1
|
de Oliveira Neto RS, Souza TDM, Rosa SJ, Vivan RR, Alcalde MP, Honório HM, Duarte MAH. Biological response to endodontic treatment in one versus two-visit: a systematic review and meta-analysis of animal studies. Clin Oral Investig 2024; 28:173. [PMID: 38407663 DOI: 10.1007/s00784-024-05571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To perform a systematic review of animal studies that compared the histopathological characteristics between teeth with apical periodontitis after endodontic treatment in one or two visits. MATERIALS AND METHODS This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42022340849. Studies were collected from PubMed/MEDLINE, LILACS, EMBASE, Livivo, SciELO, Web of Science, Scopus, and Cochrane Library and manual and gray literature searches. Animal studies that evaluated histological characteristics after endodontic treatment of teeth with apical periodontitis in one or two visits were included. Risk of bias analysis of the included studies was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. Data synthesis of the included studies with quantitative data was performed, and meta-analysis was conducted with the Comprehensive Meta-Analysis software, using the random effects model and odds ratio (OR). RESULTS Eighteen studies met the inclusion criteria (Kappa = 0.891). Meta-analyses indicated values in inflammatory infiltrate intensity with effect size of 5.5% (95% CI: 0.020-0.148; p < 0.001), periodontal ligament thickness: 25.6% (95% CI: 0.134-0.487; p < 0.001), dentin resorption: 13% (95% CI: 0.015-1.141; p = 0.066), cementum resorption: 7.1% (95% CI: 0.015-0.325; p = 0.001), bone resorption: 1.4% (95% CI: 0.002-0.130; p < 0.001), mineralized tissue resorption: 42.8% (95% CI: 0.110-1.671; p = 0.222), biological apical sealing: 13.1% (95% CI: 0.055-0.314; p < 0.001), and presence of microorganisms: 10.3% (95% CI: 0.014-0.747; p = 0.025). CONCLUSIONS When considering animal studies, the two-visit endodontic treatment, using calcium hydroxide-based intracanal medication, resulted in better biological repair characteristics. CLINICAL RELEVANCE A two-visit endodontic treatment with calcium hydroxide-based intracanal medication yields superior histopathological outcomes.
Collapse
Affiliation(s)
- Raimundo Sales de Oliveira Neto
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil.
| | - Thais de Moraes Souza
- Department of Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo - USP, Bauru, Brazil
| | - Stefani Jovedi Rosa
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
| | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
| | - Murilo Priori Alcalde
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
| | - Heitor Marques Honório
- Department of Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo - USP, Bauru, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
| |
Collapse
|
2
|
Weissheimer T, Pinto KP, da Silva EJNL, Hashizume LN, da Rosa RA, Só MVR. Disinfectant effectiveness of chlorhexidine gel compared to sodium hypochlorite: a systematic review with meta-analysis. Restor Dent Endod 2023; 48:e37. [PMID: 38053784 PMCID: PMC10695732 DOI: 10.5395/rde.2023.48.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
This study aimed to compare the disinfectant ability of chlorhexidine (CHX) gel and sodium hypochlorite (NaOCl). Systematic searches were conducted from inception until December 8th, 2022 (MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, Embase, and Grey Literature databases). Only randomized clinical trials were included. The revised Cochrane risk of bias tools for randomized trials were used to assess the quality of studies. Meta-analyses were performed. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. Six studies were included. Five had a low risk of bias and 1 had some concerns. Three studies assessed bacterial reduction. Two were included in the meta-analysis for bacterial reduction (mean difference, 75.03 [confidence interval, CI, -271.15, 421.22], p = 0.67; I2 = 74%); and 3 in the meta-analysis for cultivable bacteria after chemomechanical preparation (odds ratio, 1.03 [CI, 0.20, 5.31], P = 0.98; I2 = 49%). Five studies assessed endotoxin reduction. Three were included in a meta-analysis (mean difference, 20.59 [CI, -36.41, 77.59], p = 0.48; I2 = 74%). There seems to be no difference in the disinfectant ability of CHX gel and NaOCl, but further research is necessary.
Collapse
Affiliation(s)
- Theodoro Weissheimer
- Department of Endodontics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Karem Paula Pinto
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Emmanuel João Nogueira Leal da Silva
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Lina Naomi Hashizume
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Department of Endodontics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Endodontics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| |
Collapse
|
3
|
Alquria TA, Alfirdous RA, Gupta S, Santamaria MP, Santamaria IF, Gomes APM, Tiradentes N, Silva EG, Martinho FC. Comparison of conventional and contemporary root canal disinfection protocols against bacteria, lipoteichoic acid (LTA), and lipopolysaccharide (LPS). Sci Rep 2023; 13:1206. [PMID: 36681702 PMCID: PMC9867776 DOI: 10.1038/s41598-022-26855-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023] Open
Abstract
This study devised a dual-species biofilm model to investigate bacteria, lipoteichoic acid (LTA), and lipopolysaccharide (LPS) simultaneously, and compared the efficacy of conventional and contemporary disinfection protocols. Seventy single-rooted mandibular premolars were included. Fourteen teeth were negative control, and 56 teeth were infected with 3-week-old E. faecalis and E. coli GFP biofilm. Fourteen/56 teeth were positive control, with seven teeth processed for CLSM analysis and seven teeth sampled with paper points (PPs) and cryogenically ground for bacterial, LTA, and LPS analyses. Forty-two teeth were randomly divided into three groups: GWS (GentleWave system) + MIT (minimally invasive technique), PUI (passive ultrasonic irrigation) + CIT (conventional instrumentation technique), and XP-EF (XP-endo Finisher) + CIT (All, n = 14). Samples were collected before (s1) and after disinfection (s2) with PPs and after cryogenically ground (s3). CFUs were counted, and LTA and LPS were quantified with LTA-ELISA and LAL assay, respectively. XP-EF was as effective as PUI (p > 0.05). GWS + MIT was the most effective disinfection protocol against bacteria, LTA, and LPS (p < 0.05). In conclusion, PUI, XP-EF, and GWS were highly effective against bacteria, LTA, and LPS, with GWS being the most effective.
Collapse
Affiliation(s)
- Theeb A Alquria
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
- Department of Restorative Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rayyan A Alfirdous
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
- Prince Abdulrahman Advanced Dental Institute, Riyadh, Kingdom of Saudi Arabia
| | - Swati Gupta
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | | | - Ingrid F Santamaria
- Department of General Dentistry, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Ana P M Gomes
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Naiara Tiradentes
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Eduardo G Silva
- Department of Social and Pediatric Dentistry, Institute of Science and Technology, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Frederico C Martinho
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.
| |
Collapse
|
4
|
Ahmad MZ, Merdad KA, Sadaf D. An overview of systematic reviews on endotoxins in endodontic infections and the effectiveness of root canal therapy in its removal. Evid Based Dent 2022:10.1038/s41432-022-0826-x. [PMID: 36482195 DOI: 10.1038/s41432-022-0826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/16/2022] [Indexed: 06/17/2023]
Abstract
Background The objective of this overview was to synthesise the current evidence on the role of endotoxins in endodontics infections and to evaluate the effectiveness of endodontic procedures in its removal using information from published systematic reviews.Methods Electronic databases Medline, Scopus, Embase, Cochrane Library and Google Scholar were searched for reviews published up to July 2021. Systematic reviews on endotoxins based on clinical and/or observational studies were included. The quality of systematic reviews was assessed with the AMSTAR2 tool.Results A total of five systematic reviews were selected, of which two reviews were of high quality. A significantly higher level of endotoxins were found in teeth with exudation, teeth with a previous episode of pain and pain on percussion. Chemomechanical preparation of root canals significantly reduce endotoxin levels. Calcium hydroxide intracanal medication in symptomatic teeth was significantly effective in endotoxin reduction (standardised mean difference -1.051 [95% confidence interval -2.039 to -0.063]; p <0.05; I2 = 83.3%; certainty of evidence = very low). Multiple session root canal treatment in teeth with symptomatic apical periodontitis was significantly more effective in endotoxins/lipopolysaccharides removal than single-session treatment.Conclusion Limited quality of evidence showed a significant association of endotoxins in infected teeth with clinical symptoms. Conventional chemomechanical preparation of root canals and intracanal medication were unable to eliminate endotoxins from the root canal system. Future evolution of effective disinfection therapies is warranted.
