Efetividade da terapia fotodinâmica antimicrobiana como adjuvante à remoção seletiva de tecido cariado: uma revisão sistemática

Abstract

Dental caries is currently understood as a dynamic and multifactorial disease resulting from an imbalance in the dental biofilm, mediated by biological, behavioral, and socio- environmental factors. Traditionally, its treatment involved the complete removal of carious tissue. However, Minimally Invasive Dentistry (MID) currently advocates for the maximum preservation of healthy thoot structure. In this context, Antimicrobial Photodynamic Therapy (aPDT) emerges as a promising adjunct to selective caries removal, a technique that removes only infected dentin while preserving affected tissue. aPDT combines photosensitizers (such as methylene blue or toluidine) and light at a specific wavelength to generate reactive oxygen species, eliminating cariogenic microorganisms such as Streptococcus mutans and Lactobacillus spp. without damaging healthy tissue. Thus, this systematic review evaluated the clinical and microbiological efficacy of aPDT as an adjunct to selective caries removal, analyzing its ability to reduce bacterial load and improve restoration longevity. Randomized controlled trials were included, sourced from PubMed, SciELO, Web of Science, ScienceDirect, Cochrane Library, EMBASE, LILACS and Scopus, following PRISMA guidelines. Out of 710 identified studies, 9 met the inclusion criteria. The results indicated that aPDT promotes a significant reduction in bacteria within carious cavities, especially in deep lesions, although some studies showed no significant difference immediately after treatment. Furthermore, aPDT demonstrated potential in reducing the incidence of secondary caries and improving the marginal adaptation of restorations in the long term. It is concluded that aPDT is an effective and conservative technique capable of complementing selective caries removal, with microbiological and clinical benefits. However, further studies are needed to standardize protocols and evaluate its efficacy over periods longer than 12 months. This review reinforces the importance of minimally invasive approaches in modern dentistry, aligned with microbiological control and tissue preservation.