Search Results (213)

Background: Metallic and metal oxide nanoparticles are increasingly explored as antimicrobial biomaterials in endodontics due to their multi-target mechanisms of action, largely mediated by metal ion release (e.g., Ag⁺, Cu⁺). However, bacterial metal resistance systems, particularly efflux-related proteins, may influence their antimicrobial performance. This study aimed to analyze the prevalence and distribution of metal resistance-associated proteins in bacteria involved in endodontic infections using a bioinformatic approach. Methods: An in silico, cross-sectional bioinformatic analysis was conducted using publicly available genomes from the Bacterial and Viral Bioinformatics Resource Center (BV-BRC). Bacterial species associated with acute apical abscess (AAA), symptomatic apical periodontitis (SAP), asymptomatic apical periodontitis (AAP), and post-treatment apical periodontitis (PTAP) were included. The presence of selected metal resistance-related proteins (CutC, CopA, CzcA, CusA, SilA, P-type ATPase, and PA3920) was assessed using a binary presence/absence framework. Prevalence, group comparisons (Fisher’s exact test), and co-occurrence patterns (Phi coefficient) were analyzed. Results: Metal resistance-associated proteins were widely distributed across all infection types, with prevalence ranging from 70.0% to 82.9% and no significant differences between groups (p > 0.05). CutC was the most prevalent protein, followed by CopA and CzcA, whereas SilA and PA3920 were not detected. Correlation analysis revealed consistent co-occurrence patterns among key taxa, including Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella spp. Conclusions: Metal resistance-related proteins are broadly distributed in endodontic microbiota, indicating a conserved genetic capacity for metal tolerance. These findings suggest that microbial resistance determinants may influence, but do not directly determine, the antimicrobial performance of nanoparticle-based biomaterials. This study provides a hypothesis-generating, bioinformatic framework to support the design and optimization of antimicrobial biomaterials, highlighting the need for experimental validation and integration of phenotypic and biofilm-based analyses. Full article

Objectives: Oral healthcare and regular dental follow-up are important during pregnancy, as maternal oral health may have important implications for both maternal and fetal well-being. However, dental attendance remains low. Therefore, this cross-sectional e-survey aimed to explore pregnant women’s dental pain management strategies, their perceptions of endodontic treatment, and avoidance of specific endodontic procedures during pregnancy. Methods: An 18-item online questionnaire was administered to 130 pregnant women. Data were collected on dental attendance, experiences of toothache, use of analgesics or antibiotics, and perceptions of the safety of dental anesthesia and radiographic procedures during pregnancy. Statistical analyses were conducted using Chi-square or Fisher’s exact tests and multivariate logistic regression (p < 0.05). Results: The mean age of participants was 32 years. Only 26.15% reported attending regular dental visits during pregnancy. Among participants who experienced toothache, 51.52% used analgesics and 1.54% used antibiotics. Although 92.31% believed dental infections should be treated during pregnancy, concerns regarding dental procedures were common; 76.92% considered dental radiography unsafe and only 50% considered local anesthesia safe. Multivariate analysis showed that the number of pregnancies was associated with dental visits during pregnancy (p = 0.048), age with analgesic use (p = 0.018), and education level with perception of dental radiography safety (p = 0.013). Conclusions: Despite awareness of the importance of treating dental infections, pregnant women may delay endodontic care during pregnancy, highlighting a need for improved patient education and clearer clinical guidance. Full article

Background: Oral biofilms are a major etiological factor in dental caries, periodontal disease, peri-implantitis, and endodontic infections. Increasing antimicrobial resistance and the limitations of conventional therapies have intensified interest in antimicrobial photodynamic therapy (aPDT). Hypericin, a natural photosensitizer derived from Hypericum perforatum, demonstrates potent reactive oxygen species generation and broad antimicrobial activity; however, its dental applications remain insufficiently synthesized. Objective: To systematically evaluate the antimicrobial efficacy, treatment parameters, safety, and clinical potential of hypericin-mediated aPDT against oral biofilms and infections in dentistry. Methods: This systematic review was conducted according to PRISMA 2020 and registered in PROSPERO CRD42024617727. Electronic searches of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library (January 2010 to December 2025) were performed. Studies assessing hypericin-mediated aPDT in oral or dental contexts were included. Methodological quality was evaluated using a predefined nine-domain risk-of-bias tool. Results: Eleven studies met the inclusion criteria. Hypericin-mediated aPDT demonstrated strong antimicrobial effects, achieving up to 99% planktonic inactivation and significant biofilm reduction across bacterial and fungal species. Activity was particularly pronounced against Gram-positive organisms, including Staphylococcus aureus and Enterococcus faecalis. However, efficacy against mature biofilms was variable and often dependent on formulation and irradiation parameters. Most studies showed moderate methodological quality, with frequent deficiencies in reporting light calibration and dosimetry. Advanced delivery systems, including liposomal and nanoparticle formulations, improved photodynamic performance. Conclusions: Hypericin-mediated aPDT shows promising antimicrobial activity against oral pathogens and biofilms, with favorable selectivity and safety profiles. Nevertheless, the evidence remains predominantly preclinical and heterogeneous. Standardized protocols and well-designed clinical trials are required before routine dental implementation can be recommended. Full article