Collapse
Affiliation(s)
- Muhammad Z Ahmad
- Restorative Dentistry Department, College of Dentistry in Ar Rass, Qassim University, Alrass, Saudi Arabia
| | - Khalid A Merdad
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Durre Sadaf
- Department of Microbial Diseases, University College London, Eastman Dental Institute, London, United Kingdom.
| |
Collapse
|
5
|
Biomolecules of the Horseshoe Crab’s Hemolymph: Components of an Ancient Defensive Mechanism and Its Impact on the Pharmaceutical and Biomedical Industry. Cell Microbiol 2022. [DOI: 10.1155/2022/3381162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Without adaptive immunity, invertebrates have evolved innate immune systems that react to antigens on the surfaces of pathogens. These defense mechanisms are included in horseshoe crab hemocytes’ cellular responses to pathogens. Secretory granules, large (L) and small (S), are found on hemocytes. Once the invasion of pathogens is present, these granules release their contents through exocytosis. Recent data in biochemistry and immunology on the granular constituents of granule-specific proteins are stored in large and small granules which are involved in the cell-mediated immune response. L-granules contain most clotting proteins, which are necessary for hemolymph coagulation. They also include tachylectins; protease inhibitors, such as cystatin and serpins; and anti-lipopolysaccharide (LPS) factors, which bind to LPS and agglutinate bacteria. Big defensin, tachycitin, tachystatin, and tachyplesins are some of the essential cysteine-rich proteins in S-granules. These granules also contain tachycitin and tachystatins, which can agglutinate bacteria. These proteins in granules and hemolymph act synergistically to fight infections. These biomolecules are antimicrobial and antibacterial, enabling them to be drug resistant. This review is aimed at explaining the biomolecules identified in the horseshoe crab’s hemolymph and their application scopes in the pharmaceutical and biotechnology sectors.
Collapse
|
6
|
Alfirdous RA, Alquiria TA, Jacinto RC, Martinho FC. A modified dentin infection model with Fluorescent Lipopolysaccharide and
LPS
sampling technique to compare
XP‐Endo
finisher and passive ultrasonic irrigation. Int Endod J 2022; 55:1081-1090. [DOI: 10.1111/iej.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- R. A. Alfirdous
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
- Prince Abdulrahman Advanced Dental Institute Riyadh Kingdom of Saudi Arabia
| | - T. A. Alquiria
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
- Prince Abdulrahman Advanced Dental Institute Riyadh Kingdom of Saudi Arabia
| | - R. C. Jacinto
- Division of Endodontics, Department of preventive and restorative dentistry School of Dentistry, Aracatuba São Paulo SP Brazil
| | - F. C. Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
| |
Collapse
|
7
|
Velardi JP, Alquria TA, Alfirdous RA, Corazza BJM, Gomes APM, Silva EG, Griffin IL, Tordik PA, Martinho FC. Comparison of GentleWave system and passive ultrasonic irrigation with minimally invasive and conventional instrumentation against LPS in infected root canals. Sci Rep 2022; 12:4894. [PMID: 35318365 PMCID: PMC8940914 DOI: 10.1038/s41598-022-08835-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/14/2022] [Indexed: 01/22/2023] Open
Abstract
This study compared the effectiveness of GentleWave system (GWS) and passive ultrasonic irrigation (PUI) in removing lipopolysaccharides (LPS) from infected root canals after minimally invasive (MIT) and conventional instrumentation (CIT) techniques. Sixty first premolars with two roots were inoculated with fluorescent LPS conjugate (Alexa Fluor 594). Of those, twelve were dentin pretreated, inoculated with fluorescent LPS conjugate, and submitted to confocal laser scanning microscopy (CLSM) to validate the LPS-infection model. Forty-eight teeth were randomly divided into treatment groups: GWS + MIT, GWS + CIT, PUI + MIT, and PUI + CIT (all, n = 12). Teeth were instrumented with Vortex Blue rotary file size 15/0.04 for MIT and 35/0.04 for CIT. Samples were collected before (s1) and after a root canal procedure (s2) and after cryogenically ground the teeth (s3) for intraradicular LPS analysis. LPS were quantified with LAL assay (KQCL test). GWS + MIT and GWS + CIT were the most effective protocols against LPS, with no difference between them (p > 0.05). PUI + CIT was more effective than PUI + MIT (p < 0.05) but less effective than GWS + MIT and GWS + CIT. GWS was the most effective protocol against LPS in infected root canals using MIT and CIT techniques.
Collapse
Affiliation(s)
- Johnathan P Velardi
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, MD, USA
| | - Theeb A Alquria
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, MD, USA
| | - Rayyan A Alfirdous
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, MD, USA
| | - Bruna J M Corazza
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, Brazil
| | - Ana P M Gomes
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, Brazil
| | - Eduardo G Silva
- Department of Social and Pediatric Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, Brazil
| | - Ina L Griffin
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, MD, USA
| | - Patricia A Tordik
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, MD, USA
| | - Frederico C Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, MD, USA.
| |
Collapse
|
8
|
Gabrielli ES, Lima AR, Francisco PA, Herrera DR, de-Jesus-Soares A, Ferraz CCR, Almeida JFA, Marciano MA, Gomes BPFA. Comparative analysis of bacterial content, levels of lipopolysaccharides and lipoteichoic acid in symptomatic and asymptomatic endodontic infections at different stages of endodontic treatment. Clin Oral Investig 2021; 26:287-302. [PMID: 34114101 DOI: 10.1007/s00784-021-03998-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/19/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to detect the presence of specific bacteria and to evaluate the levels of lipopolysaccharides (LPS) and lipoteichoic acid (LTA) in symptomatic necrotic root canals associated with acute apical abscess (symptomatic group - GI). It also aimed to compare the findings with those presented by asymptomatic necrotic root canals (asymptomatic group - GII) in the different stages of the endodontic treatment. MATERIALS AND METHODS Microbiological samples were collected from 20 root canals, including purulent collection from acute apical abscesses, before and after chemo-mechanical preparation (CMP) preparation (CMP) with chlorhexidine gel 2% and after 30 days of intracanal medication (ICM) with (Ca[OH]2) + chlorhexidine. The culture method was used to evaluate the efficacy of CMP and ICM. Nested PCR was used to detect the presence of 17 specific bacteria. Levels of LPS were measured by using limulus amebocyte lysate, whereas enzyme-linked immunosorbent assay was used for the quantification of LTA. RESULTS CMP was effective in reducing the microbial load in both groups (P < 0.05). LPS levels were higher in GI than in GII (P < 0.05). There was a significant reduction in the LPS levels after CMP and ICM (P < 0.05) in GI and GII. LTA levels were significantly reduced in GI after ICM and in GII after CMP and ICM (both P < 0.05). Fusobacterium nucleatum and Enterococcus faecalis were frequently identified in both groups, alone or in combination with each other. CONCLUSION Different species were detected in all stages of the endodontic treatment. CMP was able to reduce bacterial content and the levels of LPS, but not of LTA in the symptomatic group. High levels of LPS were correlated with spontaneous pain and pain to percussion in the symptomatic group. CLINICAL RELEVANCE This clinical study showed that chemo-mechanical preparation was able to reduce bacterial load and levels of LPS, but not of LTA in the symptomatic group. Elevated levels of LPS were correlated with the presence of symptomatology.
