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Ahmed S, Jehad Hassan S, Gajdhar S, Saleh Alhazmi L, Yahya Khalifah R, Alhusain Alrifai J, Salem Aljhdali S, Sheriff Maqbul M. Prevalence of Enterococcus faecalis and Candida albicans in endodontic retreatment Cases: A comprehensive study. Saudi Dent J 2024; 36:539-545. [PMID: 38690386 PMCID: PMC11056411 DOI: 10.1016/j.sdentj.2024.01.009] [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: 10/29/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Endodontic treatment failures often stem from the presence of microbial pathogens, particularly Enterococcus faecalis and Candida albicans. This study systematically assesses the prevalence of E. faecalis and C. albicans in endodontic retreatment cases, aiming to explore their impact on treatment outcomes. Methods Employing a systematic sampling approach, 30 patients with a history of previous endodontic treatment were selected. Rigorous clinical and radiographic assessments were conducted, following standardized protocols for root canal sample collection. Microbiological analysis, utilizing selective culture media, was employed to identify and quantify E. faecalis and C. albicans. Statistical analyses, including chi-square and logistic regression tests, were performed. Results The study involved 30 patients undergoing endodontic retreatment, with comprehensive clinical and radiographic evaluations for cases with and without periradicular lesions. Microbiological analysis unveiled a significant prevalence of E. faecalis and C. albicans, establishing a robust association between these pathogens and retreatment failure. These findings underscore the critical need for targeted antimicrobial interventions to enhance the overall success rates of endodontic retreatment procedures. Conclusion This study highlights the substantial prevalence of E. faecalis and C. albicans in endodontic retreatment cases, emphasizing the importance of identifying and effectively managing these pathogens for successful treatment outcomes. The notable association between these microbial agents and retreatment failure underscores the imperative for tailored antimicrobial strategies to enhance the efficacy of endodontic retreatment procedures.
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Affiliation(s)
- Siddiq Ahmed
- Department of Conservative Dental Sciences, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | - Sami Jehad Hassan
- Department of Conservative Dental Sciences, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | - Shaiq Gajdhar
- Department of Prosthodontics, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
| | - Lama Saleh Alhazmi
- Dental interns, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | - Rawan Yahya Khalifah
- Dental interns, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
| | | | | | - Muazam Sheriff Maqbul
- Department of Microbiology and Immunology, Ibn Sina national College for medical studies, Jeddah, Saudi Arabia
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Kalyani P, Patwa N, Gupta N, Bhatt A, Saha S, Kanjani V. Clinical and radiographic assessment of post-treatment endodontic disease by primary healthcare professionals: A hospital-based 1-year follow-up. J Family Med Prim Care 2022; 11:1114-1118. [PMID: 35495841 PMCID: PMC9051704 DOI: 10.4103/jfmpc.jfmpc_2033_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/02/2020] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The comprehensive healthcare approach including prophylactic guidance and motivation by the primary healthcare professionals towards oral and maxillofacial diseases such as post-treatment endodontic disease (PTED) plays a significant role in diagnosing and managing the condition. Especially in the developing countries like India where the hygiene practices are severely compromised, the primary healthcare professional plays an upfront role. Objectives: The present study was conducted to assess the clinical and radiographic characteristics of PTED by primary healthcare professional. Materials and Methods: The cross-sectional study was conducted in a dental hospital in Kutch, Gujarat, India. In the present study, out of a total of 755, 96 patients were diagnosed with PTED, met the inclusion criteria, and were enrolled for the study. After performing intraoral and extraoral examination, intraoral periapical radiographs were taken of the concerned teeth. Under dark room conditions, radiographs were examined using dentsply light box and magnifying glass by healthcare professionals. Results: Out of 755 patients, 96 (12.71%) patients were enrolled in the study with 98 concerned teeth. The most common teeth diagnosed with PTED were maxillary molars with 25.51% (21) individuals. Well-defined radiolucent lesions were seen in 62.24% (61) individuals. Voids in both coronal and apical region were seen in majority (38.77%) of patients. The length of root-end fillings with respect to the radiographic apex was satisfactory in 44.89% (44) individuals. The present study showed strong correlation between sinus formation and presence of periapical lesion with P value of 0.0219*. Conclusion: The proper guidance and preventive care by primary healthcare professionals leads to the relatively less prevalence of post-treatment endodontic disease in Indian population. The present study further suggests the higher substandard quality of root-end fillings of endodontically treated teeth.
