This document provides information on various cavity disinfectants used in operative dentistry. It discusses traditional disinfectants such as chlorhexidine gluconate, sodium hypochlorite, and benzalkonium chloride. It also covers natural disinfectants like propolis and aloe vera as well as nanoparticles and peroxynitric acid. For each disinfectant, the document outlines their antimicrobial effectiveness, mechanisms of action, effects on the pulp and restorative treatments, as well as any disadvantages or side effects. The document thus serves as a literature review on cavity disinfectants and their efficacy and effects in dental procedures.

1. Cavity Disinfectants in
Operative Dentistry
Dr.SheetalKotni

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EN TER TITLE
EN TER TITLE
EN TER TITLE
CONTENTS
Introduction
History
Cavity disinfectants:
• Chlorhexidine gluconate
• Sodium hypochlorite
• Benzalkonium chloride
• Iodine based disinfectants
• LASERS
• Ozone
• Naturally based disinfectants
 Propolis
 Aloe vera
 Tea tree oil
 Salvadora persica
 Morinda citrofolia
• Nanoparticles
 Silver
 Zinc oxide
 Titanium dioxide
• Peroxynitric acid
Conclusion
• Antimicrobial
effectiveness
• MOA
• Effects on the
pulp
• Effects on
restorative
treatment
• Cons
• Side effects

3. Introduction
• During tooth cavity preparation, the success of
restorative treatment can be affected by bacterial
remnants in the cavity walls.
• Bacteria remaining after restorative procedure may
survive and multiply, especially in the presence of
microleakage: Pulpal irritation, risk of recurrent
caries, and/or postoperative sensitivity, and
therefore failure of the dental restoration.
• Attempts at the complete removal of deep carious
dentin, by solely mechanical means: Pulpal violation
and/or gross destruction of the tooth structure.
• This seminar reviews the literature on different
disinfectant materials and techniques that have
been reported to be used during cavity preparation
and their efficacy as antimicrobial agents and
reported effects on dental restorations.

4. History
Brännström and Nyborg, early 1970s
• Emphasized the importance of eliminating bacteria
remaining on cavity walls after caries excavation by
means of antibacterial agents.
• Recommended disinfecting the cavity preparation
before inserting the restoration.

5. History
How did Cavity disinfection come into the actual
scenario/ Rationale?
• MID modalities such as ART use hand instruments to
remove soft, demineralized dental tissues followed by
the placement of an adhesive restoration.
• However, the available evidence pertaining to efficacy of
hand instruments in elimination of cariogenic bacteria
suggests that neither color nor dentin consistency is
effective in differentiating the level of infection.
• Bacteria remain in the cavity even when excavation is
carried to firm tissue and hence quite a few ART
restorations fail due to secondary caries development
subsequently.
• Thus, the survival of ART restorations would probably
increase if near total elimination of cariogenic
microorganisms could be done in the process of cavity
cleaning before going ahead with the restoration.
• The use of disinfecting agents for achieving this goal could
herald a new beginning for the field of contemporary,
minimal intervention dentistry
Prabhakar AR, Karuna YM, Yavagal C, Deepak BM. Cavity disinfection in minimally invasive dentistry-comparative evaluation of Aloe vera and
propolis: A randomized clinical trial. Contemporary clinical dentistry. 2015 Mar;6(Suppl 1):S24.

6. Cavity disinfectants

7. Bin-Shuwaish MS. Effects and
Effectiveness of Cavity Disinfectants in Operative Dentistry: A
Literature Review. J Contemp Dent Pract 2016;17(10):867-879
Cavity
disinfectants
Traditional
NaOCl CHX
Benzalkonium
chloride
Iodine based
disinfectants
Natural
Propolis
Aloe vera
Tea tree oil
Salvadora persica
Morinda citrofolia
Nanoparticles
Silver
Zinc oxide
Titanium dioxide
Contemporary:
Peroxynitric acid