Collapse
Affiliation(s)
- Ezequiel S Gabrielli
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil
| | - Augusto R Lima
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil
| | - Priscila A Francisco
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil
| | - Daniel R Herrera
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil.,Department of Endodontics, Fluminense Federal University, Rua Mario Santos Braga, 28, Niterói, Rio de Janeiro, Brazil
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil
| | - Caio C R Ferraz
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil
| | - José Flávio A Almeida
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil
| | - Marina A Marciano
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil.
| |
Collapse
|
9
|
Lima AR, Herrera DR, Francisco PA, Pereira AC, Lemos J, Abranches J, Gomes BPFA. Detection of Streptococcus mutans in symptomatic and asymptomatic infected root canals. Clin Oral Investig 2021; 25:3535-3542. [PMID: 33170373 PMCID: PMC8152374 DOI: 10.1007/s00784-020-03676-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the presence of Streptococcus mutans in root canals of symptomatic necrotic teeth (SNT) and their associated acute apical abscesses (AAA) and in the root canals of asymptomatic necrotic teeth (ANT). It also aimed to investigate the presence of the cnm and cbm genes in specimens that harbored S. mutans. MATERIALS AND METHODS DNA was extracted from samples collected from 10 patients presenting pulpal necrosis associated with radiographic evidence of apical periodontitis (ANT) and from 10 patients in need of endodontic therapy due to the presence of pulpal necrosis (SNT) and AAA. The control group consisted of 10 patients with teeth with normal vital pulp and requiring endodontic treatment for prosthetic reasons. The presence of S. mutans was detected by quantitative real-time-PCR (qPCR) using species-specific primers. Samples harboring S. mutans were further evaluated for the presence of CBP genes by qPCR as well. RESULTS All studied sites showed a high prevalence of S. mutans, except the control group. Specifically, 60% of ANT and 70% of AAA/SNT paired samples were positive for S. mutans. The cnm gene was detected positive for S. mutans only in ANT samples (66.6%). The cbm gene was not detected in any of the investigated sites. CONCLUSIONS S. mutans was found in high prevalence in both asymptomatic and symptomatic endodontic infections, including in abscesses, but it was not detected in the root canals of teeth with normal vital pulp. Interestingly, cnm+ S. mutans was only detected in asymptomatic/chronic primary endodontic infections associated with apical lesion. Therefore, it appears that cnm, and possibly other CBPs, may play an underestimated role in chronic endodontic infections. CLINICAL RELEVANCE A high prevalence of Streptococcus mutans cnm+ gene was detected only in asymptomatic primary endodontic infections associated with apical lesion. Therefore, it appears that this collagen-binding protein gene plays an underestimated role in asymptomatic/chronic endodontic infections.
Collapse
Affiliation(s)
- Augusto Rodrigues Lima
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, University of Campinas-UNICAMP, Av Limeira, 901, Bairro Areião, Piracicaba, SP, 13414-903, Brazil
- Department of Oral Biology, University of Florida, UF. College of Dentistry, 1395 Center Drive, Box 100424, Gainesville, FL, 32610-0424, USA
| | - Daniel Rodrigo Herrera
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, University of Campinas-UNICAMP, Av Limeira, 901, Bairro Areião, Piracicaba, SP, 13414-903, Brazil
- Department of Endodontics, Fluminense Federal University - UFF, Niteroi, RJ, Brazil
| | - Priscila Amanda Francisco
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, University of Campinas-UNICAMP, Av Limeira, 901, Bairro Areião, Piracicaba, SP, 13414-903, Brazil
| | - Andrea Cardoso Pereira
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, University of Campinas-UNICAMP, Av Limeira, 901, Bairro Areião, Piracicaba, SP, 13414-903, Brazil
- Department of Oral Biology, University of Florida, UF. College of Dentistry, 1395 Center Drive, Box 100424, Gainesville, FL, 32610-0424, USA
| | - Jose Lemos
- Department of Oral Biology, University of Florida, UF. College of Dentistry, 1395 Center Drive, Box 100424, Gainesville, FL, 32610-0424, USA
| | - Jacqueline Abranches
- Department of Oral Biology, University of Florida, UF. College of Dentistry, 1395 Center Drive, Box 100424, Gainesville, FL, 32610-0424, USA.
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, University of Campinas-UNICAMP, Av Limeira, 901, Bairro Areião, Piracicaba, SP, 13414-903, Brazil.
| |
Collapse
|
10
|
Martinho FC, Leite FRM, Arruda-Vasconcelos R, Louzada LM, Darveau RP, Gomes BPFA. Influence of Bacterial Profiles in Cytokine and Clinical Features of Endodontic Disease. J Endod 2021; 47:1265-1271. [PMID: 34015415 DOI: 10.1016/j.joen.2021.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION We verified the association between selected bacterial profiles and levels of cytokines, chemokines, and the expression of signs and symptoms of primary endodontic infection with apical periodontitis. METHODS Samples were collected from 21 root canals, and macrophages were stimulated for 24 hours. Tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-10, IL-12p70, interferon gamma, and chemokine (C-C motif) ligand 2 (CCL2) were measured using cytometric bead array. We investigated the overlapping networks between cytokines and chemokines with regression analysis. Checkerboard DNA-DNA hybridization was used to assess 40 target bacteria species. Using factor analysis, bacterial species aggregated in 2 factors. The association of bacteria species-based factors on cytokine and chemokine levels and clinical features was estimated with regression analysis. RESULTS A negative relationship between IL-10 (anti-inflammatory cytokine) and CCL2, TNF-α, and IFN-γ (proinflammatory cytokines) (all P < .05) was observed. CCL2 was positively correlated with TNF-α (P < .01). Thirty-eight bacteria species were detected in primary endodontic infection with apical periodontitis. The first bacteria species-based factor was associated with the size of the radiolucent area (coefficient = 15.42) and tenderness to percussion/pain on palpation (coefficient = 20.79). The second factor was associated with CCL2 levels (coefficient = 1.28). CONCLUSIONS Different bacterial profiles can be differentially related to the expression of inflammatory proteins and the experience of clinical features.
Collapse
Affiliation(s)
- Frederico C Martinho
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil; Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland.
| | - Fabio R M Leite
- Department of Dentistry and Oral Health, Section for Periodontology, Aarhus University, Aarhus, Denmark
| | - Rodrigo Arruda-Vasconcelos
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Lidiane M Louzada
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Richard P Darveau
- Department of Periodontics, University of Washington, Seattle, Washington
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.
| |
Collapse
|
11
|
Wang L, Liu W, Liu J, Wang Y, Tai J, Yin X, Tan J. Identification of Immune-Related Therapeutically Relevant Biomarkers in Breast Cancer and Breast Cancer Stem Cells by Transcriptome-Wide Analysis: A Clinical Prospective Study. Front Oncol 2021; 10:554138. [PMID: 33718103 PMCID: PMC7945036 DOI: 10.3389/fonc.2020.554138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022] Open
Abstract
Cancer stem cells (CSCs) represent a subset of tumor cells that are responsible for recurrence and metastasis of tumors. These cells are resistant to radiotherapy and chemotherapy. Immunotherapeutic strategies that target CSCs specifically have provided initial results; however, the mechanism of action of these strategies is unclear. The data were requested from The Cancer Genome Atlas and Genotype-Tissue Expression, followed with the survival analysis and weighted gene co-expression network analysis to detect survival and stemness related genes. Patients were divided into three groups based on their immune status by applying single sample GSEA (ssGSEA) with proven dependability by ESTIMATE analysis. The filtered key genes were analyzed using oncomine, GEPIA, HPA, qRT-PCR, and functional analysis. Patients in a group with a higher stemness and a lower immune infiltration showed a worse overall survival probability, stemness and immune infiltration characteristics of breast cancer progressed in a non-linear fashion. Thirteen key genes related to stemness and immunity were identified and the functional analysis indicated their crucial roles in cell proliferation and immune escape strategies. The qRT-PCR results showed that the expression of PIMREG and MTFR2 differed in different stages of patients. Our study revealed a promising potential for CSC-target immunotherapy in the early stage of cancer and a probable value for PIMREG and MTFR2 as biomarkers and targets for immunotherapy.
