The efficacy of antimicrobial photodynamic therapy in the disinfection of coronal and radicular dentine of primary teeth: A systematic review and meta-analysis.

BACKGROUND: Optimal endodontic disinfection by means of conventional root canal treatment of primary teeth remains a challenge. Recently, antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunct to conventional endodontic treatment for microbial disinfection. The purpose of this review is to critically appraise and synthesize the currently-available evidence about the antimicrobial efficacy of aPDT (antimicrobial photodynamic therapy) when used as an adjunct to traditional root canal therapy. MATERIALS AND METHODS: The focused question was ''In primary teeth needing root canal treatment (participants), is adjunct aPDT (intervention) more effective in disinfecting coronal and radicular dentine (outcomes) than root canal treatment alone (control)?'. The electronic research databases PubMED/Medline, ISI Web of Knowledge, Embase and CENTRAL (Cochrane Central Register of Controlled Trials) using relevant keyword phrases including 'antimicrobial photodynamic therapy', 'primary teeth', 'deciduous teeth', and 'endodontic treatment'. Original studies that described endodontic treatment of primary teeth or dentine using aPDT in comparison to conventional endodontic treatment were included. Case reports, reviews and other non-comparative studies were excluded. The literature search and quality assessment were carried out by two reviewers independently. RESULTS: Ultimately, 9 studies were included in this review. Overall, majority of the studies concluded that adjunct aPDT improves the antimicrobial efficacy of conventional root canal therapy. However, several sources of bias were found in the studies. CONCLUSION: Within the limitations of the studies, it is concluded that aPDT is a suitable adjunct to improve the disinfection of conventional root canal treatment. However, future studies should focus on the clinical outcomes, in relation to the reduction of microbial counts to ascertain the efficacy of aPDT in disinfection of primary dentine.

Efficacy of antimicrobial photodynamic therapy (aPDT) in reducing cariogenic bacteria in primary deciduous dentine.

AIM: The aim is to systematically review the efficacy of aPDT in minimizing cariogenic bacteria in primary dentine when compared to tooth preparation and endodontic debridement. MATERIALS AND METHODS: The focused question was: Is aPDT (intervention) effective in minimizing the cariogenic bacteria (outcome) in deciduous dentine (participants) after caries removal when compared to before aPDT or mechanical caries removal alone (controls). The keywords that were used were: 'antimicrobial photodynamic therapy', 'dentine', 'primary teeth' and 'deciduous teeth' in different combinations. Following the exclusion of the irrelevant studies, eight (seven clinical studies and one in vitro study) studies were included in the review. The data from each study was extracted and the quality of each article was assessed. RESULTS: In four out of the eight studies, aPDT with methylene blue or toluidine blue had improved the efficacy of microbial reduction in deciduous dentine when compared to conventional root canal treatment or caries removal. In four studies, no significant improvement in microbial reduction was observed following aPDT compared to caries removal or endodontic debridement without aPDT. Four studies received an overall quality grading of 'medium', three studies were assessed as having a 'low' quality and only one study received an overall grading of 'high' quality. CONCLUSION: Within the limitations of this review, aPDT may improve the anti-bacterial efficacy of restorative and endodontic procedures in deciduous teeth. However, due to lack of long-term clinical trials and robust study designs, the efficacy of aPDT in minimizing cariogenic bacteria in deciduous dentine is debatable.

Association of Dental Caries and Anthropometric Measures among Primary School Children.

Aim: This study aimed to investigate an association between dental caries status and anthropometric measures in primary school children. Methods and Materials: An analytical cross-sectional study (n = 376) was conducted among primary school children (age range = 6-9 years) registered in private schools. Non-clinical data was gathered from parents of participating children through a self-administered structured questionnaire as well as from the children through an interviewer-administered questionnaire. Clinical data included the examination of dental caries using dmft/DMFT index and anthropometric measures including calculated z-scores of height-for-age (HAZ), weight-for-age (WAZ), BMI-for-age (BAZ), and physical examination. Inferential statistics included Kruskal Wallis and linear regression for univariate and multivariate analysis respectively. Results: The proportion of dental caries in primary and secondary dentition was 67.6% and 8.2% respectively. A significant association was observed between dental caries status and HAZ, WAZ, and BAZ (p < 0.001). An inverse relation was found between low, medium, and high dental caries categories and anthropometric measures. Conclusions: In the primary dentition, dental caries were significantly and inversely related to weight-for-age, height-for-age, and BMI-for-age. Hence, it can be concluded that among the low-income population dental caries is associated with lower anthropometric outcomes in children and therefore caries management should be considered an approach impacting overall health and quality of life.

Synergistic effect of graphene oxide/calcium phosphate nanofiller in a dentin adhesive on its dentin bond integrity and degree of conversion. A scanning electron microscopy, energy dispersive X-ray spectroscopy, Fourier transform infrared, micro-Raman, and bond strength study.