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Daood U, Parolia A, Matinlinna J, Yiu C, Ahmed HMA, Fawzy A. Properties of a modified quaternary ammonium silane formulation as a potential root canal irrigant in endodontics. Dent Mater 2020; 36:e386-e402. [PMID: 33010944 DOI: 10.1016/j.dental.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/28/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Evaluate a new modified quaternary ammonium silane irrigant solution for its antimicrobial, cytotoxic and mechanical properties of dentine substrate. METHODS Root canal preparation was performed using stainless steel K-files™ and F4 size protaper with irrigation protocols of 6% NaOCl + 2% CHX; 3.5% QIS; 2% QIS and sterile saline. Biofilms were prepared using E. faecalis adjusted and allowed to grow for 3 days, treated with irrigants, and allowed to grow for 7 days. AFM was performed and surface free energy calculated. MC3T3 cells were infected with endo irrigant treated E. faecalis biofilms. Raman spectroscopy of biofilms were performed after bacterial re-growth on root dentine and exposed to different irrigation protocols and collagen fibers analysed collagen fibers using TEM. Antimicrobial potency against E. faecalis biofilms and cytoxicity against 3T3 NIH cells were also. Resin penetration and MitoTracker green were also evaluated for sealer penetration and mitochondrial viability. Data were analysed using One-way ANOVA, principal component analysis and post-hoc Fisher's least-significant difference. RESULTS Elastic moduli were maintained amongst control (5.5 ± 0.9) and 3.5% QIS (4.4 ± 1.1) specimens with surface free energy higher in QIS specimens. MC3T3 cells showed reduced viability in 6%NaOCl+2%CHX specimens compared to QIS specimens. DNA/purine were expressed in increased intensities in control and 6% NaOCl + 2% CHX specimens with bands around 480-490 cm-1 reduced in QIS specimens. 3.5% QIS specimens showed intact collagen fibrillar network and predominantly dead bacterial cells in confocal microscopy. 3.5% QIS irrigant formed a thin crust-type surface layer with cytoplasmic extensions of 3T3NIH spread over root dentine. Experiments confirmed MitoTracker accumulation in 3.5% treated cells. SIGNIFICANCE Novel QIS root canal irrigant achieved optimum antimicrobial protection inside the root canals facilitating a toxic effect against the Enterococcus faecalis biofilm. Root dentine substrates exhibited optimum mechanical properties and there was viability of fibroblastic mitochondria.
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Affiliation(s)
- Umer Daood
- Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Abhishek Parolia
- Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Jukka Matinlinna
- Dental Materials Science, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - Cynthia Yiu
- Pediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Pokfulam, Hong Kong, China Hong Kong Special Administrative Region
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Amr Fawzy
- UWA Dental School, University of Western Australia, Nedlands, WA 6009, Australia
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Next-Generation Sequencing to Assess Potentially Active Bacteria in Endodontic Infections. J Endod 2020; 46:1105-1112. [PMID: 32497654 DOI: 10.1016/j.joen.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Because active bacteria present a higher abundance of ribosomal RNA (rRNA) than DNA (rRNA gene), the rRNA/DNA ratio of next-generation sequencing (NGS) data was measured to search for active bacteria in endodontic infections. METHODS Paired complementary DNA and DNA samples from 5 root canals of teeth with apical periodontitis were subjected to polymerase chain reaction with bar-coded primers amplifying the 16S rRNA gene hypervariable regions V4-V5. High-throughput sequencing was performed using MiSeq (Illumina, San Deigo, CA), and data were analyzed using Quantitative Insights Into Microbial Ecology and Human Oral Microbiome Database. Statistical analysis was performed for relative abundance of bacteria in the DNA- and rRNA-based NGS data using the Mann-Whitney test, whereas differences in the diversity and richness indexes were assessed using a nonparametric 2-sample t test (P < .05). For bacterial taxa detected in both approaches, the rRNA/DNA ratios were calculated by dividing the average abundance of individual species in the respective analysis. RESULTS Although no significant difference was found in the indexes of bacterial richness and diversity, the relative abundance of bacterial members varied in both analyses. Comparing rRNA with DNA data, there was a significant decrease in the relative abundance of Firmicutes (P < .05). The bacterial taxa Bacteroidales [G-2] bacterium HMT 274, Porphyromonas endodontalis, Tannerella forsythia, Alloprevotella tannerae, Prevotella intermedia, Pseudoramibacter alactolyticus, Olsenella sp. HMT 809, Olsenella sp. HMT 939, Olsenella uli, and Fusobacterium nucleatum subsp. animalis were both dominant (DNA ≥ 1%) and active (rRNA/DNA ≥ 1). CONCLUSIONS The integrated DNA- and rRNA-based NGS strategy was particularly important to disclose the activity of as-yet-uncultivated or difficult-to-culture bacteria in endodontic infections.