Collapse
Affiliation(s)
- Linbang Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingkun Liu
- Department of Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yuanyuan Wang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaojiao Tai
- Department of Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xuedong Yin
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinxiang Tan
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
12
|
Nascimento GG, Rabello DGD, Corazza BJM, Gomes APM, Silva EG, Martinho FC. Comparison of the effectiveness of single- and multiple-sessions disinfection protocols against endotoxins in root canal infections: systematic review and meta-analysis. Sci Rep 2021; 11:1226. [PMID: 33441646 PMCID: PMC7806761 DOI: 10.1038/s41598-020-79300-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
This systematic review (SR) addressed the following common clinical question: What is more effective in reducing or eliminating endotoxin in endodontic infections—single or multiple-session treatments using calcium hydroxide medications? Literature searches of Medline/PubMed, Embase, Cochrane Library, Scielo, Science Direct, Web of Knowledge, Scopus, and Google Scholar databases. Two reviewers independently assessed the eligibility for inclusion, extracted data, and evaluated the quality of the studies using the risk of bias tools. Electronic searches resulted in 358 articles, of which 32 studies were included for full-text assessment, and nine were included in this review. Meta-analysis pooling all the nine studies revealed lower levels of endotoxin for multiple-session treatment (P < 0.001). The sub-group analysis indicated no difference between single-session and 7 days of Ca(OH)2 medication (SMD − 0.32; P = 0.22). However, 14-days (I2 = 80.5%, P < 0.001) and 30-days (I2 = 78.9%, P < 0.01) of Ca(OH)2 medication was more effective than single-session treatment (both, p < 0.001). Overall, Overall, this SR provides evidence to support that multiple-session disinfection protocols with the placement of Ca(OH)2 medications are more effective in reducing the levels of endotoxin from root canal infections compared to single-session when applied for 14 and 30 days.
Collapse
Affiliation(s)
- Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Diego G D Rabello
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Bruna J M Corazza
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Ana P M Gomes
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Eduardo G Silva
- Department of Social and Pediatric Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Frederico C Martinho
- Endodontic Division, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.
| |
Collapse
|
13
|
Resolution of Nasal Sinus Tract after Endodontic Therapy: A Case Report with Microbial Analysis. J Endod 2020; 47:327-334. [PMID: 33065178 DOI: 10.1016/j.joen.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/20/2022]
Abstract
This case report describes the resolution of a 20-year misdiagnosed nasal sinus tract after root canal therapy with multiple sessions of calcium hydroxide (Ca[OH]2) intracanal medication. Clinical evaluation, including diagnostic testing and sinus tract tracing, was performed followed by a cone-beam computed tomographic scan and 3-dimensional reconstruction of the apical lesion. Bacteria and endotoxin analyses were performed from the nasal sinus tract and paired root canal infection before (s1) and after instrumentation (s2) and after 7 (s3), 14 (s4), and 21 (s5) days of Ca(OH)2 medication. The bacteria analysis was performed using the checkerboard DNA-DNA hybridization method and endotoxin quantified by the limulus amebocyte lysate method. A similar microbiota profile was found in the sinus tract and paired root canal infection. No target bacterial species were detected in the root canal at s2, s3, and s5. In contrast, Actinomyces israellii and Eubacterium nodatum were detected at s4. Differences in bacterial detection were found between s1 × s2, s3 × s4, and s4 × s5 (all P < .05). Endotoxin was detected in the root canal at all sampling times. Differences in the levels of endotoxin were found between s1 × s2, s2 × s3, and s3 × s4 (all P < .05).The bacterial analysis revealed similar microbiota profiles present in the nasal sinus tract and paired root canal infection with the participation of a wide variety of gram-positive and -negative species. Additionally, root canal therapy with multiple sessions of Ca(OH)2 intracanal medication for 21 days was effective in disinfecting the root canal system and resolving the nasal sinus tract.
Collapse
|
14
|
Barbosa-Ribeiro M, Arruda-Vasconcelos R, Louzada LM, Dos Santos DG, Andreote FD, Gomes BPFA. Microbiological analysis of endodontically treated teeth with apical periodontitis before and after endodontic retreatment. Clin Oral Investig 2020; 25:2017-2027. [PMID: 32860137 DOI: 10.1007/s00784-020-03510-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To characterize the microbiota of teeth with endodontic treatment failure by 16S ribosomal RNA genetic sequencing (GS) and PCR at the different phases of the endodontic retreatment and to associate the presence of specific bacteria with clinical and radiographic features in teeth with apical periodontitis. MATERIALS AND METHODS Twenty infected root canals of single-rooted teeth were selected. Samples were collected with sterile paper points before chemo-mechanical preparation (CMP) (S1), after CMP (S2) and after 30 days of intracanal medication (ICM) (S3). Microbial identification was performed using GS and PCR. Tukey-Kramer post hoc test and post hoc ANOVA were used for intergroup analysis. Paired t test and repeated-measures ANOVA were applied for intragroup analysis, at a significance level of 5%. RESULTS A total of 89 strains were identified using GS. Sixty-five strains were recovered in S1 and 15 strains in S2, and 9 strains remained in S3. Enterococcus faecalis was the most predominant bacteria. Gram-positive cocci bacteria predominated. Gram-negative species were also detected. Using species-specific PCR primers to detect seven species, the most prevalent ones at all the phases of the endodontic retreatment were E. faecalis and Porphyromonas gingivalis. However, Parvimonas micra and P. gingivalis were associated with previous pain, P. gingivalis was associated with tenderness to percussion and E. faecalis, Fusobacterium nucleatum and P. gingivalis were associated with periapical lesion > 3 mm. CONCLUSIONS In conclusion, the microbiota of persistent infection is polymicrobial with predominance of E. faecalis and P. gingivalis in all phases of the endodontic retreatment, regardless of the method used for microbial identification. Associations were found between specific bacteria and clinical/radiographic features. CLINICAL RELEVANCE The characterization of the bacteria present at all phases of the endodontic retreatment is important for the monitoring of the effectiveness of the techniques used and to better understand the susceptibility of these species to the disinfection agent used during the procedures.
Collapse
Affiliation(s)
- Marlos Barbosa-Ribeiro
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Av. Limeira 901, Bairro Areao, Piracicaba, São Paulo, Brazil.,Department of Endodontics School of Dentistry , University Center UniRuy- Wyden , BA, Salvador, Brazil
| | - Rodrigo Arruda-Vasconcelos
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Av. Limeira 901, Bairro Areao, Piracicaba, São Paulo, Brazil
| | - Lidiane M Louzada
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Av. Limeira 901, Bairro Areao, Piracicaba, São Paulo, Brazil
| | - Danielle G Dos Santos
- Department of Soil Science, Luiz de Queiroz College of Agriculture, University of São Paulo (USP), Piracicaba, SP, Brazil
| | - Fernando D Andreote
- Department of Soil Science, Luiz de Queiroz College of Agriculture, University of São Paulo (USP), Piracicaba, SP, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Av. Limeira 901, Bairro Areao, Piracicaba, São Paulo, Brazil.
| |
Collapse
|
15
|
Bedran NR, Nadelman P, Magno MB, de Almeida Neves A, Ferreira DM, Braga Pintor AV, Maia LC, Primo LG. Does Calcium Hydroxide Reduce Endotoxins in Infected Root Canals? Systematic Review and Meta-analysis. J Endod 2020; 46:1545-1558. [PMID: 32795549 DOI: 10.1016/j.joen.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/01/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the potential of endotoxin reduction by comparing the number of lipopolysaccharides (LPSs) before and after the use of calcium hydroxide (Ca[OH]2) as intracanal medication (ICM). METHODS Searches were performed up to June 2020. Clinical and experimental studies comparing the amount of LPSs before and after the use of Ca(OH)2 as ICM in infected root canals were included. Risks of bias assessment and data extraction were performed. Meta-analysis was conducted by subgrouping according to Ca(OH)2, the presence of an antimicrobial substance (AS), irrigant solution during chemomechanical preparation (CMP), and the incidence of LPS reduction. The certainty of evidence was determined by the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Nine studies were included in the qualitative synthesis and 7 in the meta-analysis. Three articles had low risk of bias (RB), 1 had moderate RB, 2 had high RB, and 3 "some concerns." Overall, Ca(OH)2, with or without AS, reduced mean LPSs before CMP (standardized mean difference [SMD] = -1.087 [confidence interval {CI}, -1.453 to -0.721], P < .001, I2 = 58.7%) and after CMP (SMD = -0.919 [CI, -1.156 to -0.682], P < .001, I2 = 24.7%). Considering the irrigant solutions, the overall results showed a reduction before (SMD = -1.053 [CI, -1.311 to -0.795], P < .001, I2 = 58.7%) and after CMP (SMD = -0.938 [CI, -1.147 to -0.729], P < .001, I2 = 24,6%). Analyses presented very low certainty of evidence. The incidence of LPS reduction was 98.9% and 61.7% for Ca(OH)2 with and without AS, respectively. CONCLUSIONS Ca(OH)2 reduces endotoxin levels when used as ICM but is unable to eliminate LPSs completely independent of the irrigating solution used with very low certainty of evidence.
