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Influence of photodynamic and sonodynamic
disinfection on the bond strength of
caries affected dentin bonded to three different
‑
tooth colored restorative materials: A
‑
comparative study
Sharma A, Raj S, Nikhil V, Mishra P, Ravider R. Influence of photodynamic and sonodynamic
disinfection on the bond strength of caries-affected dentin bonded to three different tooth-
colored restorative materials: A comparative study. Journal of Conservative Dentistry and
Endodontics. 2025 Feb 1;28(2):193-8.

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CONTENTS
 Introduction
 Aim
 Objectives
 Materials and methods
 Statistical analysis
 Results
 Discussion
 Limitations
 Conclusion
 References

3. 3
INTRODUCTION
 Partial caries removal (PCR) - total removal of all carious tissues with the
exception of caries affected dentin (CAD) that is close to the pulp.
‑
 PCR - mechanical cleaning - remove extremely disorganized and infected
dentin - preserving CAD - remineralize.
 PCR - high clinical and radiographic success rate, shortens the follow up
‑
period, and lowers the risk of pulp exposure.

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 Issues with PCR:
 may weaken the binding between the restorative material and dentin - solid
bond between the tooth substrate and the restorative materials.
 bacterial residues on the cavity wall - cavity disinfectant techniques such as
photodynamic therapy (PDT) and sonodynamic therapy (SDT).

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AIM
 To evaluate the influence of photodynamic and sonodynamic disinfection on
the bond strength of caries affected dentin bonded to three different
‑
restorative materials, i.e. Cention N, RMGIC, and Synergy D6.

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NULL HYPOTHESIS
No effect of PDT and SDT with different photo/sonosensitizers on the
bond strength of CAD bonded to three different restorative materials.

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OBJECTIVES
 To evaluate the shear bond strength of Cention N bonded to caries affected
‑
dentin after using PDT and SDT, using universal testing machine.
 To evaluate the shear bond strength of RMGIC bonded to caries affected
‑
dentin after using PDT and SDT, using universal testing machine.
 To evaluate the shear bond strength of Synergy D6 bonded to caries affected
‑
dentin after using PDT and SDT, using universal testing machine.
 To compare the shear bond strength of Cention N, RMGIC, and Synergy D6
bonded to caries affected dentin
‑ after using PDT and SDT, using universal
testing machine.

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SAMPLE SIZE
 Statistical model - ANOVA model and using the data obtained from
a previous study conducted by Alrahlah et al., and the sample size of
each group was set as 9.

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SAMPLE SELECTION
 108 carious and 18 non-carious teeth - freshly extracted.
Inclusion criteria
International caries
detection and assessment
system (ICDAS) code 5
Caries limited to the
occlusal surface
Exclusion criteria
ICDAS criteria 1, 2, 3, 4,
and 6
Fractured tooth, cracked
tooth, and severe
attrition

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SAMPLE GROUPS
Control group (n = 18)
Positive control group
(n=9)
Negative control group
(n=9)

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Photodynamic
therapy ( n = 54)
Methylene
Cention N
(n = 9)
RMGIC
(n = 9)
Synergy D6
(n = 9)
Indocyanine
Cention N
(n = 9)
RMGIC
(n = 9)
Synergy D6
(n = 9)

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Sonodynamic
therapy ( n = 54)
Methylene
Cention N
(n = 9)
RMGIC
(n = 9)
Synergy D6
(n = 9)
Indocyanine
Cention N
(n = 9)
RMGIC
(n = 9)
Synergy D6
(n = 9)

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SAMPLE PREPARATION
Each sample - mounted separately in self cure acrylic resin till
‑
cementoenamel junction using 4mm diameter polyvinyl tubing.
‑
The occlusal surface - reduced axially using a diamond disc in a
straight handpiece under water coolant.
Infected dentin - removed with the help of silicon carbide
grinding discs 1200 and 600 grits under water lubrication.

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 In carious teeth - removal of all carious infected dentin - confirmed using
caries detector dye 0.5% basic fuchsin. CAD - not removed.

