluidine Blue O formulation) and 3% sodium hypochlorite (NaOCl). METHODOLOGY: Dentin and root blocks were infected with mixed biofilms of Enterococcus faecalis and Candida albicans; exposed for 15 min to 0.1 mg/mL of Zn(II)e6Me or Fotosan® and then irradiated with red light (627 nm, 75 mW, 3150 J/cm2) for 90 s or treated with NaOCl. Biofilm removal was calculated with safranin red assay and biofilm cells viability with XTT® assay. The PSs cytotoxicity was evaluated over human apical papilla primary cell line (hAPCs) with AlamarBlue® assay and cell morphology assessed with widefield fluorescence microscopy. RESULTS: At dentin discs, the chlorophyll derivative performed better in biofilm removal (59.1%) than FotoSan® agent (57.5%), however, with lower efficacy than NaOCl (68.1%) (P = 0.0185). Conversely, at the root block, the chlorophyll Zn(II)e6Me (79.7%) present better antimicrobial efficacy than NaOCl (75.5%) and the disinfection pattern was more consistent at inner and outer samples for the former. No dark or photoinduced cytotoxic outcomes were detected for Zn(II)e6Me over human cells at 24 and 48 h when compared with other PSs (FotoSan®, Rose Bengal and 5,10,15,20-tetrakis(1-methylpyridinium-4-yl)porphyrin - TMPyP). CONCLUSIONS: The chlorophyll derivative Zn(II)e6Me showed adequate antimicrobial efficacy, performing better in mixed biofilm removal than FotoSan® in both experimental conditions. No cytotoxic effects over human apical papilla cells were identified for this chlorophyll derivative, subsequently it deserves further evaluation to assess its potential use in endodontic therapy.

Antimicrobial Photodynamic Therapy against Endodontic Enterococcus faecalis and Candida albicans Mono and Mixed Biofilms in the Presence of Photosensitizers: A Comparative Study with Classical Endodontic Irrigants.

Endodontic biofilms eradication from the infected root canal system remains as the primary focus in endodontic field. In this study, it was assessed the efficacy of antimicrobial Photodynamic Therapy (aPDT) with the Zn(II)chlorin e6 methyl ester (Zn(II)e6Me) activated by red light against monospecies and mixed biofilms of Enterococcus faecalis and Candida albicans. The results were compared with the ones obtained with Rose Bengal (RB), Toluidine Blue-O (TBO), the synthetic tetracationic porphyrin (TMPyP) as well as classical endodontic irrigants (3% NaOCl, 17% EDTA and 2% CHX). The antimicrobial efficacy of aPDT toward monospecies and mixed biofilms was quantified resorting to safranin red method. The changes of biofilm organization and of cellular ultrastructure were evaluated through several microscopy techniques (light, laser confocal and transmission electron microscopy). Zn(II)e6Me once activated with light for 60 or 90 s was able to remove around 60% of the biofilm's biomass. It was more efficient than TBO and RB and showed similar efficiency to TMPyP and classical irrigants, CHX and EDTA. As desirable in a PS, Zn(II)e6Me in the dark showed smaller activity than TMPyP. Only NaOCl revealed higher efficiency, with 70-90% of the biofilm's biomass removal. The organization of biofilms and the normal microbial cell ultrastructure were extensively damaged by the presence of Zn(II)e6Me. aPDT with Zn(II)e6Me showed to be an efficient antimicrobial strategy deserving further studies leading to a future clinical usage in endodontic disinfection.