Collapse
Affiliation(s)
- Natália Rocha Bedran
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia Nadelman
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline de Almeida Neves
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil; Center for Oral Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Daniele Masterson Ferreira
- Central Library of the Health Science Center, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa Vaz Braga Pintor
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura Guimarães Primo
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
16
|
Louzada LM, Arruda-Vasconcelos R, Duque TM, Casarin RC, Feres M, Gomes BP. Clinical Investigation of Microbial Profile and Levels of Endotoxins and Lipoteichoic Acid at Different Phases of the Endodontic Treatment in Teeth with Vital Pulp and Associated Periodontal Disease. J Endod 2020; 46:736-747. [DOI: 10.1016/j.joen.2020.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 12/13/2022]
|
17
|
Samir Abouelenien S, Mohamed Ibrahim S, Gameel Shaker O, Mohamed Ahmed G. Evaluation of postoperative pain in infected root canals after using double antibiotic paste versus calcium hydroxide as intra-canal medication: A randomized controlled trial. F1000Res 2018; 7:1768. [PMID: 30728951 PMCID: PMC6347033 DOI: 10.12688/f1000research.16820.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Postoperative pain is defined as pain of any degree after initiation of endodontic treatment either intra-appointment or post-obturation and is considered an undesirable occurrence for both patient and dentist. It was suggested that bacterial injury is probably the major cause of pain. Intra-canal medicaments are widely used to kill any bacteria surviving after instrumentation and irrigation. The aim of this study was to assess the ability of double antibiotic paste versus calcium hydroxide used as intra-canal medication in reducing postoperative pain. Methods: 36 patients with single rooted necrotic premolars with apical periodontitis were randomly assigned into two groups according to the intra-canal medication used: calcium hydroxide group (CH) and double antibiotic paste group (DAP). Preoperative pain was recorded using numerical rating scale. After isolation, access cavity was performed followed by chemico-mechanical preparation using rotary Race files with 2.5% sodium hypochlorite irrigation. Subsequently, intra-canal medication was placed and postoperative pain was recorded at 6, 12, 24 and 48 hours postoperatively. Results: There was no statistically significant difference between both groups. Both groups resulted in an increase in median pain value from preoperative to 6 hours postoperative, followed by gradual decrease from 6 hours to 12, 24, 48 hours postoperatively with statistically significant difference. When comparing both groups, DAP group showed lower postoperative pain values than CH group at 12 and 24 hours, but this was not statistically significant. Conclusion: The use of intra-canal medication in necrotic teeth with apical periodontitis was efficient in reducing postoperative pain regardless of type of intra-canal medication used. Trial registration: PACTR201605001482394 (Date: 22 nd February 2016).
Collapse
Affiliation(s)
- Sarah Samir Abouelenien
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, 11553, Egypt
| | - Salsabyl Mohamed Ibrahim
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, 11553, Egypt
| | - Olfat Gameel Shaker
- Medical Biochemistry and Molecular Biology, Cairo University, Cairo, 11553, Egypt
| | - Geraldine Mohamed Ahmed
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, 11553, Egypt
| |
Collapse
|
18
|
Effectiveness of calcium hydroxide-based intracanal medication on infectious/inflammatory contents in teeth with post-treatment apical periodontitis. Clin Oral Investig 2018; 23:2759-2766. [DOI: 10.1007/s00784-018-2719-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
|
19
|
Gomes BPFDA, Herrera DR. Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology. Braz Oral Res 2018; 32:e69. [PMID: 30365610 DOI: 10.1590/1807-3107bor-2018.vol32.0069] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/12/2018] [Indexed: 12/16/2022] Open
Abstract
Evidence shows the polymicrobial etiology of endodontic infections, in which bacteria and their products are the main agents for the development, progression, and dissemination of apical periodontitis. Microbial factors in necrotic root canals (e.g., endotoxin) may spread into apical tissue, evoking and supporting a chronic inflammatory load. Thus, apical periodontitis is the result of the complex interplay between microbial factors and host defense against invasion of periradicular tissues. This review of the literature aims to discuss the complex network between endodontic infectious content and host immune response in apical periodontitis. A better understanding of the relationship of microbial factors with clinical symptomatology is important to establish appropriate therapeutic procedures for a more predictable outcome of endodontic treatment.
Collapse
Affiliation(s)
| | - Daniel Rodrigo Herrera
- Universidade Estadual de Campinas -Unicamp, Piracicaba Dental School, Department of Restorative Dentistry, Piracicaba, SP, Brazil
| |
Collapse
|
20
|
Neelakantan P, Herrera DR, Pecorari VGA, Gomes BPFA. Endotoxin levels after chemomechanical preparation of root canals with sodium hypochlorite or chlorhexidine: a systematic review of clinical trials and meta-analysis. Int Endod J 2018; 52:19-27. [DOI: 10.1111/iej.12963] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- P. Neelakantan
- Faculty of Dentistry; The University of Hong Kong; Hong Kong
| | - D. R. Herrera
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas-UNICAMP; Piracicaba SP Brazil
| | - V. G. A. Pecorari
- Dental Research Division; School of Dentistry; Paulista University; São Paulo SP Brazil
| | - B. P. F. A. Gomes
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas-UNICAMP; Piracicaba SP Brazil
| |
Collapse
|
21
|
Periodontal and endodontic infectious/inflammatory profile in primary periodontal lesions with secondary endodontic involvement after a calcium hydroxide-based intracanal medication. Clin Oral Investig 2018; 23:53-63. [DOI: 10.1007/s00784-018-2401-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/22/2018] [Indexed: 12/19/2022]
|
22
|
Scudder J, Ye JY. Limulus amoebocyte lysate test via an open-microcavity optical biosensor. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-6. [PMID: 29411562 PMCID: PMC5800461 DOI: 10.1117/1.jbo.23.2.027001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/12/2018] [Indexed: 06/08/2023]
Abstract
Almost since its discovery, Limulus amoebocyte lysate (LAL) testing has been an important part of the pharmaceutical quality control toolkit. It allows for in vitro endotoxin testing, which has replaced tests using animals, such as using rabbits' thermal response to judge pyrogenicity of test samples, thus leading to a less expensive and faster test of parenteral pharmaceuticals and medical devices that contact blood or cerebrospinal fluid. However, limited by the detection mechanisms of the LAL assays currently used in industry, further improvement in their performance is challenging. To address the growing demand on optimizing LAL assays for increased test sensitivity and reduced assay time, we have developed an LAL assay approach based on a detection mechanism that is different from those being used in industry, namely, gel-clot, turbidimetric, and chromogenic detection. Using a unique open-microcavity photonic-crystal biosensor to monitor the change in the refractive index due to the reaction between LAL regents and endotoxins, we have demonstrated that this approach has improved the LAL assay sensitivity by 200 times compared with the commercial standard methods, reduced the time needed for the assay by more than half, and eliminated the necessity to incubate the test samples. This study opens up the possibility of using the significantly improved LAL assays for a wide range of applications.
