Terapia fotodinâmica como coadjuvante ao tratamento endodôntico : análise da literatura e estudo em ratos

Abstract

The aims of this study were: (a) establish, through a review of the literature, the state of the art regarding the use of photodynamic therapy for the disinfection of the root canal system as well as future prospects, (b) evaluate the periapical tissues response on rats teeth with apical periodontitis, to photodynamic therapy as an adjunct to endodontic treatment through histological, microbiological and radiological analysis. Therefore, 32 left lower rats molars were exposed to the oral environment for 21 days to induce apical periodontitis. The animals were randomly divided into four groups according to proposed treatment: endodontic treatment in one session (G1); endodontic treatment in two sessions with with calcium hydroxide [Ca(OH)2] dressing for 14 days (G2) ; endodontic treatment in one session associated with photodynamic therapy (PDT) (G3) and endodontic treatment in two sessions with Ca(OH)2 for 14 days, associated with PDT (G4). After 28 days, the animals were killed and the jaws prepared for evaluation. For microbiological analysis samples were collected before and after each treatment step. Quantification of CFU/mL were analyzed using linear mixed models, showing significant microbial reduction after all proposed treatments, compared to the initial collection, although no significant difference between groups were found. The radiographic results were submitted to ANOVA, showing no statistically significant difference between groups. For histological data, Kruskal-Wallis test were used, followed by Mann-Whitney U test for those cases where differences were detected. These differences were found in neutrophils and eosinophils populations in groups where PDT was used and macrophages and giant cells when Ca(OH)2 was used, with or without PDT. These data seem to point to a better repair quality when PDT is applied, caused by laser biomodulator effect in periapical tissues. The association of PDT with an interappointment dressing with Ca(OH)2 produces better conditions to stimulate repair, being more research needed to determine this relationship.