Efficacy of photodynamic therapy and sodium hypochlorite on the disinfection of <i>Enterococcus faecalis</i> in infected root canal: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHENG Taijing , ZHENG Jiawen , LIU Honghong ,  WANG Ping

Department of Stomatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding author：

WANG Ping, Email: cqykdxwp@126.com

Keywords：

Photodynamic therapy; Sodium hypochlorite; Root canal; Enterococcus faecalis; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201902086

Video：

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Objectives To systematically review the efficacy of photodynamic therapy (PDT) and sodium hypochlorite (NaClO) for removal of Enterococcus faecalis (E. faecalis) in root canal therapy.Methods We searched PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases to collect randomized controlled trials (RCTs) on PDT versus NaClO for removal of E. faecalis from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.Results A total of 17 RCTs were included. The results of meta-analysis showed that, comparing PDT with 5.25%NaClO, there was no significant difference in the remaining colony-forming units (CFUs) of E. faecalis between both groups (MD=0.55, 95%CI −0.72 to 1.83, P=0.40); comparing PDT with 2.5%NaClO, there was no significant difference in the remaining CFUs of E. faecalis between both groups (MD=0.54, 95%CI −0.32 to 1.41, P=0.22).Conclusions The current evidence indicates that PDT and NaClO show similar efficacy against the intracanal E. faecalis. Due to the limited quality and quantity of included studies, more high quality studies are required to verify the above conclusions.

Citation： ZHENG Taijing, ZHENG Jiawen, LIU Honghong, WANG Ping. Efficacy of photodynamic therapy and sodium hypochlorite on the disinfection of Enterococcus faecalis in infected root canal: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(8): 946-952. doi: 10.7507/1672-2531.201902086 Copy