Objectives: To quantitatively evaluate the inhibitory effects of commercially available probiotic formulations (Probien, Enterogermina, Reflor) applied as intracanal medicaments against mature dual-species biofilms of Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) using a qPCR-based in vitro root canal model, with calcium hydroxide included as the reference intracanal medicament for comparison. Materials and Methods: Root canal specimens containing mature dual-species biofilms were medicated with probiotic–poloxamer gel formulations (Probien, Enterogermina, or Reflor) or calcium hydroxide (reference inhibitory control); infected but untreated canals served as the non-inhibitory control, and sterile non-inoculated specimens were included to confirm procedural sterility. After a 7-day intracanal application period, microbial loads were quantified at baseline and post-treatment by qPCR, and results were expressed as delta cycle threshold (ΔCt), colony-forming equivalents (CFE/mL), and percentage reduction values. Results: A total of 78 specimens (n = 13 per group) were analyzed. No significant intergroup differences were found in E. faecalis ΔCt or reduction percentages (p > 0.05), indicating its persistence despite intracanal medication. For C. albicans, differences among groups were significant (p < 0.001). Calcium hydroxide showed the strongest antifungal effect, producing marked ΔCt and CFE reductions versus probiotic and positive control groups, whereas probiotic formulations displayed only limited antifungal activity and no measurable inhibition against E. faecalis. Conclusions: Under the conditions of this in vitro model, the tested commercially available probiotic formulations—originally developed for gastrointestinal use—did not demonstrate significant antimicrobial effects against mature E. faecalis–C. albicans biofilms. These findings should be interpreted in the context of the absence of probiotic formulations specifically designed for intracanal use and the distinct ecological characteristics of the root canal system, which represents a closed, low-oxygen environment dominated by hard-tissue surfaces. Rather than excluding the potential of probiotics in endodontics, the present results highlight the need for root canal–adapted probiotic strains and delivery strategies tailored to intracanal conditions. Clinical Relevance: This in vitro study provides experimental insight into the limitations of directly applying commercially available gastrointestinal probiotic formulations within the root canal system. The findings highlight the importance of developing root canal–specific probiotic strains and delivery strategies tailored to the unique ecological conditions of the intracanal environment, thereby informing future translational and experimental research in biological endodontics. Full article

Persistent endodontic infections are frequently associated with Enterococcus faecalis, a microorganism capable of penetrating dentinal tubules and surviving conventional disinfection procedures. This in vitro study evaluated the antimicrobial activity of Chihuahuan propolis against E. faecalis using planktonic and intratubular infection models. Propolis extract was tested at concentrations of 15, 35, and 70 mg/mL and compared with triple antibiotic paste (TAP) as a clinically relevant intracanal medicament. Antimicrobial efficacy was assessed by disk diffusion, minimum inhibitory concentration (MIC), colony-forming unit (CFU) reduction in infected dentinal tubules, and scanning electron microscopy (SEM). Chihuahuan propolis exhibited concentration-dependent antimicrobial activity, with a MIC of 17.5 mg/mL. In the intratubular model, propolis at 70 mg/mL achieved a CFU reduction comparable to TAP after seven days of application. SEM analysis confirmed a marked reduction of bacterial colonization within dentinal tubules. Within the limitations of this in vitro, monoespecies model, Chihuahuan propolis demonstrated antimicrobial efficacy against E. faecalis comparable to TAP, supporting its further investigation as a potential non-antibiotic intracanal medicament. Full article