8. Bin-Shuwaish MS. Effects and
Effectiveness of Cavity Disinfectants in Operative Dentistry: A
Literature Review. J Contemp Dent Pract 2016;17(10):867-879
Chlorhexidine gluconate
• Biguanide biocide
• Inhibits the formation and progression of dental
plaque and has been used as an oral antimicrobial
agent since the 1970s.
• Most widely used antimicrobial agents in oral health
• “Gold standard” of oral antiseptics.
• Different concentrations: 0.12 to 0.2% mouthrinses,
2% cavity-cleaning solutions, and 0.5 to 1% gels.
Corsodyl, Consepsis

9. • Gram-positive, especially Streptococcus mutans, and Gram-negative bacteria
• Effects on Gram-negative were to a lesser extent
• Suppresses the growth of S. mutans.
• Reduced susceptibility of Staphylococci to CHX has also been reported.
• Bactericidal at high concentrations and bacteriostatic at low concentrations.
• At low concentrations, CHX destroys the cell wall then attacks the cytoplasmic membrane.
• At high concentrations: Causes coagulation of intracellular components, leading to
cytoplasmic congealing.
• Range of application times:5 to 120 minutes.
• Most of researchers applied the CHX for 60 seconds.
• Sassone et al: found that 0.12% CHX did not eliminate Enterococcus faecalis at any time
interval, recommended using CHX at a concentration greater than 0.12%.
Bin-Shuwaish MS. Effects and
Effectiveness of Cavity Disinfectants in Operative Dentistry: A
Literature Review. J Contemp Dent Pract 2016;17(10):867-879
Chlorhexidine gluconate: Antibacterial effectiveness
• Gram-positive, especially Streptococcus mutans, and Gram-negative bacteria
• Effects on Gram-negative were to a lesser extent
• Suppresses the growth of S. mutans.
• Reduced susceptibility of Staphylococci to CHX has also been reported.
• Range of application times: 5 to 120 minutes.
• Most of researchers applied the CHX for 60 seconds.
• Sassone et al: found that 0.12% CHX did not eliminate Enterococcus faecalis at
any time interval, recommended using CHX at a concentration greater than
0.12%.

10. • Gram-positive, especially Streptococcus mutans, and Gram-negative bacteria
• Effects on Gram-negative were to a lesser extent
• Suppresses the growth of S. mutans.
• Reduced susceptibility of Staphylococci to CHX has also been reported.
• Bactericidal at high concentrations and bacteriostatic at low concentrations.
• At low concentrations, CHX destroys the cell wall then attacks the cytoplasmic membrane.
• At high concentrations: Causes coagulation of intracellular components, leading to cytoplasmic
congealing.
• Range of application times:5 to 120 minutes.
• Most of researchers applied the CHX for 60 seconds.
• Sassone et al: found that 0.12% CHX did not eliminate Enterococcus faecalis at any time interval,
recommended using CHX at a concentration greater than 0.12%.
Bin-Shuwaish MS. Effects and
Effectiveness of Cavity Disinfectants in Operative Dentistry: A
Literature Review. J Contemp Dent Pract 2016;17(10):867-879
Chlorhexidine gluconate: Mechanism of action
• Bactericidal at high
concentrations and
bacteriostatic at low
concentrations.
• At low concentrations, CHX
destroys the cell wall then
attacks the cytoplasmic
membrane.
• At high concentrations:
Causes coagulation of
intracellular components,
leading to cytoplasmic
congealing.

11. Chlorhexidine gluconate: Effect on the pulp
• 2% aqueous solution: biocompatible and toxicologically safe disinfectant.
• Pretreatment in deep caries lesions during restorative treatment:
increases the clinical success of both direct and indirect pulp-capping
procedures.
• Pameijer et al: 2% CHX applied for 60 seconds immediately after
contamination of the exposed pulp was an effective hemostatic agent and
aided in dentin bridge formation

12. Chlorhexidine gluconate: Effects on Restorative Treatment
• Meiers et al: Effects of CHX disinfectant on composite restorations,
material-specific
• Syntac: Adverse effect on bonding compared with the tenure-adhesive
system when used after the cavity was cleaned with 2% CHX.
• CHX wash, 2% solution, before composite bonding: Successfully preserve
the bond strength, up to 6 months, when etch-and-rinse adhesive
systems were used.