1.	Haapasalo M, Endal U, Zandi H, et al. Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Topics, 2005, 10(1): 77-102.
2.	Mônika CM, Fröner IC. A scanning electron microscopic evaluation of different root canal irrigation regimens. Braz Oral Res, 2006, 20(3): 235-240.
3.	Eldeniz AU, Ozer F, Hadimli HH, et al. Bactericidal efficacy of Er, Cr: YSGG laser irradiation against Enterococcus faecalis compared with NaClO irrigation: an ex vivo pilot study. Int Endod J, 2007, 40(2): 112-119.
4.	黄定明, 周学东. 感染根管的治疗难点和对策. 华西口腔医学杂志, 2011, 29(3): 225-228.
5.	Rôças IN, Siqueira JF Jr, Santos KR. Association of Enterococcus faecalis with different forms of periradicular diseases. J Endod, 2004, 30(5): 315-320.
6.	金艳, 邹韵秋, 郑雨燕. 醋酸氯己定和次氯酸钠对粪肠球菌抑菌作用的体外研究. 口腔医学研究, 2011, 27(5): 386-388.
7.	McGurkin-Smith R, Trope M, Caplan D, et al. Reduction of intracanal bacteria using GT rotary instrumentation, 5.25% NaClO, EDTA, and Ca(OH)2. J Endod, 2005, 31(5): 359-363.
8.	Kvist T, Molander A, Dahlén G, et al. Microbiological evaluation of one- and two-visit endodontic treatment of teeth with apical periodontitis: a randomized, clinical trial. J Endod, 2004, 30(8): 572-576.
9.	Siqueira JF Jr, Rôças IN, Paiva SS, et al. Bacteriologic investigation of the effects of sodium hypochlorite and chlorhexidine during the endodontic treatment of teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007, 104(1): 122-130.
10.	Zan R, Hubbezoglu I, Sümer Z, et al. Antibacterial effects of two different types of laser and aqueous ozone against Enterococcus faecalis in root canals. Photomed Laser Surg, 2013, 31(4): 150-154.
11.	Meisel P, Kocher T. Photodynamic therapy for periodontal diseases: state of the art. J Photochem Photobiol B, 2005, 79(2): 159-170.
12.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
13.	Benedicenti S, Cassanelli C, Signore A, et al. Decontamination of root canals with the gallium-aluminum-arsenide laser: an in vitro study. Photomed Laser Surg, 2008, 26(4): 367-370.
14.	Cheng X, Guan S, Lu H, et al. Evaluation of the bactericidal effect of Nd:YAG, Er:YAG, Er,Cr:YSGG laser radiation, and antimicrobial photodynamic therapy (aPDT) in experimentally infected root canals. Lasers Surg Med, 2012, 44(10): 824-831.
15.	孙盼盼, 邹朝晖, 陶亚东, 等. 光动力疗法对侧支根管内粪肠球菌杀灭作用的实验研究. 中国激光医学杂志, 2012, 21(6): 370-374.
16.	Miranda RG, Santos EB, Souto RM, et al. Ex vivo antimicrobial efficacy of the EndoVac system plus photodynamic therapy associated with calcium hydroxide against intracanal Enterococcus faecalis. Int Endod J, 2013, 46(6): 499-505.
17.	Ashofteh K, Sohrabi K, Iranparvar K, et al. In vitro comparison of the antibacterial effect of three intracanal irrigants and diode laser on root canals infected with Enterococcus faecalis. Iran J Microbiol, 2014, 6(1): 26-30.
18.	靳晓兰, 邹朝晖, 张亚男, 等. 光动力疗法联合EDTA进行根管消毒的体外研究. 口腔医学研究, 2014, 30(4): 317-320.
19.	Bago Jurič I, Plečko V, Anić I, et al. Antimicrobial efficacy of photodynamic therapy, Nd:YAG laser and QMiX solution against Enterococcus faecalis biofilm. Photodiagnosis Photodyn Ther, 2016, 13: 238-243.
20.	Sohrabi K, Sooratgar A, Zolfagharnasab K, et al. Antibacterial activity of diode laser and sodium hypochlorite in enterococcus faecalis-contaminated root canals. Iran Endod J, 2016, 11(1): 8-12.
21.	Soares JA, Santos Soares SMC, Santos César CA, et al. Monitoring the effectiveness of photodynamic therapy with periodic renewal of the photosensitizer on intracanal Enterococcus faecalis biofilms. Photodiagnosis Photodyn Ther, 2016, 13: 123-127.
22.	Bago I, Plečko V, Gabrić Pandurić D, et al. Antimicrobial efficacy of a high-power diode laser, photo-activated disinfection, conventional and sonic activated irrigation during root canal treatment. Int Endod J, 2013, 46(4): 339-347.
23.	Vaziri S, Kangarlou A, Shahbazi R, et al. Comparison of the bactericidal efficacy of photodynamic therapy, 2.5% sodium hypochlorite, and 2% chlorhexidine against Enterococcous faecalis in root canals; an in vitro study. Dent Res J (Isfahan), 2012, 9(5): 613-618.
24.	Samiei M, Shahi S, Abdollahi AA, et al. The antibacterial efficacy of photo-activated disinfection, chlorhexidine and sodium hypochlorite in infected root canals: an in vitro study. Iran Endod J, 2016, 11(3): 179-183.
25.	Camacho-Alonso F, Salmerón-Lozano P, Martínez-Beneyto Y. Effects of photodynamic therapy, 2 % chlorhexidine, triantibiotic mixture, propolis and ozone on root canals experimentally infected with Enterococcus faecalis: an in vitro study. Odontology, 2017, 105(3): 338-346.
26.	Tuncay Ö, Dinçer AN, Kuştarcı A, et al. Effects of ozone and photo-activated disinfection against Enterococcus faecalis biofilms in vitro. Niger J Clin Pract, 2015, 18(6): 814-818.
27.	Beltes C, Economides N, Sakkas H, et al. Evaluation of antimicrobial photodynamic therapy using indocyanine green and near-infrared diode laser against enterococcus faecalis in infected human root canals. Photomed Laser Surg, 2017, 35(5): 264-269.
28.	Vaid D, Shah N, Kothari D, et al. Additive effect of photoactivated disinfection on the antibacterial activity of QMix 2in1 against 6-week. J Conserv Dent, 2017, 20(1): 41-45.
29.	Estrela CRA, de Oliveira JD, Tirintan FC, et al. Antimicrobial potential of laser diode in infected dentin. J Contemp Dent Pract, 2018, 19(8): 904-909.
30.	Stuart CH, Schwartz SA, Beeson TJ, et al. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod, 2006, 32(2): 93-98.
31.	Liao YF, Mars M. Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J, 2005, 42(6): 594-600.
32.	郭惠杰, 岳林. 粪肠球菌在根管内定植模式的体外研究. 北京大学学报(医学版), 2009, 41(6): 699-701.
33.	Gomes BP, Ferraz CC, Vianna ME, et al. In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis. Int Endod J, 2001, 34(6): 424-428.
34.	Bonsor SJ, Nichol R, Reid TM, et al. An alternative regimen for root canal disinfection. Br Dent J, 2006, 201(2): 101-105.
35.	Garcez AS, Nuñez SC, Hamblim MR, et al. Photodynamic therapy associated with conventional endodontic treatment in patients with antibiotic-resistant microflora: a preliminary report. J Endod, 2010, 36(9): 1463-1466.
36.	Garcez AS, Nu?ez SC, Hamblin MR, et al. Antimicrobial effects of photodynamic therapy on patients with necrotic pulps and periapical lesion. J Endod, 2008, 34(2): 138-142.
37.	Chrepa V, Kotsakis GA, Pagonis TC, et al. The effect of photodynamic therapy in root canal disinfection: a systematic review. J Endod, 2014, 40(7): 891-898.
38.	Susila AV, Sugumar R, Chandana CS, et al. Combined effects of photodynamic therapy and irrigants in disinfection of root canals. J Biophotonics, 2016, 9(6): 603-609.
39.	Rios A, He J, Glickman GN, et al. Evaluation of photodynamic therapy using a light-emitting diode lamp against Enterococcus faecalis in extracted human teeth. J Endod, 2011, 37(6): 856-859.

