Comparative evaluation of antimicrobial effectiveness of photodynamic therapy using curcumin and beta vulgaris extract in teeth with periapical pathology :An in vivo study

Need for the study-

Despite the promising individual outcomes of curcumin and beetroot as natural photosensitizers  in vitro models there is a lack of comparative in vivo studies evaluating their antimicrobial effectiveness in teeth with periapical pathology. The clinical relevance of these agents in real-time biological environments remains underexplored.

Thus, a study comparing curcumin mediated aPDT and beetroot mediated aPDT following standard chemo mechanical preparation, could provide valuable insight into their relative efficacy biocompatibility and potential as low cost natural alternatives for endodontic disinfection.

This study is a randomized double blind parallel group  single centre trial wherein the effect of photodynamic therapy using curcumin and beet root extract on the microbial load in teeth with periapical pathology is assessed.

Brief summary of the process

METHODOLOGY:

Obtaining the herbal extracts:

The herbal extracts Curcumin and Beta vulgaris will be obtained from AGHP enterprises Chennai India and manufacturer has given authentication certificate for the herbal extracts.

 Preparation of irrigation solution:

Beta vulgaris and Curcumin will be dissolved in a DMSO to a concentration of 0.5 mg per mL

 Access opening and Chemomechanical preparation

 Patients reporting to the department of Conservative Dentistry and Endodontics with complaint of pain will be screened for eligibility after assessing the inclusion and exclusion criteria for this in vivo study .

Healthy patients ,between 18 to 55 years will be shortlisted. The participants will be allotted to  2 different groups by randomization.

After explaining each patient about the study and procedure they will be asked to sign an informed consent form.

After administration of local anaesthesia rubber dam isolation will be obtained access opening will be done and working length will be measured using J morita root ZX 2 PLUS endomotor.The root canal contents  that is dentinal shavings will  be collected  in normal saline in eppendoff tube before  proceeding for chemomechanical preparation.This will be sample 1.

Chemomechanical preparation will be performed with protaper gold of Dentsply til F1 or F2 according to manufacturer’s instructions using 3 percent  NaOCl,saline  and EDTA 17 percent  as irrigating solutions alternatively .Canal instrumentation is either done by crown down or hybrid method depending upon the canal configuration. To neutralize NaoCl the root canal contents will be rinsed with 1 mL 5 percent  sodium thiosulphate and 1 mL of normal saline for 30 seconds. The root canal contents that is dentinal shavings will collected in normal saline  before  proceeding for photodynamic therapy.This will be sample 2.

 Photodynamic therapy

Depending on the group assigned curcumin or beet root photodynamic therapy will be done . The respective photosensitizers will be injected into the root canals and remained for 120 seconds prior to irradiation with Novolase dual wave endo laser. PDT will be carried out for 120 seconds by means of a Novolase dual wave endo laser with a power peak at 640 nm and output intensity of 240 mw per cm square. The irradiation will be  performed using an endodontic tip of 0.5 mm diameter which will be  introduced into the canal up to ½ of the working length.Immediately after photodynamic therapy, the root canals were irrigated with 5mL of sterile saline solution for complete removal of the photosensitizer. The root canal contents that is dentinal shavings will be collected which will be the final sample.This will be sample 3.

Microbiological culture

The shavings that is all the three samples will then be transferred into eppendorf tubes containing 1 ml of normal saline and will be vortexed for 1 minute. The diluted bacterial suspensions will be cultured on Blood  agar plates using the Spread plate technique. After 24 hours of incubation colony forming units  will be counted using a colony counter. The actual bacterial counts will be calculated reported as CFU per mL for each sample .