Background: Persistent endodontic infections involving Enterococcus faecalis and Candida albicans are a major cause of root canal treatment failure. Although conventional irrigants, such as sodium hypochlorite and chlorhexidine (CHX), exhibit strong immediate antimicrobial activity, microbes may survive and recover from the initial antimicrobial effect, hence limiting their effectiveness, especially in complex root canal anatomies and in the apical terminus of the tooth. Antibacterial dressing techniques were not proven satisfactory due to depletion of the antibacterial component or difficulty in spreading it evenly along the entire root canal. This study aimed to develop and evaluate the antimicrobial efficacy and release characteristics of a novel sustained-release device (SRD), delivering CHX via gutta-percha points coated with a sustained-release formulation used as a temporary intracanal medicament. Methods: Gutta-percha points were coated with two sustained-release CHX varnishes (CHX1 and CHX2) or a placebo and assessed in vitro. Antimicrobial activity against E. faecalis and C. albicans was evaluated using agar diffusion assays over time. Release kinetics were analyzed using Rhodamine-labeled SRD in a 3D-printed acrylic molar tooth model via fluorescence microscopy. Additionally, biofilm-infected acrylic molar teeth were treated with a placebo, a single 2% CHX irrigation, or SRD-coated gutta-percha points placed as an intracanal dressing prior to obturation. Microbial viability was quantified by colony-forming unit (CFU/mL) analysis from root canals and gutta-percha points. Statistical analysis was performed using one-way ANOVA followed by Tukey’s post hoc multiple comparison test (p < 0.05). Results: SRD-coated gutta-percha points demonstrated sustained antimicrobial activity for up to 21 days against E. faecalis and 19 days against C. albicans. Fluorescence analysis, in an acrylic tooth model, confirmed continuous release for up to 15 days, with pronounced diffusion in the isthmus and palatal canals. In biofilm-infected acrylic teeth models, SRD treatment resulted in a significant reduction of 2–3 log₁₀ CFU/mL compared to placebo groups (p < 0.001) and prevented microbial rebound over the 14-day observation period. In contrast, a single application of 2% CHX solution showed only transient reduction followed by regrowth. Conclusions: Sustained-release CHX delivery via polymer-coated gutta-percha points provided prolonged antimicrobial activity against bacterial and fungal biofilms compared to conventional single-dose CHX application in this in vitro model. These findings support the potential use of coated gutta-percha points as a removable intracanal drug delivery platform prior to final obturation, although further studies incorporating direct-release quantification and in vivo validation are required before clinical translation. Full article

Background: Persistent endodontic infections remain a significant challenge in root canal therapy, primarily due to the complexity of root canal anatomy and the formation of resistant microbial biofilms. Conventional irrigants, including sodium hypochlorite and chlorhexidine, show limited penetration into dentinal tubules and reduced efficacy against mature biofilms, contributing to treatment failure. Electrically charged lipid nanoparticles (ECLNs), such as cationic solid lipid nanoparticles, nanostructured lipid carriers, and liposomes, have emerged as potential adjunctive systems to enhance intracanal antimicrobial delivery. This focused narrative review, informed by a structured literature search, aimed to synthesize and critically evaluate preclinical and exploratory clinical evidence regarding the use of electrically charged lipid nanoparticles for antibiotic delivery and biofilm control in root canal disinfection. Methods: A structured literature search of PubMed, Scopus, and Web of Science (2010–2026) identified 312 records, of which 20 studies met the inclusion criteria and were included in qualitative synthesis. The majority of included studies were in vitro investigations, followed by ex vivo studies using extracted human teeth, with only a limited number of exploratory animal or clinical studies. Overall, the level of evidence was predominantly preclinical. Results: Across studies, ECLNs demonstrated enhanced antimicrobial efficacy compared with free antibiotics or non-charged formulations, with improved biofilm interaction, enhanced penetration into dentinal tubules, and sustained antimicrobial release. However, most investigations relied on mono-species Enterococcus faecalis biofilm models, and substantial heterogeneity in nanoparticle formulation and methodology was observed. Clinical evidence remains scarce. Conclusions: Although these findings about ECLNs suggest a promising experimental adjunct for root canal disinfection, current evidence remains largely preclinical and insufficient to support routine clinical application. Standardized formulations, clinically relevant multispecies biofilm models, and well-designed controlled clinical trials are required to establish safety, efficacy, and translational feasibility. Full article