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POSITIVE AND NEGATIVE CONTROL
GROUP
 The occlusal sound dentin surfaces and carious dentin surfaces were cleaned with
distilled water and allowed to dry for 5 seconds before being restored.

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SUBGROUP PHOTODYNAMIC
METHYLENE CENTION N
Methylene blue (Qualigens Fine Chemicals, Mumbai, India) -
concentration of 100 mg/mL - CAD surface - left for 60 seconds.
CAD surface - radiation for 60 s using a diode laser (Picasso, AMD Lasers,
Indianapolis, USA) - continuous mode at 660 nm and 2mW/cm2
.
The laser - 45° from the dentin surface and operated continuously for 30
seconds , wavelength of 400 μm using a fiber optic tip.
‑
CAD surface - distilled water, air dried for 5 seconds.

17. Cention N (Ivoclar Vivadent, Germany) - mixed according to the
manufacturer’s instructions, condensed into transparent plastic tube placed
perpendicular to prepared CAD surface - plastic instrument.
Each sample - light cured for 20 seconds.
Height of total restorative material buildup - approximately 4 mm.
17

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SUBGROUP PHOTODYNAMIC
METHYLENE RMGIC
Methylene blue - smeared - procedure as described in photodynamic methylene
Cention N (PMC) subgroup.
RMGIC (GC Fuji ll LC) - mixed according to the manufacturer’s instructions,
condensed with the help of plastic instrument into transparent plastic tube
placed perpendicular to prepared CAD surface.
Each sample - light cured for 20 seconds.
Height of total restorative material buildup - 4 mm.

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SUBGROUP PHOTODYNAMIC
METHYLENE SYNERGY D6
Methylene blue –
applied.
Etchant - applied for
15 seconds, washed
off with distilled
water.
Excess moisture -
removed
Bonding agent (One Coal
Bond SL, Coltene,
Whaledent, Switzerland) - 20
seconds- air dried, light cured
for 30 seconds.
Synergy D6 composite (Coltene,
Whaledent, USA) - inserted -
transparent plastic tube -
composite placing instrument in
increments of 2 mm.

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Photodynamic methylene Synergy D6 subgroup

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SUBGROUP PHOTODYNAMIC
INDOCYANINE CENTION N
Nearly 1.25mg
of indocyanine
green powder
(Aurogreen,
Aurolab, Tamil
Nadu, India)
5 ml of
phosphate buf
‑
-fered saline
5 ml solution,
used to
achieve a final
concentration
of 250 μg/ml.

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Each cavity - 0.5 ml of the Indocyanine green powder solution
(ICGP) solution - applied.
Using E4 tips, a diode laser operating at 300 mW power at a
wavelength of 810 nm - irradiate the solution for 60 seconds.
Cention N - mixed according to the manufacturer’s
instructions, condensed into transparent plastic tube with the
help of plastic instrument.
Each sample - light cured for 20 seconds.
The height of total restorative material buildup was 4mm.

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SUBGROUP PHOTODYNAMIC
INDOCYANINE RMGIC
Indocyanine green
(IG) - applied on the
samples,
photosensitized.
Standardized
transparent plastic
tube - placed
perpendicular to
prepared CAD
surface.
RMGIC – placed.

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SUBGROUP PHOTODYNAMIC
INDOCYANINE SYNERGY
Samples – treated with
indocyanine green.
Synergy D6 - placed in
transparent pastic tube
over CAD surface and
light cured.

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SUBGROUP SONODYNAMIC
METHYLENE CENTION N
CAD surface - smeared with methylene blue -100 mg/ml.
With a medical ultrasonic coupling agent connected (Medi Pulse Ultrasonic
Physiotherapy Machine, Spanco Industries, Gurugram, Haryana), 300 W/cm2
and
1MHz of ultrasound power - applied for 5 minutes.
CAD surface - cleaned with distilled water, air dried for 5 seconds.
Cention N - mixed and placed.