The objective was to formulate and analyze a dentin adhesive incorporated with graphene oxide (GO) nanoparticle and calcium phosphate (CaP) composite. Methods comprising of scanning electron microscopy (SEM)-energy dispersive X-ray spectroscopy (EDX), micro-Raman spectroscopy, shear bond strength (SBS), and Fourier transform infrared (FTIR) spectroscopy were used to characterize nanoparticle composite, dentin bond toughness, degree of conversion (DC), and adhesive-dentin interaction. Postsynthesis of GO nanoparticles, they were functionalized with CaP using standard process. The GO-CaP composite was not added to experimental adhesive (negative control group, GO-CaP-0%), and added at 2.5 and 5 wt% to yield GO-CaP-2.5% and GO-CaP 5% groups, respectively. Teeth were set to form bonded samples utilizing adhesives in three groups for SBS testing, with and without thermocycling. The homogenous diffusion of GO-CaP composite was verified in the adhesive. Resin tags having standard penetrations were observed on SEM micrographs. The EDX analysis confirmed the occurrence of calcium, phosphorus, and carbon ions in the composite containing adhesives. The SBS test revealed highest mean values for GO-CaP-5% followed by GO-CaP-2.5%. The FTIR spectra verified the presence of apatite peaks and the micro-Raman spectra showed characteristic D and G bands for GO nanoparticles. GO-CaP composite in dentin adhesive may improve its bond strength. The addition of 5 wt% resulted in a bond strength that was superior to all other groups. GO-CaP-5% group demonstrated lower DC (to control), uniform distribution of GO and CaP composite within adhesive, appropriate dentin interaction, and resin tag formation.

Dentin Bond Integrity of Hydroxyapatite Containing Resin Adhesive Enhanced with Graphene Oxide Nano-Particles-An SEM, EDX, Micro-Raman, and Microtensile Bond Strength Study.

The aim was to synthesize and characterize an adhesive incorporating HA and GO nanoparticles. Techniques including scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX), micro-tensile bond strength (µTBS), and micro-Raman spectroscopy were employed to investigate bond durability, presence of nanoparticles inside adhesive, and dentin interaction. Control experimental adhesive (CEA) was synthesized with 5 wt% HA. GO particles were fabricated and added to CEA at 0.5 wt% (HA-GO-0.5%) and 2 wt% GO (HA-GO-2%). Teeth were prepared to produce bonded specimens using the three adhesive bonding agents for assessment of µTBS, with and without thermocycling (TC). The adhesives were applied twice on the dentin with a micro-brush followed by air thinning and photo-polymerization. The HA and GO nanoparticles demonstrated uniform dispersion inside adhesive. Resin tags with varying depths were observed on SEM micrographs. The EDX mapping revealed the presence of carbon (C), calcium (Ca), and phosphorus (P) in the two GO adhesives. For both TC and NTC samples, HA-GO-2% had higher µTBS and durability, followed by HA-GO-0.5%. The representative micro-Raman spectra demonstrated D and G bands for nano-GO particles containing adhesives. HA-GO-2% group demonstrated uniform diffusion in adhesive, higher µTBS, adequate durability, and comparable resin tag development to controls.

Influence of Hydroxyapatite Nanospheres in Dentin Adhesive on the Dentin Bond Integrity and Degree of Conversion: A Scanning Electron Microscopy (SEM), Raman, Fourier Transform-Infrared (FTIR), and Microtensile Study.

An experimental adhesive incorporated with different nano-hydroxyapatite (n-HA) particle concentrations was synthesized and analyzed for dentin interaction, micro-tensile bond strength (µTBS), and degree of conversion (DC). n-HA powder (5 wt % and 10 wt %) were added in adhesive to yield three groups; gp-1: control experimental adhesive (CEA, 0 wt % HA), gp-2: 5 wt % n-HA (HAA-5%), and gp-3: 10 wt % n-HA (HAA-10%). The morphology of n-HA spheres was evaluated using Scanning Electron Microscopy (SEM). Their interaction in the adhesives was identified with SEM, Energy-Dispersive X-ray (EDX), and Micro-Raman spectroscopy. Teeth were sectioned, divided in study groups, and assessed for µTBS and failure mode. Employing Fourier Transform-Infrared (FTIR) spectroscopy, the DC of the adhesives was assessed. EDX mapping revealed the occurrence of oxygen, calcium, and phosphorus in the HAA-5% and HAA-10% groups. HAA-5% had the greatest µTBS values followed by HAA-10%. The presence of apatite was shown by FTIR spectra and Micro-Raman demonstrated phosphate and carbonate groups for n-HA spheres. The highest DC was observed for the CEA group followed by HAA-5%. n-HA spheres exhibited dentin interaction and formed a hybrid layer with resin tags. HAA-5% demonstrated superior µTBS compared with HAA-10% and control adhesive. The DC for HAA-5% was comparable to control adhesive.