Collapse
Affiliation(s)
- Jonathan Scudder
- The University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, Texas, United States
- Texas Biomedical Research Institute, San Antonio, Texas, United States
| | - Jing Yong Ye
- The University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, Texas, United States
| |
Collapse
|
23
|
Santos Soares SMC, Brito-Júnior M, de Souza FK, Zastrow EV, Cunha COD, Silveira FF, Nunes E, César CAS, Glória JCR, Soares JA. Management of Cyst-like Periapical Lesions by Orthograde Decompression and Long-term Calcium Hydroxide/Chlorhexidine Intracanal Dressing: A Case Series. J Endod 2017; 42:1135-41. [PMID: 27325458 DOI: 10.1016/j.joen.2016.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/22/2016] [Accepted: 04/24/2016] [Indexed: 12/14/2022]
Abstract
Cyst-like periapical lesions should be treated initially with conservative nonsurgical procedures. In this case series, we describe the clinical and radiographic outcomes of large cyst-like lesions that were treated by orthograde decompression and long-term intracanal use of calcium hydroxide [Ca(OH)2] mixed with 2% chlorhexidine digluconate. Ten cases of cyst-like periapical lesions involving 15 teeth from 10 patients were selected. Maximal radiographic diameters of the lesions ranged from 11 to 28 mm. Nonsurgical procedures were performed, including apical patency, orthograde puncture of cyst-like exudates, chemomechanical preparation, and placement of intracanal Ca(OH)2/CHX dressings, which were periodically replaced during 6-10 months. The root canals were then filled with gutta-percha and sealer. The follow-up periods ranged from 6 to 24 months, and the outcome was classified as healed, healing, or failure. Nine lesions drained copious exudates after canal patency. One lesion only drained bloody serous exudate after periapical overinstrumentation. In 9 patients, intracanal exudation ceased in the first follow-up visit. At the 24-month follow-up, 6 lesions (60.0%) had healed, and 3 lesions (30.0%) were healing, with the corresponding patients being without clinical signs or symptoms. The case of treatment failure was submitted to surgical treatment. Microscopically, the lesion appeared to be an apical cyst with exuberant extraradicular bacterial biofilms attached to the sectioned root apex. This case series supports the use of nonsurgical methods to resolve larger cyst-like periapical lesions.
Collapse
Affiliation(s)
| | - Manoel Brito-Júnior
- Department of Dentistry, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Flávia Kelly de Souza
- Department of Dentistry, Federal University of Waleys Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Eduardo Von Zastrow
- Department of Dentistry, Federal University of Waleys Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Carla Oliveira da Cunha
- Department of Dentistry, Federal University of Waleys Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Frank Ferreira Silveira
- Department of Dentistry, Pontificial Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eduardo Nunes
- Department of Dentistry, Pontificial Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carlos Augusto Santos César
- Department of Dentistry, Federal University of Waleys Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - José Cristiano Ramos Glória
- Department of Dentistry, Federal University of Waleys Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Janir Alves Soares
- Department of Dentistry, Federal University of Waleys Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil.
| |
Collapse
|
24
|
Shrestha A, Friedman S, Torneck CD, Kishen A. Bioactivity of Photoactivated Functionalized Nanoparticles Assessed in Lipopolysaccharide-contaminated Root Canals In Vivo. J Endod 2017; 44:104-110. [PMID: 29153731 DOI: 10.1016/j.joen.2017.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The persistence of dentin-bound lipopolysaccharides (LPS) in disinfected root canals impedes treatment outcomes of endodontic procedures. This study assessed the effects of photoactivated rose bengal-functionalized chitosan nanoparticles (CSRBnps) on LPS-contaminated root dentin in vivo using an intraosseous implantation model and neotissue formation as a marker. METHODS Fifty human, 3-mm-long root segments with a 1.2-mm canal lumen were divided into 5 groups (n = 10): group 1, canals not contaminated; group 2, canals contaminated with Pseudomonas aeruginosa LPS; group 3, canals contaminated and disinfected with sodium hypochlorite (NaOCl); group 4, canals contaminated and disinfected with NaOCl and calcium hydroxide; and group 5, canals contaminated and disinfected with NaOCl and CSRBnps (300 μg/mL) with photoactivation (λ = 540 nm, 40 J/cm2). Specimens were implanted into mandibles of guinea pigs, block dissected after 4 weeks, and the canal content evaluated histologically and immunohistochemically. The ingrown neotissue interface (50 μm) with dentin was characterized for fibroblasts, osteoclasts, inflammatory markers, dentin resorption, mineralization, and angiogenesis and dichotomized as type 1 (no inflammation and resorption, indicative of LPS inactivation) or type 2 (inflammation and resorption). The frequency of the observed parameters was analyzed using the Fisher exact test. RESULTS The outcome was categorized as type 1 in groups 1 and 5, type 2 in group 2, and mixed type 1 and 2 in groups 3 and 4. The outcomes in groups 1 and 5 (P > .05) differed significantly (P < .05) from those in groups 2, 3, and 4. CONCLUSIONS Disinfection of LPS-contaminated root canals with photoactivated CSRBnps in vivo supported ingrowth of neotissue without signs of inflammation or resorption, suggestive of effective inactivation of dentin-bound LPS.
Collapse
Affiliation(s)
- Annie Shrestha
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Shimon Friedman
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Calvin D Torneck
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
25
|
Martinho FC, Leite FRM, Nóbrega LMM, Endo MS, Nascimento GG, Darveau RP, Gomes BPFA. Comparison of Fusobacterium nucleatum and Porphyromonas gingivalis Lipopolysaccharides Clinically Isolated from Root Canal Infection in the Induction of Pro-Inflammatory Cytokines Secretion. Braz Dent J 2017; 27:202-7. [PMID: 27058385 DOI: 10.1590/0103-6440201600572] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/08/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to compare the biological activity of lipopolysaccharides (LPS) purified from Fusobacterium nucleatum and Porphyromonas gingivalis strains, both isolated from primary endodontic infection (PEI) in the levels of IL-1β and TNF-α released by macrophage cells. Moreover, LPS was purified from F. nucleatum and P. gingivalis American Type Collection (ATCC) and its biological activity was compared to respectively clinical isolates strains. F. nucleatum and P. gingivalis strains clinically isolated from PEI had their identification confirmed by sequencing the 16S rRNA gene. LPS from F. nucleatum and P. gingivalis and their respective ATCC strains were extracted by using Tri-reagent method. Macrophages (Raw 264.7) were stimulated with LPS at 100 ng/mL for 4, 8 and 12 h. Secretion of IL-1 β and TNF-α was also determined. Paired t-test, repeated measures ANOVA and one-way ANOVA were employed. All LPS induced significant production of IL-1β and TNF-α, with the former being secreted at higher levels than the latter in all time-points. F. nucleatum induced a higher expression of both cytokines compared to P. gingivalis (p<0.05). No differences were observed between clinical and ATCC strains, as both presented the same potential to induce pro-inflammatory response. It was concluded that F. nucleatum and P. gingivalis LPS presented different patterns of activation against macrophages as seen by the IL-1β and TNF-α production, which may contribute to the immunopathogenesis of apical periodontitis. Moreover, clinical and ATCC strains grown under the same in vitro environment conditions presented similar biological activity.
Collapse
Affiliation(s)
- Frederico C Martinho
- Department of Restorative Dentistry, Endodontics Division, São José dos Campos Dental School, Universidade Estadual de São Paulo, São José dos Campos, SP, Brazil
| | - Fábio R M Leite
- Postgraduate Program in Dentistry, Dental School, Universidade Federal de Pelotas, RS, Brazil, Brazil
| | - Letícia M M Nóbrega
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Marcos S Endo
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Gustavo G Nascimento
- Postgraduate Program in Dentistry, Dental School, Universidade Federal de Pelotas, RS, Brazil, Brazil
| | - Richard P Darveau
- Department of Periodontics and Oral Biology, University of Washington, Seattle, WA, USA
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| |
Collapse
|
26
|
Herrera DR, Martinho FC, de-Jesus-Soares A, Zaia AA, Ferraz CCR, Almeida JFA, Gomes BPFA. Clinical efficacy of EDTA ultrasonic activation in the reduction of endotoxins and cultivable bacteria. Int Endod J 2016; 50:933-940. [PMID: 27775835 DOI: 10.1111/iej.12713] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
AIM This clinical study was conducted to investigate the influence of 17% ethylenediaminetetraacetic acid (EDTA) ultrasonic activation after chemomechanical preparation (CMP) on eliminating/reducing oral bacterial lipopolysaccharides (known as endotoxins) and cultivable bacteria in teeth with pulp necrosis and apical periodontitis. METHODOLOGY Samples were taken from 24 root canals at several clinical periods: S1 - before CMP; S2 - after CMP; S3 - after EDTA: G1 - with ultrasonic activation (n = 12) and G2 - without ultrasonic activation (n = 12). Root canals were instrumented using Mtwo rotary files. Culture techniques were used to determine the number of colony-forming units (CFU). Limulus amebocyte lysate (LAL) was used to measure endotoxin levels. Friedman's and Wilcoxon signed-rank tests were used to compare the amount of bacteria and endotoxin levels in each period (P < 0.05). RESULTS Endotoxins and cultivable bacteria were recovered in 100% of the initial samples (S1). CMP was effective in reducing endotoxins and bacterial load (all with P < 0.05). Higher values of endotoxin reduction were achieved with EDTA ultrasonic activation [G1, 0.02 EU mL-1 (range 0.01-0.75)] compared with the no activation group [G2, 1.13 EU mL-1 (range 0.01-8.34)] (P < 0.05). Regarding bacterial reduction, no statistically significant difference was found in S3, regardless of the group (G1, G2, P > 0.05). CONCLUSIONS Chemomechanical preparation was effective in reducing bacteria and endotoxins, but could not completely eliminate them. The ultrasonic activation of EDTA was effective in further reducing endotoxin levels in the root canals of teeth with pulp necrosis and apical periodontitis.