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Sonodynamic methylene blue Cention N subgroup

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SUBGROUP SONODYNAMIC
METHYLENE RMGIC
Methylene blue -
sonosensitized.
RMGIC – mixed,
condensed in transparent
plastic tube placed
perpendicular to prepared
CAD surface - light cured.

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SUBGROUP SONODYNAMIC
METHYLENE SYNERGY D6
Samples – treated
with methylene
blue.
Etchant - bonding
agent - air dried -
light cured for 30
seconds.
Synergy D6
composite -
transparent plastic
tube using a
composite placing
instrument in
increments of 2
mm.

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SUBGROUP SONODYNAMIC
INDOCYANINE CENTION N
CAD surface - 500 mg/mL
of IG solution - medical
ultrasonic coupling agent -
IG solution was activated
for 5 minutes at a
frequency of 1 MHz,
intensity of 300 W/cm2
.
Cention N - mixed
according to the
manufacturer’s
instructions - condensed in
transparent tube, light
cured.

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SUBGROUP SONODYNAMIC
INDOCYANINE RMGIC
Indocyanine green - applied on
samples.
RMGIC - mixed and
condensed into transparent
plastic tube with the help of
plastic instrument and light
cured.

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SUBGROUP SONODYNAMIC
INDOCYANINE SYNERGY D6
Indocyanine green - applied on samples and
sonosensitized.
Synergy D6 - condensed - plastic instrument - light
cured.

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 A single operator - each restoration process at a temperature of 24°C.

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EVALUATION OF SHEAR BOND
STRENGTH
 SBS testing - universal testing machine with a knife edge blade at a
‑
crosshead speed of 0.5 mm/min.

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STATISTICAL ANALYSIS
 Independent “t” test, one way ANOVA test, and post hoc Tukey test
‑
- to find whether or not a significant difference exists in the SBS of
different groups.
 P < 0.05 was taken as significant.

35. RESULTS
GROUP VARIABLE MEAN ± SD P PAIRWISE
COMPARISONS
Positive control SDC 5.28 ± 0.17 <0.001 SDC versus SDR:
<0.001
SDR 4.33 ± 0.33 SDC versus SDS:
<0.001
SDS 6.45 ± 0.29 SDR versus SDC:
<0.001
Negative control CAD-C 4.25 ± 0.33 <0.001 CAD-C versus
CAD-R: <0.001
CAD-R 3.32 ± 0.12 CAD-C versus
CAD-S: <0.001
CAD-S 5.25 ± 0.21 CAD-R versus
CAD-S: <0.001
Comparison of shear bond strength (MPa) of different restorative materials within
sound and carious dentin.
35

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GROUP SUBGROUPS MEAN ± SD MAXIMUM
VALUE
MINIMUM
VALUE
Positive control SDC 5.28 ± 0.17 5.652 4.936
SDR 4.33 ± 0.33 5.175 4.06
SDS 6.45 ± 0.29 6.687 6.13
Negative control CAD-C 4.25 ± 0.33 4.497 4.06
CAD-R 3.32 ± 0.12 3.423 3.184
CAD-S 5.25 ± 0.21 5.573 4.936
Mean values of shear bond strength

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GROUP SUBGROUPS MEAN ± SD MAXIMUM
VALUE
MINIMUM
VALUE
Photodynamic
methylene blue
PMC 5.56 ± 0.32 5.971 5.175
PMR 4.06 ± 0.92 5.175 3.184
PMS 7.16 ± 0.35 7.722 6.608
Photodynamic
indocyanine green
PIC 6.44 ± 0.29 6.926 6.13
PIR 4.95 ± 0.46 5.334 4.06
PIS 8.61 ± 0.29 8.996 8.359
Sonodynamic
methylene blue
SMC 6.44 ± 0.25 6.847 6.13
SMR 5.37 ± 0.34 5.971 5.015
SMS 8.53 ± 0.31 8.917 8.041
Sonodynamic
indocyanine green
SIC 7.48 ± 0.21 7.802 7.165
SIR 9.75 ± 0.48 10.111 9.076
SIS 9.52 ± 0.20 9.792 9.156
Mean values of shear bond strength