13. Chlorhexidine gluconate: Effects on Restorative Treatment
• The preserved bond interface explained by the inhibitory ability of CHX
to the matrix metalloproteinases (MMPs) found in etched dentin.
• MMPs in dentin: degradation of the unprotected collagen fibrils within
the hybrid layer.
• Therefore, MMP inhibitors, such as CHX can play a role in the longevity of
the resin bond to dentin.
• For etch-and-rinse adhesives, CHX solutions were applied before or
after an acid-etching procedure.
• The adverse effect on bond strength of 2% CHX solutions associated
with self-etch bonding systems: may be explained by the presence of
functional monomer, 10-methacryloyloxydecyl dihydrogenphosphate (MDP),
in the bonding resin of self-etch adhesive systems, which might have
been affected by CHX bonding.

14. Chlorhexidine gluconate: Effects on Restorative Treatment
• Effects of 0.12% and 2% CHX on the µTBS: 2% CHX exhibited lower
µTBS for the self-etch adhesives. However, the bond strength was not
significantly affected in the etch-and-rinse adhesive groups
• Di Hipólito et al: µTBS of self-adhesive luting cements to dentin were
negatively affected by dentin pretreatment with 0.2% or 2% CHX

15. Chlorhexidine gluconate: Effects on Restorative Treatment
• CHX solutions did not significantly affect the microleakage of the
restorations bonded with etch-and-rinse adhesive systems
• Controversial results on the effects of CHX on microleakage when self-
etch adhesive bonding systems were used.
• Arslan et al: no significant differences between self-etch and etch-and-
rinse in dentin margins. However, in enamel margins, the etch-and-rinse
adhesive exhibited significantly less microleakage.
• On amalgam restorations and before placement of the amalgam, 2% CHX
pretreatment shown to decrease microleakage and postoperative
sensitivity

16. Chlorhexidine gluconate: Disadvantages and Side Effects
• Brownish staining of the teeth after long-term use, as with the use of
mouthrinses.
• CHX allergy is rare, may cause contact dermatitis, desquamative gingivitis,
or taste alteration.
• CHX in a high concentration (18%) has toxic effects.
• However, concentrations of up to 10% were suitable for contact with
tissue.

17. Bin-Shuwaish MS. Effects and
Effectiveness of Cavity Disinfectants in Operative Dentistry: A
Literature Review. J Contemp Dent Pract 2016;17(10):867-879
Sodium Hypochlorite
• Effective organic solvent
• MOA: Upon contact with the dentin surface, NaOCl breaks down to sodium
chloride and oxygen, causing an oxidation process in the dentin matrix
• 5.25% NaOCl solution for 15 seconds

18. Bin-Shuwaish MS. Effects and
Effectiveness of Cavity Disinfectants in Operative Dentistry: A
Literature Review. J Contemp Dent Pract 2016;17(10):867-879
Sodium Hypochlorite
Antimicrobial Effectiveness Effects on the Pulp
• Excellent tissue-dissolving action and strong
antimicrobial effectiveness on residual
bacteria.
• Vianna et al: Application of 5.25% NaOCl
solution for 15 seconds to eliminate
 Staphylococcus aureus,
 Candida albicans,
 Porphyromonas endodontalis,
 Porphyromonas gingivalis, and
 Prevotella intermedia.
• Antimicrobial activity of NaOCl: affected by
the concentration of the solution
• Cytotoxic effects in cell cultures
• In a review on the success of pulp-capping,
Hilton reported an increased pulpal
inflammatory response after the use of
NaOCl.
• Pascon et al did not recommend NaOCl to be
used for disinfecting cavities.
• In contrast, NaOCl: described to be
biocompatible with pulp and to promote pulpal
healing, with inflammatory effects limited to
superficial cells without affecting the deep
pulp tissues.

