Antibacterial activity of silver nanoparticles activated by photodynamic therapy in infected root canals

Root canal disinfection includes mechanical, chemical and biological struggle against microorganisms (MOs). Photodynamic therapy (PDT) and nanoparticle (NP) agents may be proposed as an alternative for use against intracanal infections due to their ability to disrupt biofilm and prevent bacterial adhesion to dentin. The use of NP agents in combination with light/photosensitizer (PS) agents increases the efficiency of PDT in root canal disinfection.The aim of the study was to evaluate the effect of light application - PDT - on the antibacterial activity of the combination of a PS agent (toluidine blue O -TBO) and an NP agent (silver nanoparticles - AgNPs) for the disinfection of the root canals inoculated with Enterococcus faecalis (E. faecalis).In this study, concentrations of 20 ppm of TBO and 10 ppm of AgNPs, which showed the highest antibacterial activity against E. faecalis in the TBO/AgNPs combination, were used according to the preliminary studies. After instrumentation, 120 human, single-rooted, straight-canal mandibular premolars of a standard length of 13 mm were contaminated with bacteria, and experimental procedures were conducted against 21-day-old mature biofilm. The teeth were randomly divided into 5 main experimental groups: TBO/light; AgNPs; TBO/AgNPs; AgNPs/light; and TBO/AgNPs/light. Then, these main groups were divided into 2 subgroups each, according to the 2 application time periods (30 s and 60 s) (n = 10). The remaining 20 teeth constituted positive and negative control groups. The data was analyzed with the Kolmogorov-Smirnov test, one-way analysis of variance (ANOVA), Tukey's honestly significant difference (HSD) test, and the Bonferroni correction.The NaOCl group provided a bacterial reduction that was higher than in all other groups in a statistically significant manner. Light application on the TBO/AgNPs combination was the group that provided the highest bacterial reduction after NaOCl.The photoactivation of the TBO/AgNPs combination led to an increase in the effect of PDT, and it has the potential to be used as an adjunct for disinfection of the root canal system.