Antimicrobial Photodynamic Therapy (aPDT) in Resistant Endodontic Infections: A Promising Adjunct in Root Canal Disinfection

Antimicrobial resistance within root canal infections presents a significant challenge to conventional endodontic disinfection strategies. The persistence of microorganisms such as Enterococcus faecalis and Candida albicans in complex root canal anatomies often leads to treatment failure. Antimicrobial photodynamic therapy (aPDT) has emerged as a promising adjunct to conventional irrigation protocols, combining photosensitizers with specific wavelengths of light to produce reactive oxygen species (ROS) that effectively disrupt microbial biofilms and destroy resistant organisms. This review discusses the mechanism of action, efficacy against resistant strains, clinical applications, and future perspectives of aPDT in endodontics. Comparative insights with sodium hypochlorite, calcium hydroxide, and laser-based disinfection methods are highlighted. With its advantages of broad-spectrum antimicrobial activity, low cytotoxicity, and absence of microbial resistance, aPDT represents an innovative approach to enhance disinfection outcomes in endodontic therapy.