19. Bin-Shuwaish MS. Effects and
Effectiveness of Cavity Disinfectants in Operative Dentistry: A
Literature Review. J Contemp Dent Pract 2016;17(10):867-879
Sodium Hypochlorite
Effects on Restorative Treatment
• Controversial results on resin bond reported.
• Some authors: affect the hybrid layer – reduced bond strength, increased microleakage
• Others: no effects on bond strength.
• However, the effect of NaOCl pretreatment on the bond strength of composite resin is believed to
depend on the adhesive system used.
• Ercan et al: NaOCl disinfectant to be used with etch-and-rinse bonding systems, negative effect
with self etch systems on shear and tensile bond strength

20. Disadvantages
and Side
Effects
Strong oxidizer: corrosive reaction; therefore, it should be applied with great
care.
In addition to its tendency to bleach clothes, it has a bad taste and
possesses irritant effects on the surrounding tissue, especially at high
concentrations

23. BAC
Mixture of alkylbenzyldimethyl
ammonium chlorides and is a
nitrogenous
cationic agent containing a
quaternary ammonium group
with broad antimicrobial activity
Tubulicid (Global Dental
Products)
Quaternary ammonium compound
with EDTA that comes in three
forms
Tubulicid Red: 1.0% sodium
fluoride, to be used for cleaning
without removing the smear layer;
Tubulicid Blue: to disinfect the
whole tooth or multiple teeth, prior
to the cementation of crowns or
bridges;
Tubulicid Plus: stronger
cleaner, root canal irrigant to
remove the smear layer and open
dentinal tubules.
Benzalkonium chloride

24. Antimicrobial
Effectiveness
Reported to be less than CHX
MOA
Due to disruption of intermolecular
interactions. This can cause dissociation
of cellular membrane lipid bilayers, which
compromises cellular permeability
controls and induces leakage of cellular
contents
Effects on the Pulp
Reported to be compatible with the
dental pulp
Disadvantages and
Side Effects
High concentration: can cause
allergic reactions and toxic effects,
if a concentration of 10% or more is
ingested, severe complications may
occur which may even lead to death
Benzalkonium chloride

25. MMP Inhibitor
May preserve the adhesive bond
of the resin restoration to dentin
Effects of diff. concentrations of BAC on
the preservation of adhesive interfaces by
using two etch-and-rinse adhesives,
Sabatini et al
Improvement in bond strength and
bond stability after 18 months
Sharma et al
Recommended that only etch-and-
rinse bonding systems be
used when Tubulicid Red is used as a
cavity disinfectant
Türkün et al
Tubulicid Red did not significantly
affect the
sealing ability of self-etched
adhesives
Benzalkonium chloride: Effects on Restorative Treatment

26. Unstable solutions with
wide-ranging effects on
microorganisms
The antibacterial effects of
these agents are attributed
to the presence
of molecular iodine (I2) in
these solutions
Iodine potassium iodide (I2-KI), potassium
iodide/copper sulfate (I2-KI/CuSO4),
iodine disclosing/disinfection
solution (I2DDS), and
povidone-iodine (PVP-I)
Iodine-based Disinfectants Ora-5

27. • Bactericidal biocides.
• MOA: Ability to destroy the bacterial cell by attacking its proteins, nucleotides, and
fatty acids.
• Reported to disclose and eliminate bacteria in plaque, and their effectiveness
against cariogenic bacteria
Iodine-based Disinfectants: Antimicrobial Effectiveness

28. da Silva et al: effect of 2%
I2DDS on the µTBS. They
found µTBS to be
significantly decreased
for ethanol- and water-
based adhesive systems
Cunningham et al: SBS for
0.11% I2-KI/CuSO4 < of 2%
CHX on RMGIC
Ora-5: commercially available
I2-KI/CuSO4-based oral
disinfectant
composed of 0.3% iodine,
0.15% potassium iodide, and
5.5% copper sulfate: Gap
formation, ineffective sealing,
poor bond strength
Iodine-based Disinfectants: Effect on Restorative treatment
Disadvantages: Iodine hypersensitivity. Contraindicated during pregnancy, and because it can cause metabolic
complications, it is also contraindicated in patients with thyroid pathosis

