Effects of antimicrobial photodynamic therapy with zinc oxide and toluidine blue on Streptococcus mutans accumulation in polymethyl methacrylate resin used in orthodontic appliances.

Objective: The aim of this study was to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) using toluidine blue (TBO) activated by a diode laser and zinc oxide (ZnO) activated by light-emitting diode (LED) light in reducing bacterial accumulation on polymethyl methacrylate (PMMA) orthodontic appliances.

Methods: This in-vitro study investigated the formation of Streptococcus mutans biofilm on 32 PMMA resin discs, divided into four groups. The first group consisted of acrylic discs containing ZnO exposed to 450 nm LED radiation; the second group included acrylic discs with TBO and 635 nm diode laser radiation; the third group was the positive control with chlorhexidine (CHX); and the fourth group served as the negative control. To evaluate biofilm formation, the discs were immersed in tubes containing a microbial suspension at a 0.5 McFarland concentration. Following incubation, the discs were exposed to light according to the type of photosensitizer. After washing with saline and sonication, bacterial colony counts were determined by serial dilution and culture in Brian Heart Infusion agar medium. One-way ANOVA was used to compare the colony-forming unit (CFU) counts, and post-hoc Tamhane's test was performed for pairwise comparisons, with statistical significance set at p < 0.05.

Results: The negative control group exhibited the highest mean colony count (35.72 ± 3.35 CFU/mL), while the positive control group showed the lowest mean colony count (5.87 ± 0.92 CFU/mL). Both ZnO and TBO groups, when activated by their respective light sources, demonstrated significant antibacterial activity compared to the negative control (P < 0.001 for both). However, CHX outperformed both ZnO and TBO in reducing bacterial growth (P < 0.001 and P = 0.007, respectively). No statistically significant difference was observed between the antibacterial effects of ZnO and TBO (P = 0.280).

Conclusion: This study suggests that aPDT using ZnO and TBO can be an effective adjunctive treatment for reducing bacterial accumulation on orthodontic appliances. While CHX remains the most effective treatment, the cost-effectiveness and ease of application of both CHX and ZnO make them viable options for future clinical trials. Further research is needed to optimize treatment protocols and explore the potential impact of these treatments on other microorganisms and material properties.