Does Antimicrobial Photodynamic Therapy Influence the Bond Strength of Direct Restorative Materials to Healthy and Decayed Dentin? A Systematic Review


  • Raíssa Martins Mendes
  • Thais de Oliveira Fernandes
  • Ricardo Hidalgo
  • Leonardo dos Santos Antunes
  • Marlus Roberto Rodrigues Cajazeira
  • Lívia Azeredo Alves Antunes


Photochemotherapy, Composite Resins, Dental Caries, Dentin


Objective: To evaluate the influence of antimicrobial photodynamic therapy (aPDT) on the bond strength of adhesive restorative materials to healthy and caries-affected dentin. Material and Methods: 04 electronic databases and 02 additional searches were assessed. In vitro studies considering sound or caries-affected human or bovine dentin (population), use of aPDT before restorative treatment (intervention), use of other dentin disinfection techniques (comparison), and bond strength to dentin (outcome) were included. The risk of bias for in vitro studies was used as a method to check the evidence. The method used to present and synthesize results was data extraction. Results: The total number of included studies was 11, including 550 permanent teeth. Bond strength was evaluated mainly through the shear bond strength (SBS) test, with dentin affected by caries being the substrate most frequently used in studies. Six studies demonstrated that aPDT with methylene blue (MB) negatively affected the SBS values of resin-modified glass ionomer cement (RMGIC) to dentin. Regarding risk of bias assessment, all studies were at high risk of bias. Conclusion: The effects of aPDT on adhesion to dentin vary depending on the type of substrate and the photosensitizer used. Mainly, MB negatively affected the SBS values from RMGIC to dentin. The conclusion should be interpreted considering the high risk of bias in the studies.


Schwendicke F, Frencken J, Innes N. Clinical recommendations on carious tissue removal in cavitated lesions. Monogr Oral Sci 2018; 27:162-166.

Kidd E, Fejerskov O, Nyvad B. Infected dentine revisited. Dent Update 2015; 42(9):802-806, 808-809.

Fusayama T, Terashima S. Differentiation of two layers of carious dentin by staining. Bull Tokyo Med Dent Univ 1972; 19(1):83-92.

Fusayama T, Kurosaki N. Structure and removal of carious dentin. Int Dent J 1972; 22(3):401-411.

Ogushi K, Fusayama T. Electron microscopic structure of the two layers of carious dentin. J Dent Res 1975; 54(5):1019-1026.

Fusayama T. Two layers of carious dentin; diagnosis and treatment. Oper Dent 1979; 4(2):63-70.

Handelman SL, Buonocore MG, Heseck DJ. A preliminary report on the effect of fissure sealant on bacteria in dental caries. J Prosthet Dent 1972; 27(4):390-392.

Handelman SL, Washburn F, Wopperer P. Two-year report of sealant effect on bacteria in dental caries. J Am Dent Assoc 1976; 93(5):967-970.

Nyvad B, ten Cate JM, Fejerskov O. Arrest of root surface caries in situ. J Dent Res 1997; 76(12):1845-1853.

Kidd EAM. How “clean” must a cavity be before restoration? Caries Res 2004; 38(3):305-313.

Banerjee A, Doméjean S. The contemporary approach to tooth preservation: Minimum intervention [MI] caries management in general practice. Prim Dent J 2013; 2(3):30-37.

Weber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. J Public Health Dent 2011; 71(4):265-270.

Crespo-Gallardo I, Martín-González J, Jiménez-Sánchez MC, Cabanillas-Balsera D, Sánchez-Domínguez B, Segura-Egea JJ. Dentist's knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions. J Clin Exp Dent 2018; 10(12):e1205-1215.

Schwendicke F. Contemporary concepts in carious tissue removal: A review. J Esthet Restor Dent 2017; 29(6):403-408.

Faria LV, Fernandes T de O, Guimarães LS, Cajazeira MRR, Antunes LS, Antunes LAA. Does selective caries removal in combination with antimicrobial photodynamic therapy affect the clinical performance of adhesive restorations of primary or permanent teeth? A systematic review with meta-analysis. J Clin Pediatr Dent 2022; 46(5):1-14.

De Melo WCMA, Avci P, De Oliveira MN, Gupta A, Vecchio D, Sadasivam M, et al. Photodynamic inactivation of biofilm: Taking a lightly colored approach to stubborn infection. Expert Rev Anti Infect Ther 2013; 11(7):669-693.

Melo MAS, de-Paula DM, Lima JPM, Borges FMC, Steiner-Oliveira C, Nobre-dos-Santos M, et al. In vitro photodynamic antimicrobial chemotherapy in dentine contaminated by cariogenic bacteria. Laser Phys 2010; 20(6):1504-1513.

Hashemikamangar SS, Alsaedi RJF, Chiniforush N, Motevaselian F. Effect of antimicrobial photodynamic therapy with different photosensitizers and adhesion protocol on the bond strength of resin composite to sound dentin. Clin Oral Investig 2022; 26(5):4011-4019.

Alshammary F, Karobari MI, Assiry AA, Marya A, Shaikh GM, Siddiqui AA, et al. Effect of Nd:YAG, Er,Cr:YSGG laser irradiation, and adjunctive photodynamic therapy on push-out bond strength of zirconia posts to radicular dentin. Biomed Res Int 2021; 2021:5523242.

Opdam NJM, Van De Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, et al. Longevity of posterior composite restorations: A systematic review and meta-analysis. J Dent Res 2014; 93(10):943-949.

Isolan CP, Sarkis-Onofre R, Lima GS, Moraes RR. Bonding to sound and caries-affected dentin: A systematic review and meta-analysis. J Adhes Dent 2018; 20(1):7-18.