1. Haapasalo M, Endal U, Zandi H, et al. Eradication of endodontic infection by instrumentation and irrigation solutions. Endod Topics, 2005, 10(1): 77-102.
2. Mônika CM, Fröner IC. A scanning electron microscopic evaluation of different root canal irrigation regimens. Braz Oral Res, 2006, 20(3): 235-240.
3. Eldeniz AU, Ozer F, Hadimli HH, et al. Bactericidal efficacy of Er, Cr: YSGG laser irradiation against Enterococcus faecalis compared with NaClO irrigation: an ex vivo pilot study. Int Endod J, 2007, 40(2): 112-119.
4. 黄定明, 周学东. 感染根管的治疗难点和对策. 华西口腔医学杂志, 2011, 29(3): 225-228.
5. Rôças IN, Siqueira JF Jr, Santos KR. Association of Enterococcus faecalis with different forms of periradicular diseases. J Endod, 2004, 30(5): 315-320.
6. 金艳, 邹韵秋, 郑雨燕. 醋酸氯己定和次氯酸钠对粪肠球菌抑菌作用的体外研究. 口腔医学研究, 2011, 27(5): 386-388.
7. McGurkin-Smith R, Trope M, Caplan D, et al. Reduction of intracanal bacteria using GT rotary instrumentation, 5.25% NaClO, EDTA, and Ca(OH)2. J Endod, 2005, 31(5): 359-363.
8. Kvist T, Molander A, Dahlén G, et al. Microbiological evaluation of one- and two-visit endodontic treatment of teeth with apical periodontitis: a randomized, clinical trial. J Endod, 2004, 30(8): 572-576.
9. Siqueira JF Jr, Rôças IN, Paiva SS, et al. Bacteriologic investigation of the effects of sodium hypochlorite and chlorhexidine during the endodontic treatment of teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007, 104(1): 122-130.
10. Zan R, Hubbezoglu I, Sümer Z, et al. Antibacterial effects of two different types of laser and aqueous ozone against Enterococcus faecalis in root canals. Photomed Laser Surg, 2013, 31(4): 150-154.
11. Meisel P, Kocher T. Photodynamic therapy for periodontal diseases: state of the art. J Photochem Photobiol B, 2005, 79(2): 159-170.
12. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
13. Benedicenti S, Cassanelli C, Signore A, et al. Decontamination of root canals with the gallium-aluminum-arsenide laser: an in vitro study. Photomed Laser Surg, 2008, 26(4): 367-370.
14. Cheng X, Guan S, Lu H, et al. Evaluation of the bactericidal effect of Nd:YAG, Er:YAG, Er,Cr:YSGG laser radiation, and antimicrobial photodynamic therapy (aPDT) in experimentally infected root canals. Lasers Surg Med, 2012, 44(10): 824-831.
15. 孙盼盼, 邹朝晖, 陶亚东, 等. 光动力疗法对侧支根管内粪肠球菌杀灭作用的实验研究. 中国激光医学杂志, 2012, 21(6): 370-374.
16. Miranda RG, Santos EB, Souto RM, et al. Ex vivo antimicrobial efficacy of the EndoVac system plus photodynamic therapy associated with calcium hydroxide against intracanal Enterococcus faecalis. Int Endod J, 2013, 46(6): 499-505.
17. Ashofteh K, Sohrabi K, Iranparvar K, et al. In vitro comparison of the antibacterial effect of three intracanal irrigants and diode laser on root canals infected with Enterococcus faecalis. Iran J Microbiol, 2014, 6(1): 26-30.
18. 靳晓兰, 邹朝晖, 张亚男, 等. 光动力疗法联合EDTA进行根管消毒的体外研究. 口腔医学研究, 2014, 30(4): 317-320.
19. Bago Jurič I, Plečko V, Anić I, et al. Antimicrobial efficacy of photodynamic therapy, Nd:YAG laser and QMiX solution against Enterococcus faecalis biofilm. Photodiagnosis Photodyn Ther, 2016, 13: 238-243.
20. Sohrabi K, Sooratgar A, Zolfagharnasab K, et al. Antibacterial activity of diode laser and sodium hypochlorite in enterococcus faecalis-contaminated root canals. Iran Endod J, 2016, 11(1): 8-12.
21. Soares JA, Santos Soares SMC, Santos César CA, et al. Monitoring the effectiveness of photodynamic therapy with periodic renewal of the photosensitizer on intracanal Enterococcus faecalis biofilms. Photodiagnosis Photodyn Ther, 2016, 13: 123-127.
