Can Pulsed Electric Fields Be an Alternative for Disinfection in Endodontic Treatment?

Persistent Enterococcus faecalis infections represent a major cause of endodontic treatment failure, highlighting the need for innovative disinfection strategies beyond conventional irrigation. This in vitro study evaluated the antimicrobial potential of pulsed electric fields (PEF) as a non-thermal and non-chemical adjunctive method for root canal disinfection. Fifty-two extracted mandibular premolars with single canals were standardized to 16 ± 0.1 mm, inoculated with E. faecalis, and incubated for 28 days to establish mature biofilms. The teeth were subsequently exposed to PEF under varying electrical parameters using sterile water as the irrigant, and bacterial viability and metabolic activity were assessed post-treatment. Confocal laser scanning microscopy (CLSM) was performed to visualize bacterial distribution within dentinal tubules, with particular attention to the apical region, which is most resistant to disinfection. PEF application significantly reduced bacterial viability and metabolic activity compared with baseline (p < 0.05), although complete elimination was not achieved. CLSM images revealed both red-stained non-viable cells, reflecting irreversible electroporation, and green-stained viable cells, indicating reversible electroporation and residual bacterial survival. These findings demonstrate that PEF can inactivate microorganisms through electroporation while maintaining tissue compatibility, and its antimicrobial effect may be enhanced when combined with sodium hypochlorite. Optimization of electrical parameters and evaluation in polymicrobial biofilm models are warranted to establish clinical relevance and support translation into practice.