Background/Objectives: Endodontic–periodontal lesions (EPLs) represent complex pathological conditions arising from interactions between endodontic and periodontal infections. Existing classification systems primarily describe the etiology or periodontal tissue destruction but provide limited support for clinical interpretation, particularly pulp preservation and the sequencing of endodontic and periodontal management. This review aimed to propose a biologically informed conceptual framework intended to organize clinical reasoning considerations in EPL management. Methods: This narrative review integrates current knowledge regarding pulp vitality, pathways of infection, periodontal healing, and treatment sequencing reported in the endodontic and periodontal literature. Based on this synthesis, a conceptual framework was constructed using two clinical dimensions: the extent of remaining vital pulp and the presence or absence of coronal-originating infection (IC), defined as a potential coronal pathway of bacterial ingress that may contribute to lesion development. Results: The framework categorizes EPLs into four principal groups according to pulp vitality (vital/non-vital) and IC status (present/absent), with additional grading to describe the potential feasibility of pulp preservation and structural reassessment during initial management. Rather than prescribing specific therapies, the model organizes clinical interpretation related to pulp-preserving considerations, the timing of periodontal intervention, and evaluation of surgical management following nonsurgical treatment. Conclusions: This framework provides a biologically oriented conceptual model for understanding EPLs and structuring clinical reasoning. It is intended as a hypothesis-guided interpretive framework rather than a clinical practice guideline and is designed to support case interpretation, not to determine mandatory treatment decisions; thus, its clinical applicability requires further validation, and prospective multicenter studies are necessary before routine clinical implementation. Full article

Background: Apical periodontitis (AP) is a common inflammatory condition of the periapical tissues, most often associated with persistent endodontic infection. Conventional two-dimensional radiography may underestimate AP because of anatomical superimposition and limited sensitivity. Cone-beam computed tomography (CBCT) allows three-dimensional visualization of periapical structures and has been increasingly used in epidemiological research. Objective: This study aimed to evaluate the prevalence and distribution of apical periodontitis, with particular emphasis on apical periodontitis associated with root canal-treated teeth (AP-RCT), in a Saudi subpopulation using CBCT imaging. Methods: This retrospective cross-sectional study analyzed CBCT scans of Saudi patients obtained for routine diagnostic purposes between 2017 and 2021. Apical periodontitis was identified using standardized radiographic criteria requiring the presence of periapical radiolucency in more than one imaging plane. Demographic and clinical variables were recorded. Descriptive statistics were used to estimate prevalence. Associations between demographic factors and AP-RCT counts were evaluated using multivariable negative binomial regression. Regional tooth distribution was analyzed using generalized estimating equation models accounting for within-participant clustering. Results: A total of 320 CBCT scans were analyzed. Apical periodontitis was detected in 231 participants (72.2%) and in 667 teeth (8.3% of examined teeth). Of the affected teeth, 457 (68.5%) were associated with root canal treatment. The mean number of AP-RCT per participant was 1.36 ± 1.81 (median: 1; IQR: 0–2). Multivariable analysis identified age as the only significant predictor of AP-RCT. Compared with individuals aged 21–30 years, higher AP-RCT rates were observed in the 31–40-year and 41–50-year age groups, while participants ≤20 years showed lower rates. Tooth-level analysis demonstrated higher AP-RCT prevalence in maxillary premolars, maxillary molars, and mandibular molars, whereas mandibular anterior teeth showed the lowest prevalence. Conclusions: Apical periodontitis, particularly AP-RCT, was frequently observed in this Saudi subpopulation when assessed using CBCT. Age and tooth location were the primary determinants of disease distribution. These findings provide population-level epidemiological data on the prevalence and anatomical distribution of apical periodontitis in root canal-treated teeth. Clinical Significance: CBCT-based epidemiological assessment enables detailed evaluation of the distribution of apical periodontitis in dentate populations and may assist in characterizing disease patterns in anatomically complex regions, without implying comparative diagnostic accuracy or treatment outcome assessment. Full article

Background: This study compared the reasons for dental presentations between Indigenous and non-Indigenous Australian adults at the Nepean Centre for Oral Health, NSW, Australia. Methods: A retrospective cohort study was conducted on adult patients presenting between 1 July and 31 December 2019. Clinical notes were audited and categorized as either ‘emergency’ (pain, dental infection, dental trauma, loose teeth or dental implants, bleeding) or ‘conservative’ (dental check-ups, examinations, prosthodontic, restorative, periodontal, or non-emergency endodontic therapy). Results: A total of 4663 patients met the inclusion criteria; 61.6% were female, and 6.4% were identified as Indigenous Australians. Overall, 41.3% of presentations were for emergency dental care. Indigenous Australians were significantly more likely to present for dental emergencies compared with non-Indigenous (58.2% vs. 40.2%; χ²(1, N = 4663) = 53.4, p < 0.00001; OR = 2.07, 95% CI: 1.64–2.63), and were also more likely to undergo emergency tooth extractions (p < 0.05). Conclusions: Indigenous Australians demonstrated a higher proportion of emergency and oral surgery-related presentations and underwent tooth extractions as the primary treatment compared to their non-Indigenous counterparts. These findings suggest a higher burden of oral disease and delayed access to general dental services among Indigenous Australians, highlighting the need for targeted and culturally appropriate public health interventions. Full article