22. Bago I, Plečko V, Gabrić Pandurić D, et al. Antimicrobial efficacy of a high-power diode laser, photo-activated disinfection, conventional and sonic activated irrigation during root canal treatment. Int Endod J, 2013, 46(4): 339-347.
23. Vaziri S, Kangarlou A, Shahbazi R, et al. Comparison of the bactericidal efficacy of photodynamic therapy, 2.5% sodium hypochlorite, and 2% chlorhexidine against Enterococcous faecalis in root canals; an in vitro study. Dent Res J (Isfahan), 2012, 9(5): 613-618.
24. Samiei M, Shahi S, Abdollahi AA, et al. The antibacterial efficacy of photo-activated disinfection, chlorhexidine and sodium hypochlorite in infected root canals: an in vitro study. Iran Endod J, 2016, 11(3): 179-183.
25. Camacho-Alonso F, Salmerón-Lozano P, Martínez-Beneyto Y. Effects of photodynamic therapy, 2 % chlorhexidine, triantibiotic mixture, propolis and ozone on root canals experimentally infected with Enterococcus faecalis: an in vitro study. Odontology, 2017, 105(3): 338-346.
26. Tuncay Ö, Dinçer AN, Kuştarcı A, et al. Effects of ozone and photo-activated disinfection against Enterococcus faecalis biofilms in vitro. Niger J Clin Pract, 2015, 18(6): 814-818.
27. Beltes C, Economides N, Sakkas H, et al. Evaluation of antimicrobial photodynamic therapy using indocyanine green and near-infrared diode laser against enterococcus faecalis in infected human root canals. Photomed Laser Surg, 2017, 35(5): 264-269.
28. Vaid D, Shah N, Kothari D, et al. Additive effect of photoactivated disinfection on the antibacterial activity of QMix 2in1 against 6-week. J Conserv Dent, 2017, 20(1): 41-45.
29. Estrela CRA, de Oliveira JD, Tirintan FC, et al. Antimicrobial potential of laser diode in infected dentin. J Contemp Dent Pract, 2018, 19(8): 904-909.
30. Stuart CH, Schwartz SA, Beeson TJ, et al. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod, 2006, 32(2): 93-98.
31. Liao YF, Mars M. Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J, 2005, 42(6): 594-600.
32. 郭惠杰, 岳林. 粪肠球菌在根管内定植模式的体外研究. 北京大学学报(医学版), 2009, 41(6): 699-701.
33. Gomes BP, Ferraz CC, Vianna ME, et al. In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis. Int Endod J, 2001, 34(6): 424-428.
34. Bonsor SJ, Nichol R, Reid TM, et al. An alternative regimen for root canal disinfection. Br Dent J, 2006, 201(2): 101-105.
35. Garcez AS, Nuñez SC, Hamblim MR, et al. Photodynamic therapy associated with conventional endodontic treatment in patients with antibiotic-resistant microflora: a preliminary report. J Endod, 2010, 36(9): 1463-1466.
36. Garcez AS, Nu?ez SC, Hamblin MR, et al. Antimicrobial effects of photodynamic therapy on patients with necrotic pulps and periapical lesion. J Endod, 2008, 34(2): 138-142.
37. Chrepa V, Kotsakis GA, Pagonis TC, et al. The effect of photodynamic therapy in root canal disinfection: a systematic review. J Endod, 2014, 40(7): 891-898.
38. Susila AV, Sugumar R, Chandana CS, et al. Combined effects of photodynamic therapy and irrigants in disinfection of root canals. J Biophotonics, 2016, 9(6): 603-609.
39. Rios A, He J, Glickman GN, et al. Evaluation of photodynamic therapy using a light-emitting diode lamp against Enterococcus faecalis in extracted human teeth. J Endod, 2011, 37(6): 856-859.

Chinese Journal of Evidence-Based Medicine

Efficacy of photodynamic therapy and sodium hypochlorite on the disinfection of Enterococcus faecalis in infected root canal: a meta-analysis

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