Advancing Photodynamic Therapy for Endodontic Disinfection with Nanoparticles: Present Evidence and Upcoming Approaches

The persistence of microorganisms in the root canal system is one of the leading causes of root canal treatment failure. Root canal anatomy is complex, and it is often a challenge to obtain optimal disinfection. Biofilms of putative pathogens hidden inside dentin tubules and other root canal ramifications may limit current disinfection protocols. The search for additional disinfection of the root canal has been intensely carried out over the last twenty years. Antimicrobial photodynamic therapy (aPDT) is an adjunctive, conservative, non-selective bacterial kill approach. aPDT has been used to improve root canals disinfection without inducing bacterial resistance. This review focuses on the up-to-date aPDT performance and upcoming promising strategies for disinfection of the root canal system. First, we summarized the barriers encountered by photosensitizer (PS) and light delivery applied to root canal disinfection. Second, we compile the most updated clinical literature. A systematic search for scientific articles was conducted in PubMed, MEDLINE, SCOPUS, and EMBASE to screen the related in vivo studies about this theme. Third, we summarized and critically analyzed the current developments to overcome the aPDT limitations, and we revealed upcoming perspectives in this scoping literature review. We present a timely and opportune review article focusing on the significant potential of aPDT in endodontic disinfection. aPDT offers multiple capabilities that may be considered toward the root canal system’s disinfection with future outlooks in nanosized-platforms’ design and performance.