Background: Regenerative endodontic treatment (RET) has emerged as a biologically based alternative to traditional apexification for managing immature permanent teeth with pulp necrosis. By promoting tissue ingrowth and continued root development, RET aims not only to eliminate infection but also to reinforce structurally compromised roots. Although its clinical use has expanded, evidence regarding the long-term predictability and durability of RET remains limited, as most published studies provide only short- or mid-term follow-up. Case presentation: This report describes two pediatric cases involving regenerative procedures performed on three immature permanent maxillary incisors, each followed for more than six years. The first case involved a 7-year-old girl who developed pulp necrosis in a maxillary lateral incisor after acute dental trauma. Management followed a regenerative protocol using triple antibiotic paste (ciprofloxacin, metronidazole, and minocycline) as intracanal medication and mineral trioxide aggregate as the coronal barrier. The second case concerned an 8-year-old girl presenting with chronic infection and sinus tracts affecting both maxillary central incisors. These teeth were treated using a regenerative approach with calcium hydroxide as the intracanal medicament and Biodentine as the sealing material. Clinical, radiographic, and cone beam computed tomography evaluations demonstrated complete symptom resolution and periapical healing but incomplete progressive apical closure. All treated teeth developed a calcified apical barrier, and outcomes remained stable throughout the extended follow-up period. Conclusions: While inherently limited by the nature of case reports, these findings support RET as a reliable and durable therapeutic option for necrotic immature permanent teeth, including cases in which conventional apexification has not been successful. Full article

Background: Pulpitis requires operative dental treatment, and antibiotics are not indicated. Nevertheless, inappropriate antibiotic prescribing persists worldwide. This systematic review and meta-analysis evaluated the prevalence of antibiotic prescription for pulpitis among dentists. Methods: A systematic search of MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest (2015–2025) was performed according to PRISMA guidelines. Observational studies reporting the proportion of dentists prescribing systemic antibiotics for pulpitis were included. Random-effects meta-analyses estimated pooled prevalence for all clinicians, general dental practitioners (GDPs), and endodontists (ENs). Risk of bias was assessed using a modified Newcastle–Ottawa Scale, and certainty of evidence was rated with GRADE. Results: Twelve cross-sectional studies met the inclusion criteria, including 3189 dentists. The overall pooled prevalence of antibiotic prescribing for pulpitis was 19.2% (95% CI: 10.4–32.6%), with very high heterogeneity (I² = 98%). GDPs exhibited significantly higher prescribing rates (26.9%, 95% CI: 14.9–43.5%; I² = 98%) compared with ENs (5.1%, 95% CI: 1.2–19.2%; I² = 92%). Sensitivity analysis excluding two high-prevalence studies reduced the pooled estimate to 13.3% (95% CI: 8.0–21.3%) but heterogeneity remained substantial (I² = 95%). Most studies showed moderate-to-high risk of bias, and the certainty of evidence was graded as very low due to inconsistency, indirectness, imprecision, and potential publication bias. Conclusions: Approximately one in five dentists prescribe antibiotics for pulpitis, despite strong guideline recommendations against their use. However, certainty of evidence was very low. Marked variability across regions and clinical profiles highlights persistent gaps in diagnostic accuracy, access to emergency dental care, and antibiotic stewardship. Targeted education, improved urgent care pathways, and strengthened antimicrobial stewardship programs are needed to reduce unnecessary antibiotic use in pulpitis. Full article

