根尖周炎是一种生物膜介导的疾病;因此,抗菌方法对于治愈或阻止其发展至关重要。为了寻求实现这一目标的有效策略,抗微生物光动力疗法(aPDT)已成为经典牙髓冲洗溶液和抗生素的替代方案.本关键审查的目的是总结光敏剂(PS)的现有证据,这些证据已在不同领域的众多研究中得到证实,并结合了几种抗菌策略。以及新兴的选择,以优化它们的特性和效果,这些特性和效果可能在不久的将来在基础牙髓研究中转化和有用。已发布的数据特别支持继续寻找理想的牙髓光敏剂的需要,也就是说,一种作为优良的抗微生物剂而不会对人宿主细胞产生毒性或呈现牙齿变色的风险。目前的实验研究文献主要依赖于混合消毒方案的评估,将已经可用的方法与aPDT结合起来作为辅助治疗。在这次审查中,评估了几种有关APDT效率的方法,例如使用噬菌体,生物聚合物,药物和光输送系统,外排泵抑制剂,负压系统,和肽。作者还分析了它们与其他aPDT改进方法的结合,如声动力疗法。所有上述技术都已经过测试,我们强调了每种配方的生物学挑战,预测收集的信息可能会鼓励开发其他有效的光敏材料,除了在牙髓基础研究中有用。此外,特别注意致力于详细条件的研究,aPDT功能侧重于PS增强器策略,以及各自的最终抗菌结果。从所有提到的方法来看,这两个最广泛讨论,并显示出最有希望的结果为牙髓的目的是药物递送系统(在纳米粒子的强大发展)和PS增溶剂。
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.