30. Different kinds of lasers
manufactured with different
active media that create
the beams.
These media can be of
solid state as in Er:YAG;
gas as in CO2 lasers; or
semiconductor as in
diode lasers
U.S. Food and Drug Adm. on
(FDA) approval of Er:YAG and
Er,Cr:YSGG lasers for cutting
tooth structures, these lasers
have been extensively used and
researched in restorative
dentistry
LASER: Light Amplification by Stimulated Emission of Radiation
Antimicrobial Effectiveness: Laser irradiation uses expansion of intratubular water of the bacterial cell and has thermal
and photodisruptive effects on bacteria, leading to cell growth impairment and lysis. de Sousa Farias et al:
antimicrobial photodynamic therapy (aPDT) with a LLL significantly reduced the numbers of viable bacteria in the S. mutans
biofilm.

31. Effects on the Pulp Effects on Restorative Treatment Disadvantages and Side
Effects
When using Er:YAG lasers,
water must always be used
in conjunction with the laser
to avoid any pulpal irritation
• Multiple studies: the use of Er,Cr:YSGG
or KTP lasers does not adversely affect
the bond strength of the restoration.
• The use of the Er,Cr:YSGG laser as a
cavity disinfectant with etch-and-rinse
adhesive system was found by Celik et
al to significantly increase the µTBS
compared with those not preradiated
or bonded with self-etch adhesive.
• Expensive
• Special training of personnel
• The manufacturers instructions
must be strictly followed for
each procedure performed to
avoid any side effects on the
hard/soft tissues or dental pulp
complex

33. Pale, nonstable gas,
naturally produced
by the photodissociation of
oxygen into activated
oxygen atoms, which then
react with further oxygen
molecules.
MOA
Strong oxidizer. Hence, it
possesses antibacterial activities
by disrupting the cell wall and
cytoplasmic membrane of bacteria
and therefore destruction of the
microorganism.
In dental applications, O3 can be
used in one
of three forms: Gaseous, water,
or oil.
Ozone Ozone was first used as a disinfectant in clinical practice in the 1920s by Dr Parr.
In 1950, Dr Fisch was the first to use ozonated water for dental procedures in Germany

34. O3 application for 20 seconds can eliminate 99.9% of
microorganisms in primary caries lesions
Bayson et al
Times of O3 application
for effective antimicrobial activity,
between 10 and 60 seconds,
effectiveness increasing with time
Ozone: Antimicrobial effectiveness

35. Supp.
Evidence
SBS
Cons
µTBS
Microleakage Reduced
Decreased
Expensive.
O3 devices should be
handled with care
Higher for self
etch systems
For the prophylactic application of
O3 before the sealing of pits and
fissures
Ozone: Effects on Restorative Treatment
Bin-Shuwaish MS. Effects and Effectiveness of Cavity Disinfectants in Operative Dentistry: A Literature Review. J
Contemp Dent Pract 2016;17(10):867-879

37. Naturally based
Cavity disinfectants

38. Propolis/ Bee glue Salvadora persica/the toothbrush
tree
Morinda citrofolia
Introduction • Resin-like material found in
some tree buds and
collected by honeybees
• Crooked trunk twigs used for many years
as a natural toothbrush (miswak)
• Plays a role in the promotion of oral
hygiene
Tropical tree : broad range of
therapeutic and nutritional values
Antimicrobial
Effectiveness
• Against S. mutans,
• Flavonoids and Cinnamic
acid derivatives
• PreventS bacterial cell
division and breaks down
bacterial walls and
cytoplasm
• Akca et al: Propolis≈CHX
• Antibacterial
• Low caries levels among miswak users
compared with nonusers.
• Extracts reported to remove the smear
layer upon application to dentin
• MOA: enzyme inhibition by the oxidized
compounds that act as sources of stable-
free radical, and often leading to
inactivation of the protein and loss of
function
• Kandaswamy et al: MCJ
antimicrobial activity=propolis but
lower than that of the 2% CHX.
• 6% MCJ: smear layer remover
Effects on
Restorative
Treatment
• More microleakage in self
etch adhesive system
• No significant effect on
µTBS
Salama et al: no
statistically significant difference in
microleakage between SP, CHX, NaoCl in
dentin pretreatment
Dikmen et al: self-etching adhesive
system, “NaOCl with MCJ” group
exhibited significantly higher µTBS
than the group without MC

