Adjunctive use of antimicrobial photodynamic therapy in the surgical treatment of periapical lesions: A case series

Photodiagnosis Photodyn Ther. 2022 Mar;37:102598. doi: 10.1016/j.pdpdt.2021.102598. Epub 2021 Oct 24.


Background: Antimicrobial photodynamic therapy (aPDT) is used in endodontics to improve orthograde root canal disinfection as an adjunct to standard treatments. Conversely, evidence concerning the application of aPDT in retrograde endodontic surgery is limited. Thus, the aim of the present study was to provide additional data regarding the use of aPDT in the surgical endodontic treatment of periapical lesions.

Methods: A total of 25 consecutive patients presenting teeth with periapical radiolucency eventually associated with clinical signs and symptoms of apical periodontitis were included. Following access flap completion, osteotomy, mechanical debridement, root apical third resection, and preparation of the root-end cavity, aPDT was applied to decontaminate the surgical site using phenothiazine chloride dye at a concentration of 10 mg/mL and irradiation with a hand-held 100-mW diode laser with a wavelength of 660 ± 10 nm. At the latest follow-up visit, healing was evaluated as successful, uncertain, or failure according to well-established clinical and radiological criteria.

Results: Overall, 31 periapical lesions were treated with aPDT. Healing proceeded uneventfully. The mean follow-up time was 36.19 months, with times ranging from 12 to 85 months. A total of 25 (80.65%) cases were classified as successful, 5 (16.13%) as uncertain, and only one (3.22%) as failure. Irrespective of the treatment outcome, all treated teeth were still functional, with no symptoms reported by the patients.

Conclusion: aPDT as an adjunctive treatment modality in the surgical endodontic treatment of periapical lesions showed promising medium-term results associated with preservation of all diseased teeth.

Keywords: Apical periodontitis; Apicoectomy; Diode laser; Endodontics; Oral surgery; Periapical lesion; Photodynamic therapy.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents* / therapeutic use
  • Humans
  • Periapical Periodontitis* / drug therapy
  • Periapical Periodontitis* / surgery
  • Photochemotherapy* / methods
  • Root Canal Therapy / methods


  • Anti-Bacterial Agents
  • Anti-Infective Agents