Oxidative Adjuncts in Endodontic Disinfection: A Narrative Review of Ozone and Photodynamic Therapy Against Enterococcus faecalis Biofilms
Novelty in Biomedicine,
Vol. 14 No. 4 (2026),
13 October 2026
,
Page 209-217
https://doi.org/10.22037/nbm.v14i4.52306
Abstract
Background and Aim: Persistent endodontic infections remain a major clinical challenge due to the resilience of biofilm-forming microorganisms, particularly Enterococcus faecalis, which can survive conventional chemomechanical disinfection and persist within the complex anatomy of the root canal system. This narrative review provides a mechanism-based comparison of two oxidative adjunctive strategies—ozone therapy and photodynamic therapy (PDT)—focusing on their antimicrobial effects against E. faecalis biofilms. Both modalities act through oxidative pathways that induce damage to microbial cells independent of bacterial metabolic activity, making them theoretically suitable for targeting biofilm-associated infections. Evidence indicates that PDT demonstrates more consistent antimicrobial efficacy, attributed to its controlled generation of reactive oxygen species and localized activation within biofilm structures. In contrast, ozone therapy exhibits variable antimicrobial performance, primarily limited by its instability, rapid decomposition, and restricted penetration into mature biofilms. Despite their oxidative potential, neither modality reliably achieves complete eradication of E. faecalis when used as standalone treatments, and both remain less effective than sodium hypochlorite irrigation in conventional protocols. Current findings support their role as adjunctive rather than primary disinfection strategies. This review highlights the need for standardized clinical protocols and well-designed in vivo studies to better define their translational value and optimize their integration into multimodal endodontic disinfection approaches.
- Enterococcus faecalis
- Biofilm
- Endodontics
- Ozone therapy
- Photodynamic therapy
- Oxidative disinfection
- Narrative review
How to Cite
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