39. Aloe vera Tea tree oil
Introduction • Aloe barbadensis Mill (A. vera) is a short
succulent herb filled with a clear viscous gel
which has potent antibacterial, antifungal, and
antiviral properties
• Gel components: aloin, aloe emodin, aloetic acid,
anthracene, aloe mannan, aloeride, antranol,
chrysophanic acid, resistanol, and saponin
• It is the volatile essential oil obtained
primarily from the Australian native plant,
Melaleuca alternifolia
• Consists of terpene hydrocarbons, mainly
monoterpenes, sesquiterpenes and their
associated alcohols which are volatile,
aromatic hydrocarbons
Antimicrobial
Effectiveness
• They inhibit protein synthesis from bacterial
cells, thus explaining their antimicrobial activity.
• Anthraquinones and saponin:direct antibacterial
activities
• Acemannan: indirect bactericidal activity through
stimulation of phagocytosis
• Through cell lysis and the loss of membrane
integrity
Effects on
Restorative
Treatment
• Improved bond strength Yet to be evaluated

42. Nanoparticles

44. In the aPDT, the photosensitizer and the
light reach the contaminated area to
produce ROS that are responsible for
antimicrobial mechanism and disinfection.
The energy delivered by the light is
responsible for the displacement of
electrons from the valence to
the conduction band.
This phenomenon leads to oxidation
processes in the valence band (e.g., through
the extraction of the hydrogen atom (H)
from the external compound) and reduction
in the conduction band (e.g., by the electron
addition for the external compound),
forming ROS as superoxide, hydroxyl
radicals, hydrogen peroxide. ROS are
responsible for interacting with the
biofilms.

45. TBO-Toluidine blue
PLGA-polylactic-co-glycolic
MB-methylene blue
ICG-indocyanine green-loaded nanospheres
rb-rose bengal
QD-Quantum dots
Balhaddad AA, Garcia IM, Ibrahim MS, Rolim JP, Gomes EA, Martinho FC, Collares FM, Xu H, Melo
MA. Prospects on Nano-Based Platforms for Antimicrobial Photodynamic Therapy Against Oral
Biofilms. Photobiomodulation, Photomedicine, and Laser Surgery. 2020 Aug 1;38(8):481-96

46. Balhaddad
AA,
Garcia
IM,
Ibrahim
MS,
Rolim
JP,
Gomes
EA,
Martinho
FC,
Collares
FM,
Xu
H,
Melo
MA.
Prospects
on
Nano-Based
Platforms
for
Antimicrobial
Photodynamic
Therapy
Against
Oral
Biofilms.
Photobiomodulation,
Photomedicine,
and
Laser
Surgery.
2020
Aug
1;38(8):481-96

47. Peroxynitric Acid
 Global attention: Use of atmospheric pressure plasma for sterilization and wound healing.
 Ikawa et al.: Plasma sterilization method using a reduced pH(<4.8) method.
 MOA:
• Hydroperoxyl radicals HOO: Protonated superoxide anion radical and is supplied under acidic conditions. . Electronically neutral
HOO easily infiltrates the cells and sterilizes by causing intracellular oxidative stress.
• Sterilization could be achieved within 180 s on carious occlusal surface of molars
• 10 s
 Ikawa et al. : Species with bactericidal action, including that found in Plasma Treated Water, is peroxynitric acid (PNA). PNA emits
HOO and NO2, which are bactericidal via the dissociation of radicals. PNA is an unstable substance with a half-life of approx. a few
minutes at room temperature; however, the half-life increases to several hours or days when it is refrigerated or frozen. First to
apply PNA for sterilization purposes. Using chemical synthesis, highly concentrated PNA solutions can be produced at low cost,
and it is better than PTW as a potential treatment strategy.