Collapse
Affiliation(s)
- D R Herrera
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - F C Martinho
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil.,Department of Restorative Dentistry, Endodontic Division, São Jose dos Campos Dental School, State University of São Paulo, UNESP, Sao Jose dos Campos, SP, Brazil
| | - A de-Jesus-Soares
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - A A Zaia
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - C C R Ferraz
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - J F A Almeida
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - B P F A Gomes
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| |
Collapse
|
27
|
Marinho ACS, Polay ARO, Gomes BPFA. Accuracy of Turbidimetric Limulus Amebocyte Lysate Assay for the Recovery of Endotoxin Interacted with Commonly Used Antimicrobial Agents of Endodontic Therapy. J Endod 2015; 41:1653-9. [PMID: 26254546 DOI: 10.1016/j.joen.2015.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This study was conducted to investigate whether the interaction between the turbidimetric limulus amebocyte lysate (LAL) substrate for endotoxin measurement and the substances/antimicrobial agents used in endodontic therapy can lead to the inhibition/enhancement of endotoxin recovery. METHODS Ten microliters of a suspension of Escherichia coli endotoxin (O55:B55) was inoculated and kept in contact for 1 hour with different substances categorized as follows: group 1: auxiliary chemical substances: 5.25% and 2.5% sodium hypochlorite solutions, 2% chlorhexidine (CHX) (gel and solution), 1% Natrosol gel (Drogal Chemicals and Pharmaceuticals Ltd, Piracicaba, SP, Brazil), 17% EDTA, 10% citric acid, 3% hydrogen peroxide, 5% sodium thiosulfate, and 0.5% Tween 80 associated with 0.07% soy lecithin (Drogal Chemicals and Pharmaceuticals Ltd) and group 2: intracanal medications: neomycin/polymyxin B/hydrocortisone (Otosporin; Glaxo Wellcome, Rio de Janeiro, RJ, Brazil); calcium hydroxide (Ca[OH]2); Ca(OH)2 + 2% CHX gel; Ca(OH)2 + 2% CHX gel + zinc oxide eugenol; Ca(OH)2 + camphorated paramonochlorophenol (Calen; S.S. White, Rio de Janeiro, RJ, Brazil); triple antibiotic paste; mineral trioxide aggregate (MTA); and iodoform. Positive and negative controls consisted of root canal hemorrhagic exudate and pyrogen-free sterile water, respectively. All samples were diluted up to a 10:4 dilution. Each dilution was individually examined by the turbidimetric LAL assay. Collected data were analyzed through performance characteristics of the LAL assay such as linearity, coefficient of variation percentage, and product positive control (PPC) values. RESULTS Correlation coefficient (≥0.980) and coefficient of variation percentage (<10%) of the standard curve in triplicate showed the tests' linearity. Spike recovery of auxiliary chemical substances achieved PPC values ranging from 50%-197%, showing no interferences with LAL substrate. Conversely, 3% hydrogen peroxide achieved product inhibition in which endotoxin values were underestimated even after the 10:4 dilutions. Regarding intracanal medicaments, neomycin/polymyxin B/hydrocortisone also inhibited endotoxin detection in all dilutions investigated (PPC values <50%). In contrast, Ca(OH)2 + 2% CHX gel + ZOE as well as triple antibiotic paste led to the enhancement of endotoxin detection in which endotoxin values could not be validated by the turbidimetric kinetic LAL assay (PPC value >200%). CONCLUSIONS The performance characteristics of the kinetic turbidimetric assay for endotoxin measurement, such as precision and reproducibility, are modulated by the interaction of the LAL substrate with the substances/antimicrobial agents used in endodontic therapy.
Collapse
Affiliation(s)
- Ariane C S Marinho
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School-State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Ana R O Polay
- Lonza do Brasil Especialidades Químicas, Brooklin Novo, São Paulo, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School-State University of Campinas, Piracicaba, São Paulo, Brazil.
| |
Collapse
|
28
|
Melo TAFD, Gründling GSL, Montagner F, Scarparo RK, Figueiredo JAPD, Vier-Pelisser FV. Are bovine teeth a suitable substitute for human teeth in in vitro studies to assess endotoxin load in root canals? Braz Oral Res 2015; 29:S1806-83242015000100282. [PMID: 26154374 DOI: 10.1590/1807-3107bor-2015.vol29.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/27/2015] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to determine the feasibility of using bovine teeth as a suitable alternative for human teeth, in experiments involving in vitro endotoxin contamination. Twenty bovine central incisors and 20 human single-root premolars had their dental crowns removed and root lengths set at 16 mm. Root canals were prepared up to #60 K-file size and sterilized with cobalt-60 gamma irradiation (20 kGy, 6 h). The teeth were randomly divided into four groups: G1-bovine teeth (bovine negative control, n = 10), G2-human teeth (human negative control, n = 10), G3-bovine teeth, inoculated with Escherichia coli (055:B55) LPS, and G4-human teeth inoculated with E. coli LPS. The G1 and G2 groups were exposed to apyrogenic water. After the teeth had been incubated at 37 °C and atmospheric humidity for 24 h, the samples of solutions in the main canals were collected with apyrogenic absorbent paper tips. LPS levels were quantified using Limulus Amebocyte Lysate assay. The data obtained were statistically analyzed using one-way ANOVA, with a significance level of 5%. A high amount of endotoxin was detected in the inoculated human teeth (G4) when compared to the sterilized teeth (G2), as well as in the inoculated bovine teeth (G3) when compared to the inoculated human teeth (G4). However, there was no statistical difference between bovine teeth before and after the E. coli endotoxin inoculation. Therefore, under the mentioned experimental conditions, the use of bovine teeth should not be a choice for laboratory research on endotoxin contamination.