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DISCUSSION
 Null hypothesis - rejected as SBS of Synergy D6 - better than Cention N and
RMGIC; sonodynamic disinfection - superior bond strength as compared to
photodynamic disinfection and indocyanine activation - better bond strength as
compared to methylene blue.
 SBS of Synergy D6 - significantly higher than Cention N and RMGIC - modified
structure of the nanocomposite with nanomeric filler particles.
 Nanomeric filler particles - mechanical and physical qualities- enhanced -
increasing the filler loading.

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 When contrasted with RMGIC, Cention N demonstrated a strong connection-
strongly cross linked polymer structure.
‑
 SBS of each restorative material treated with SDT - significantly greater than treated
with PDT.
 The SBS of each restorative material treated with indocyanine green - higher than
methylene blue.

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41. Materials and methods Result Conclusion
• 30 carious and 10 non-
carious mandibular teeth -
non-traumatic extraction.
• Four groups (n = 10):
Group 1 - non-affected dentin
with no disinfection
Group 2 - caries affected
dentin treated with 2% CHX
Group 3 - affected dentin
disinfected with PDT [100
mg/L methylene blue solution
(MBS) and Diode laser]
Group 4 - affected dentin
treated with ECYL.
• Highest SBS value - group
1 (24.98 ± 1.59 MPa).
• Lowest bond strength -
group 3 (14.22 ± 1.40
MPa).
• Group 4 (15.89 ± 3.22
MPa) - SBS values
comparable to group 3
(14.22 ± 1.40 MPa).
• Group 2 (CHX-18.25 ±
1.29 MPa) - statistically
significant difference
compared to all
experimental groups (p <
0.05).
• Adhesive bond strength
of disinfected carious
dentin was higher with
CHX treatment as
compared to
Photodynamic therapy
and Er,Cr: YSGG laser
treatment.
• Carious dentin showed
lower bond strength to
composite resin as
compared to non-carious
dentin.

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43. Materials and methods Results Conclusion
• 40 carious mandibular teeth - non-
traumatic extraction.
• Four groups (n = 10):
Group 1 - affected dentin disinfected
with methylene blue (MB) [100
mg/L].
Group 2 - caries affected dentin
disinfected using curcumin
photosensitizer (CP) [500 mg/L].
Group 3 - affected dentin disinfected
with indocyanin green photosensitizer
(ICGP) [0.5 mL] .
Group 4 - affected dentin treated with
3 % H2O2.
• Group 2 dentin disinfection
using CP - highest SBS value
(18.21 ± 1.39 MPa).
• Group 4 (3% H2O2 as cavity
disinfectant) - lowest SBS
values (13.39 ± 1.26 MPa).
• SBS in Group 3 (ICGP) (17.42
± 0.55 MPa) specimens was
comparable to group 2 (p >
0.05).
• Group 1 - disinfected with MB
(15.18 ± 0.39 MPa) -
significantly lower compared to
group 2 and group 3 (p < 0.05)
respectively.
Curcumin and
Indocyanin
green have the
potential to be
used as cavity
disinfectant as
it improves
SBS of caries
affected dentin
to resin
composite.

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 ICGP on dentin increases the size of dentinal tubules orifice - pronounced
tubular, peritubular dentinal pattern - favors bonding methods.

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LIMITATIONS
 Fails to replicate the complex oral environment.
 Only one photosensitizer concentration has been assessed.

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CONCLUSION
 Adding photo/sonosensitizers - potentiate the antimicrobial action of
antimicrobial photodynamic therapy (aPDT) and antimicrobial sonodynamic
therapy (aSDT), work more effectively on the affected dentin - conservative,
minimally invasive treatment , augment its bond strength.
 The SBS of each restorative material treated with indocyanine green and SDT
outperformed those treated with methylene blue dye and PDT.

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48. 48
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