Photodynamic therapy in pediatric dentistry

Abstract

Conservation of deciduous teeth with pulp alterations caused by caries and trauma is a major therapeutic challenge in pediatric dentistry as a result of the internal anatomy and life cycle characteristic. It is essential that the root canal procedures sanitizers have a performance in eliminating bacterial. In this context, antimicrobial photodynamic therapy (PAT) is promising and emerging as adjuvant therapy in an attempt to eliminate the microorganisms persistent to chemi-mechanical preparation. Since there is presence of oxygen in cells, photosensitizer activated by light can react with molecules in its vicinity by electrons' or hydrogen's transfer, leading to microorganism death. This paper reports the case of 4-year-old patient, female, with early childhood caries. The proposed endodontic treatment incuded chemomechanical treatment allied to PAT in the decontamination of root canals using methylene blue dye 50 μg/mL during 3-5 minutes and 40 J/cm(2) as energy density, taking into account the need for tissue penetration and effectiveness of PAT inside the dentinal tubules.

Figure 1

Clinical aspect of early childhood caries.

Figure 2

Radiographic image presenting periapical lesion and increased pericementary space.

Figure 3

Early childhood caries (lingual aspect).

Figure 4

Root canal opened with spherical bur in high and low speed.

Figure 5

Chemical-mechanical preparation using K-flex file with endo-PTC (ASFER, Chemical Ind, São Caetano do Sul, SP, Brazil) and NaClO 1%.

Figure 6

Use of methylene blue solution (50 μg/mL) as a photosensitizing agent and preirradiation time of 5 minutes.

Figure 7

Dentin tissue stained with photosensitizing agent. It is important to aspirate the contents prior to light irradiation.

Figure 8

Optical fiber positioned and irradiation of red laser (40 J/cm²).

Figure 9

Laser irradiation.

Figure 10

Laser unit used (λ = 660 nm) and optical fiber (Therapy XT-DMC, São Carlos, SP, Brazil).

Figure 11

Root canal filling using calcium hydroxide Calen (SSWhite Duflex, Rio de Janeiro, RJ, Brazil).

Figure 12

Root canal filling.

Figure 13

Temporary restoration with high viscosity glass ionomer cement Maxxion R (FGM Produtos Odontológicos, Joinville, SC, Brazil).

Figure 14

Final radiographic image.