Collapse
Affiliation(s)
- Tiago André Fontoura de Melo
- Clinical Department, Dental School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Francisco Montagner
- Endodontics Division, Dental School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Fabiana Vieira Vier-Pelisser
- Clinical Department, Dental School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
29
|
Marinho AC, Martinho FC, Leite FR, Nascimento GG, Gomes BP. Proinflammatory Activity of Primarily Infected Endodontic Content against Macrophages after Different Phases of the Root Canal Therapy. J Endod 2015; 41:817-23. [DOI: 10.1016/j.joen.2015.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/27/2014] [Accepted: 01/17/2015] [Indexed: 10/23/2022]
|
30
|
Herrera DR, Silva EJNL, Santos CC, Zaia AA, Ferraz CCR, Almeida JFA, Gomes BPFA. Root canal content from primary endodontic infection and upregulation of gelatinases in fibroblast cells. Int Endod J 2015; 48:1168-74. [DOI: 10.1111/iej.12421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022]
Affiliation(s)
- D. R. Herrera
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas - UNICAMP; Piracicaba Brazil
| | - E. J. N. L. Silva
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas - UNICAMP; Piracicaba Brazil
- Health and Science Center; Grande Rio University (UNIGRANRIO); Rio de Janeiro Brazil
| | - C. C. Santos
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas - UNICAMP; Piracicaba Brazil
| | - A. A. Zaia
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas - UNICAMP; Piracicaba Brazil
| | - C. C. R. Ferraz
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas - UNICAMP; Piracicaba Brazil
| | - J. F. A. Almeida
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas - UNICAMP; Piracicaba Brazil
| | - B. P. F. A. Gomes
- Department of Restorative Dentistry; Endodontics Division; Piracicaba Dental School; State University of Campinas - UNICAMP; Piracicaba Brazil
| |
Collapse
|
31
|
Sousa ELR, Martinho FC, Leite FRM, Nascimento GG, Gomes BPFA. Macrophage cell activation with acute apical abscess contents determined by interleukin-1 Beta and tumor necrosis factor alpha production. J Endod 2014; 40:1752-7. [PMID: 25205261 DOI: 10.1016/j.joen.2014.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/22/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This clinical study has investigated the antigenic activity of bacterial contents from exudates of acute apical abscesses (AAAs) and their paired root canal contents regarding the stimulation capacity by levels of interleukin (IL)-1 beta and tumor necrosis factor alpha (TNF-α) throughout the root canal treatment against macrophage cells. METHODS Paired samples of infected root canals and exudates of AAAs were collected from 10 subjects. Endodontic contents were sampled before (root canal sample [RCS] 1) and after chemomechanical preparation (RCS2) and after 30 days of intracanal medication with calcium hydroxide + chlorhexidine gel (Ca[OH]2 + CHX gel) (RCS3). Polymerase chain reaction (16S rDNA) was used for detection of the target bacteria, whereas limulus amebocyte lysate was used to measure endotoxin levels. Raw 264.7 macrophages were stimulated with AAA exudates from endodontic contents sampled in different moments of root canal treatment. Enzyme-linked immunosorbent assays were used to measure the levels of TNF-α and IL-1 beta. RESULTS Parvimonas micra, Porphyromonas endodontalis, Dialister pneumosintes, and Prevotella nigrescens were the most frequently detected species. Higher levels of endotoxins were found in samples from periapical exudates at RCS1 (P < .005). In fact, samples collected from periapical exudates showed a higher stimulation capacity at RCS1 (P < .05). A positive correlation was found between endotoxins from exudates with IL-1 beta (r = 0.97) and TNF-α (r = 0.88) production (P < .01). The significant reduction of endotoxins and bacterial species achieved by chemomechanical procedures (RCS2) resulted in a lower capacity of root canal contents to stimulate the cells compared with that at RCS1 (P < .05). The use of Ca(OH)2 + CHX gel as an intracanal medication (RCS3) improved the removal of endotoxins and bacteria from infected root canals (P < .05) whose contents induced a lower stimulation capacity against macrophages cells at RCS1, RCS2, and RCS3 (P < .05). CONCLUSIONS AAA exudates showed higher levels of endotoxins and showed a greater capacity of macrophage stimulation than the paired root canal samples. Moreover, the use of intracanal medication improved the removal of bacteria and endotoxins from infected root canals, which may have resulted in the reduction of the inflammatory potential of the root canal content.
Collapse
Affiliation(s)
- Ezilmara L R Sousa
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil; Department of Conservative Dentistry, Endodontics Division, Pelotas School of Dentistry
| | - Frederico C Martinho
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil; Department of Restorative Dentistry, Endodontics Division, São Jose dos Campos Dental School, State University of São Paulo, UNESP, São Jose dos Campos, São Paulo, Brazil
| | | | - Gustavo G Nascimento
- Pelotas School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil.
| |
Collapse
|
32
|
Marinho ACS, Martinho FC, Zaia AA, Ferraz CCR, Gomes BPFDA. Monitoring the effectiveness of root canal procedures on endotoxin levels found in teeth with chronic apical periodontitis. J Appl Oral Sci 2014; 22:490-5. [PMID: 25075670 PMCID: PMC4307761 DOI: 10.1590/1678-775720130664] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/27/2014] [Indexed: 11/21/2022] Open
Abstract
Objective: The aim of this study was to monitor the effectiveness of root canal procedures by
using different irrigants and intracanal medication on endotoxin levels found in
root canals of teeth with chronic apical periodontitis. Material and Methods: Thirty root canals of teeth with pulpal necrosis associated with periapical
lesions were selected and randomly divided into groups according to the irrigants
used: GI - 2.5% NaOCl, GII - 2% chlorhexidine (CHX) gel, and GIII - saline
solution (SS) (all, n=10). Samples were collected with sterile/apyrogenic paper
points before (S1) and after root canal instrumentation (S2), after use of 17%
ethylenediaminetetraacetic acid (EDTA) (S3), and after 30 days of intracanal
medication (Ca(OH)2+SS) (S4). A turbidimetric kinetic Limulus Amebocyte
Lysate assay was used for endotoxin measurement. Results: Endotoxins were detected in 100% of the root canals investigated (30/30), with a
median value of 18.70 EU/mL. After S2, significant median percentage reduction was
observed in all groups, irrespective of the irrigant tested: 2.5% NaOCl (99.65%)
(GI), 2% CHX (94.27%) (GII), and SS (96.79%) (GIII) (all p<0.05). Root canal
rinse with 17% EDTA (S3) for a 3-minute period failed to decrease endotoxin levels
in GI and a slight decrease was observed in GII (59%) and GIII (61.1%) (all
p>0.05). Intracanal medication for 30 days was able to significantly reduce
residual endotoxins: 2.5% NaOCl (90%) (GI), 2% CHX (88.8%) (GII), and SS (85.7%)
(GIII, p<0.05). No differences were found in the endotoxin reduction when
comparing s2 and s4 treatment groups. Conclusion: Our findings demonstrated the effectiveness of the mechanical action of the
instruments along with the flow and backflow of irrigant enduring root canal
instrumentation for the endotoxin removal from root canals of teeth with chronic
apical periodontitis. Moreover, the use of intracanal medication for 30 days
contributed for an improvement of endotoxin reduction.
Collapse
|
33
|
Clinical investigation of bacterial species and endotoxin in endodontic infection and evaluation of root canal content activity against macrophages by cytokine production. Clin Oral Investig 2014; 18:2095-102. [PMID: 24535073 DOI: 10.1007/s00784-014-1198-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study investigated the presence of different Gram-negative bacterial species and the levels of endotoxins found in primary endodontic infection (PEI), determining their stimulation ability against macrophages through the levels of interleukin (IL)-1, IL-6, IL-10, and tumor necrosis factor alpha (TNF-α), and evaluated their relationship with clinical and radiographic findings. MATERIAL AND METHODS Samples were taken from 21 root canals with primary endodontic infection with apical periodontitis (PEIAP). Molecular techniques were used for bacterial detection. Limulus amebocyte lysate assay was used to measure endotoxins. Pro-inflammatory cytokines were measured by ELISA assay. RESULTS All samples were positive for bacterial DNA (21/21). Prevotella nigrescens (57.2 %) was the most frequent species. Higher levels of endotoxins were found in teeth with pain on palpation and exudation (all p < 0.05). Positive correlations were found between endotoxins and the levels of TNF-α and IL-1β, whereas a negative correlation was found between endotoxin and the amount of IL-10 (p < 0.05). Endotoxin levels were found to be a risk factor for exudation and increased the number of Gram-negative bacterial species for the presence of a larger area of bone destruction (all p < 0.05). CONCLUSION A wide variety of Gram-negative bacterial species are involved in primary endodontic infection, with participation of different Treponema species. Thus, the levels of endotoxins and the number of Gram-negative bacteria species present in root canals were considered risk factors for the severity of endodontic infection. CLINICAL RELEVANCE The present study revealed that Gram-negative bacterial species and endotoxins play an important role in the development of signs/symptoms and the severity of bone destruction, this knowledge is essential for the establishment of an effective therapy.
Collapse
|