Background/Objectives: Apical periodontitis is a prevalent dental condition associated with systemic inflammation. C-reactive protein (CRP) is a sensitive biomarker of inflammatory status. While previous studies have examined CRP changes after endodontic treatment, limited evidence exists on short-term systemic effects following clinically indicated endodontic therapy in healthy individuals. This prospective observational cohort study aimed to evaluate the impact of endodontic treatment or retreatment on serum CRP levels in patients with symptomatic and asymptomatic apical periodontitis and assess demographic influences. No control group was included. Methods: A prospective observational cohort study was conducted in a private endodontic clinic in Jeddah, Saudi Arabia (2021–2023). Three hundred ASA I patients were enrolled and categorized into symptomatic apical periodontitis (SAP) and asymptomatic apical periodontitis (AAP) groups. Blood samples were collected before treatment and two weeks post-treatment. CRP levels were measured using a high-sensitivity assay. Statistical analyses included paired t-tests, Mann–Whitney U tests, and multiple regression. Laboratory personnel were blinded to patient grouping. Results: CRP levels significantly decreased after treatment in both groups (SAP: 6.99 to 2.01 mg/L; AAP: 5.40 to 1.64 mg/L; p < 0.001). Reduction was greater in SAP (mean difference = 4.98 mg/L) than AAP (3.76 mg/L; p < 0.001). Paired t-test showed a very large effect size (Cohen’s d = 3.51). Age and sex were not significant predictors of CRP changes (R² < 0.02). Conclusions: Endodontic treatment or retreatment significantly reduces systemic inflammation in patients with apical periodontitis. These findings reinforce the oral–systemic health link and highlight the clinical relevance of managing apical infections. Longer-term studies and inclusion of additional biomarkers are recommended. Full article

Background: Porphyromonas gingivalis is one of the most prevalent periodontal pathogens, involved in the development of periodontitis, deep caries, pulpitis, endodontic infections, and peri-implantitis. Antiseptics are commonly used in the treatment of oral diseases, but their effectiveness against P. gingivalis remains only partially understood. This preliminary study investigated antimicrobial and antibiofilm activity of eight pure antiseptics: boric acid (BA), chlorhexidine (CHX), ethacridine lactate (ET), hydrogen peroxide (H₂O₂), octenidine (OCT), polyhexanide (PHMB), potassium permanganate (KMnO₄), and sodium hypochlorite (NaOCl), as well as five commercial rinses containing these agents, against periopathogen P. gingivalis ATCC 33277. Methods: Minimal inhibitory concentrations (MICs) were determined using the broth microdilution method. The Clinical Efficiency of MIC (CEMIC) was subsequently calculated. Antibiofilm activity was evaluated using the crystal violet method, LIVE/DEAD fluorescence assay and by measuring biofilm thickness with digital microscopy in combination with the author’s Python-based application Biofilm Thickness Analyzer. Results: OCT, CHX, PHMB and ET showed the strongest activity against P. gingivalis, in both its planktonic and biofilm forms. H₂O₂ and BA had variable MIC efficacy and moderate antibiofilm activity. In contrast, NaOCl and KMnO₄ demonstrated the weakest activity or no significant effect against P. gingivalis. Conclusions: The results have a translational dimension, supporting the potential clinical relevance of the selected compounds. However, this study was conducted strictly in vitro on a single strain under monomicrobial biofilm conditions. Therefore, while the findings suggest that mouthwashes containing OCT, CHX, and PHMB may be effective against P. gingivalis, their actual clinical efficacy in the treatment and prevention of oral diseases remains to be confirmed in in vivo studies. Full article

Failure of the endodontic treatment is often associated with persistent polymicrobial biofilms, particularly those involving Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans), which display synergistic pathogenicity and resistance to standard disinfection methods. This in vitro study compared the antimicrobial activity and oxidative damage induced by indocyanine green (ICG)–mediated laser ablation (LA) with that produced by antimicrobial photodynamic therapy (aPDT) using methylene blue (MB) or curcumin (CUR) in root canals infected with dual-species biofilms. The samples were divided into five experimental groups (n = 20): Group A—Methylene Blue + Red Laser (RL), Group B—Curcumin + Blue LED (BL), Group C—Indocyanine Green + Infrared Diode Laser (DL), Group D—saline solution (Negative Control—NC), Group E—2.5% sodium hypochlorite (Positive Control—PC). One hundred treated bovine incisors (20 per group) were analyzed for microbial viability (colony-forming unit (CFU/mL)), the metabolic functionality of biofilms was assessed through the 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide (XTT) based reduction method, and oxidative stress markers, including Thiobarbituric Acid Reactive Substances (TBARS), protein carbonyl content, total oxidant capacity (TOC), and total protein levels. All experimental treatments significantly reduced microbial load compared to the negative control (p < 0.05), with ICG achieving the greatest reduction. ICG also induced the highest levels of oxidative stress across all parameters (p < 0.05). These findings suggest that LA with ICG is more effective than aPDT with MB or CUR, achieving disinfection outcomes comparable to those of 2.5% sodium hypochlorite, and warrant further investigation in complex clinical models. Full article