49. CONCLUSION

50. • The antibacterial effectiveness of different disinfectants has been well
documented; however, the antimicrobial potency of some agents varies
according to the percentage and time of application.
• Selection of cavity disinfectant is guarded by the type of adhesive system.
• Although the effect of disinfectant pretreatment on the tooth/restoration bond
is believed to be material based, the literature strongly supports the use of 2%
CHX solutions when etch-and-rinse adhesive systems are used.
• When a self-etch adhesive system is used, there is good evidence for the use of
1% CHX gel as a cavity disinfectant. However, more research is needed to
evaluate its biocompatibility with different systems.
• Modern disinfection modalities like laser, O3 devices, nanoparticles exhibit
promising results in terms of biocompatibility with adhesive systems and
restorative materials. However, these devices should be manipulated with care
to avoid any side effects.
• There is insufficient clinical and laboratory evidence for the use of naturally
based disinfectants; therefore, more studies to evaluate these products are
warranted.

51. REFERENCES
1. Bin-Shuwaish MS. Effects and Effectiveness of Cavity Disinfectants in Operative Dentistry: A Literature Review. J
Contemp Dent Pract 2016;17(10):867-879
2. Reddy MSC, Mahesh MC, Bhandary S, Pramod J, Shetty A. Evaluation of Effect of Different Cavity Disinfectants on Shear
Bond Strength of Composite Resin to Dentin using Two-Step Self-Etch and One-Step Self-Etch Bonding Systems: A
Comparative in vitro Study. J Contemp Dent Pract 2013;14(2):275-280.
3. Arslan I, Baygin O, Bayramoglu G, Akyol R, Tuzuner T. Effects of various agents and laser systems on antibacterial activity
and microtensile bond strength when used for cavity disinfection. J Dent Lasers 2019;13:12-8.
4. Şifa Güneş, Emrullah Bahsi, Bayram İnce, Hakan Çolak, Mehmet Dalli, İzzet Yavuz, Cafer Sahbaz & Suzan Cangül (2014)
Comparative Evaluation of the Effects of Ozone, Diode Laser, and Traditional Cavity Disinfectants on Microleakage, Ozone:
Science & Engineering: The Journal of the International Ozone Association, 36:2, 206-211,
DOI:10.1080/01919512.2013.842888
5. Prabhakar AR, Karuna YM, Yavagal C, Deepak BM. Cavity disinfection in minimally invasive dentistry-comparative evaluation
of Aloe vera and propolis: A randomized clinical trial. Contemporary clinical dentistry. 2015 Mar;6(Suppl 1):S24.
6. Goel S, Sinha DJ, Singh UP, Ahuja U, Haider N, Sharma N. Comparative evaluation of effect of chlorhexidine, Azadirachta
indica (neem), and Aloe barbadensis miller (Aloe vera) on resin-dentin bond stabilization using shear bond testing: An in
vitro study. J Conserv Dent [serial online] 2019 [cited 2020 Oct 7];22:300-4. Available from:
https://www.jcd.org.in/text.asp?2019/22/3/300/262009
7. Iwaki T et al., High microbicidal effect of peroxynitric acid on biofilm-infected dentin in a root carious tooth model and
verification of tissue safety, Journal of Oral Biosciences, https://doi.org/10.1016/j.job.2020.03.002
8. Jowkar Z, Fattah Z, Ghanbarian S, Shafiei F. The Effects of Silver, Zinc Oxide, and Titanium Dioxide Nanoparticles Used
as Dentin Pretreatments on the Microshear Bond Strength of a Conventional Glass Ionomer Cement to Dentin.
International Journal of Nanomedicine. 2020;15:4755.
9. Balhaddad AA, Garcia IM, Ibrahim MS, Rolim JP, Gomes EA, Martinho FC, Collares FM, Xu H, Melo MA. Prospects on Nano-
Based Platforms for Antimicrobial Photodynamic Therapy Against Oral Biofilms. Photobiomodulation, Photomedicine, and
Laser Surgery. 2020 Aug 1;38(8):481-96.

52. THANK
YOU