Alrahlah A, Naseem M, Tanveer SA, Abrar E, Charania A, AlRifaiy MQ, et al. Influence of disinfection of caries effected dentin with different concentration of silver diamine fluoride, curcumin and Er, Cr:YSGG on adhesive bond strength to resin composite. Photodiagnosis Photodyn Ther 2020; 32:102065.

Pinna R, Maioli M, Eramo S, Mura I, Milia E. Carious affected dentine: Its behaviour in adhesive bonding. Aust Dent J 2015; 60(3):276-293.

Sarkis-Onofre R, Skupien J, Cenci M, Moraes R, Pereira-Cenci T. The role of resin cement on bond strength of glass-fiber posts luted into root canals: A systematic review and meta-analysis of in vitro studies. Oper Dent 2014; 39(1):E31-44.

Al-Khureif AA, Mohamed BA, Al-Shehri AM, Khan AA, Divakar DD. Bond assessment of resin modified glass ionomer cement to dentin conditioned with photosensitizers, laser and conventional regimes. Photodiagnosis Photodyn Ther 2020; 30:101795.

Alshahrani A. Influence of silver diamine fluoride compared to photodynamic therapy on the bond integrity of resin modified glass ionomer cement to demineralized dentin. Photodiagnosis Photodyn Ther 2020; 32:102007.

Al Deeb L, Bin-Shuwaish MS, Abrar E, Naseem M, Al-Hamdan RS, Maawadh AM, et al. Efficacy of chlorhexidine, Er Cr YSGG laser and photodynamic therapy on the adhesive bond integrity of caries affected dentin. An in-vitro study. Photodiagnosis Photodyn Ther 2020; 31:101875.

Al Rifaiy MQ, Vohra F. Effect of phototherapy on dentin bond strength and microleakage when bonded to resin with different conditioning regimes. Photodiagnosis Photodyn Ther 2019; 25:271-274.

Alshahrani A, Abrar E, Maawadh AM, Al-Hamdan RS, Almohareb T, AlFawaz Y, et al. Management of caries affected dentin (CAD) with resin modified glass ionomer cement (RMGIC) in the presence of different caries disinfectants and photosensitizers. Photodiagnosis Photodyn Ther 2020; 32:101978.

Al-Qahtani YM. Impact of graphene oxide and silver diamine fluoride in comparison to photodynamic therapy on bond integrity and microleakage scores of resin-modified glass ionomer cement to demineralized dentin. Photodiagnosis Photodyn Ther 2021; 33:102163.

Al Deeb L. Disinfection of caries-affected dentin using activated vitamin B2 and diode laser with total-etch technique. An assessment of adhesive bond. Photodiagnosis Photodyn Ther 2022; 39:102970.

Alrefeai MH, Aljamhan AS, Alhabdan A, Alzehiri MH, Naseem M, Alkhudhairy F. Influence of methylene blue, Riboflavin, and indocyanine green on the bond strength of caries affected dentin when bonded to resin-modified glass ionomer cement. Photodiagnosis Photodyn Ther 2022; 38:102792.

Al-Khureif AA, Mohamed BA, Khan AA. Resin modified glass ionomer bonded to caries affected dentin disinfected with carbon dioxide laser, diode lasers, bee glue and photosensitizing agents: An estimation of bond strength. Photodiagnosis Photodyn Ther 2022; 38:102829.

Alrahlah A, Niaz MO, Abrar E, Vohra F, Rashid H. Treatment of caries affected dentin with different photosensitizers and its effect on adhesive bond integrity to resin composite. Photodiagnosis Photodyn Ther 2020; 31:101865.

Schwendicke F. Removing carious tissue: Why and how? Monogr Oral Sci 2018; 27:56-67.

Cieplik F, Buchalla W, Hellwig E, Al-Ahmad A, Hiller K-A, Maisch T, et al. Antimicrobial photodynamic therapy as an adjunct for treatment of deep carious lesions-A systematic review. Photodiagnosis Photodyn Ther 2017; 18:54-62.

Fusayama T. Intratubular crystal deposition and remineralization of carious dentin. J Biol Buccale 1991; 19(3):255-262.

Schwendicke F, Meyer-Lueckel H, Doerfer C, Paris S. Attitudes and behaviour regarding deep dentin caries removal: A survey among German dentists. Caries Res 2013; 47(6):566-573.

Choi K, Oshida Y, Platt JA, Cochran MA, Matis BA, Yi K. Microtensile bond strength of glass ionomer cements to artificially created carious dentin. Oper Dent 2006; 31(5):590-597.

Neves PAM, Lima LA, Rodrigues FCN, Leitão TJ, Ribeiro CCC. Clinical effect of photodynamic therapy on primary carious dentin after partial caries removal. Braz Oral Res 2016; 30(1):S1806-83242016000100246.

Khan AA, Al-Khureif AA, Saadaldin SA, Mohamed BA, Musaibah ASO, Divakar DD, et al. Graphene oxide-based experimental silane primers enhance shear bond strength between resin composite and zirconia. Eur J Oral Sci 2019; 127(6):570-576.




How to Cite

Mendes, R. M., Fernandes, T. de O., Hidalgo, R., Antunes, L. dos S., Cajazeira, M. R. R., & Antunes, L. A. A. (2024). Does Antimicrobial Photodynamic Therapy Influence the Bond Strength of Direct Restorative Materials to Healthy and Decayed Dentin? A Systematic Review. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 24, e230082. Retrieved from



Systematic Reviews (and Meta-Analysis)