Exploring the Antimicrobial and Clinical Efficacy of a Novel Technology in Pediatric Endodontics: An In Vivo Study  
[PERSON]  
1 Department of Medical, Oral and Biotechnological Sciences, \"[PERSON]\" University of Chieti-Pescara, 66100 Chieti, Italy; [EMAIL_ADDRESS] (L.D.G. ); [EMAIL_ADDRESS] (M.P. ); [EMAIL_ADDRESS] (D.T. )1  
[PERSON]  
2 Department of Dental Materials and Prostodontics, Ribeirao Preto School of Dentistry, University of Sao Paulo, Sio Paulo 14040-904, Brazil; [EMAIL_ADDRESS] 2  
[PERSON]  
1 Department of Medical, Oral and Biotechnological Sciences, \"[PERSON]\" University of Chieti-Pescara, 66100 Chieti, Italy; [EMAIL_ADDRESS] (L.D.G. ); [EMAIL_ADDRESS] (M.P. ); [EMAIL_ADDRESS] (D.T. )1  
[PERSON]  
3 Department of Medical, Oral and Biotechnological Sciences, \"[PERSON]\" University of Chieti-Pescara, 66100 Chieti, Italy; [EMAIL_ADDRESS] (L.D.G. ); [EMAIL_ADDRESS] (M.P. ); [EMAIL_ADDRESS] (D.T. )1  
[PERSON]  
4 Department of Medical Physics, Fondazione IRCCS Policinico San Matteo, 27100 Pavia, Italy; l.dercole@matteo.pyit 4  
[PERSON]  
4 Department of Medical Physics, Fondazione IRCCS Policinico San Matteo, 27100 Pavia, Italy; [EMAIL_ADDRESS] 4  
[PERSON]  
1 Department of Medical, Oral and Biotechnological Sciences, \"[PERSON]\" University of Chieti-Pescara, 66100 Chieti, Italy; [EMAIL_ADDRESS] (L.D.G. ); [EMAIL_ADDRESS] (M.P. ); [EMAIL_ADDRESS] (D.T. )1  
Footnote 1: email: [EMAIL_ADDRESS]  
pulp necrosis, which is especially concerning in primary teeth, as inflammation can evolve into necrosis more rapidly and with fewer symptoms than in permanent teeth [2; 3]. Within pediatric dentistry, pediatric endodontics plays a critical role in managing infections in the pulp and root canals of primary teeth, requiring precise and efficient therapeutic strategies to prevent complications and support long-term oral health [4]. Treating young patients presents unique challenges due to limited cooperation, heightened anxiety, and smaller anatomical structures, necessitating tailored, minimally invasive protocols to enhance comfort and ensure success. These procedures often require local anesthesia and rubber dam isolation, making it essential to implement swift protocols that reduce discomfort and increase efficiency [5]. Ensuring cooperation is also vital for meeting therapeutic goals and fostering positive dental experiences that help reduce anxiety in future appointments [6; 7]. In some cases, retaining a compromised primary tooth is crucial for space maintenance and preventing malocclusion. Palliative therapies may help manage symptoms and delay extraction, preserving occlusal integrity and supporting oral development [8]. Despite advances, achieving the complete disinfection of primary root canals remains a challenge. Conventional treatments may not fully control microbial infections, which can compromise treatment success [9]. In response, photodynamic therapy (PDT) has emerged as a promising adjunct to traditional endodontic protocols [10; 11; 12; 13]. PDT uses a photosensitizing agent that, when activated by light, produces reactive oxygen species capable of destroying bacterial cells [14]. Various photosensizers have been tested, with phenothiazazine derivatives like methylene blue and toluidine blue being widely recognized for their bactericidal activity, including against _Enterococcus faecalis_, a common endodontic pathogen [15; 16; 17; 18; 19; 20; 21; 22]. Light sources commonly used in PDT include lasers, halogen lamps, and LEDs, with LEDs being particularly advantageous due to their cost-effectiveness and ease of use across different tissues [23; 24; 25; 26; 18]. A recently explored protocol used 5-aminolevulinic acid (ALA) gel combined with red LED light, showing significant antibacterial effects against endodontic pathogens, including _E. faecalis_[27]. ALA stands out as an intrinsic photosensizer, as it is metabolized in situ into protoporphyrin IX (PpIX), a key compound in heme synthesis and a potent photosensitizer [28].