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ElReash AA, Hamama H, Eldars W, Lingwei G, Zaen El-Din AM, Xiaoli X. Antimicrobial activity and pH measurement of calcium silicate cements versus new bioactive resin composite restorative material. BMC Oral Health 2019; 19:235. [PMID: 31684929 PMCID: PMC6829974 DOI: 10.1186/s12903-019-0933-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/21/2019] [Indexed: 01/16/2023] Open
Abstract
Background The purpose of this in vitro study is to compare the antimicrobial effect and pH of two calcium silicate cements Mineral trioxide aggregate high plasticity (Angelus PR, Brazil) and iRoot BP Plus (BioCeramix Inc., Vancouver, BC, Canada) and new bioactive restorative resin composite restorative material (ACTIVA, MA, Pulpdent, USA) against aerobic bacteria, strictly anaerobic bacteria and a yeast by using an agar diffusion test. Methods The materials were tested immediately after manipulation and were applied to the agar plates. Sodium hypochlorite (NaOCl) 5.25% was used as a positive control group. The dry filter paper acted as a negative control group for this study. The size of the inhibition zone for each material was measured after 12, 24 and 48 h. At the time of pH measurement; materials were prepared, crushed then dispersed in distilled water. Results The one-way Anova test revealed that iRoot BP Plus significantly showed superior antimicrobial efficacy compared to MTA-HP against the following species; Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, Enterococcus faecium, Peptostreptococcus anaerobius and Candida albicans (P < 0.05). All of the tested materials did not show any antimicrobial effect against Porphyromonas gingivalis and Actinomyces israelii. The new bioactive resin composite material (ACTIVA) showed the least antimicrobial activity against the previously mentioned microorganisms except E. faecalis. NaOCl significantly showed the highest antimicrobial activity among the test group (P < 0.05). iRoot BP Plus was more alkaline (pH 12.1 ± 0.14/ 11.9 ± 0.25) in comparison to MTA-HP (pH 11.6 ± 0.16/ 11.2 ± 0.10) while ACTIVA was slightly acidic (pH 5.4 ± 0.09/ 6.5 ± 0.08). Conclusions According to the findings of this study, it was concluded that calcium silicate- based cements showed a potential antimicrobial activity mainly due to its high alkalinity. The new bioactive resin composite restorative material exhibits less antimicrobial activity due to its resinous ingredients and slightly acidic nature. Antimicrobial effect of calcium silicate cements against strictly anaerobic bacterial species is still questionable.
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Affiliation(s)
- Ashraf Abou ElReash
- Department of Endodontic, Xiangya School of stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan province, China
| | - Hamdi Hamama
- Department of Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Waleed Eldars
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gong Lingwei
- Department of Endodontic, Xiangya School of stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan province, China
| | - Ahmed M Zaen El-Din
- Department of Restorative Dentistry, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, International Coastal Road, Gamasa, Mansoura, Egypt
| | - Xie Xiaoli
- Department of Endodontic, Xiangya School of stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan province, China.
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An in vitro study of a novel quaternary ammonium silane endodontic irrigant. Dent Mater 2019; 35:1264-1278. [PMID: 31201019 DOI: 10.1016/j.dental.2019.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/19/2019] [Accepted: 05/22/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze effect of NaOCl+2% quaternary ammonium silane (QAS)-containing novel irrigant against bacteria impregnated inside the root canal system, and to evaluate its antimicrobial and mechanical potential of dentine substrate. METHODS Root canal was prepared using stainless steel K-files™ and ProTaper™ and subjected to manual and ultrasonic irrigation using 6% NaOCl+2% CHX, 6% NaOCl+2% QAS and saline as control. For confocal-microscopy, Raman spectroscopy and SEM analysis before and after treatment, Enterococcus faecalis cultured for 7 days. Raman spectroscopy analysis was done across cut section of gutta percha/sealer-dentine to detect resin infiltration. Indentation of mechanical properties was evaluated using a Berkovich indenter. The contact angle of irrigants and surface free energy were evaluated. Mineralization nodules were detected through Alazarin red after 14 days. RESULTS Control biofilms showed dense green colonies. Majority of E. faecalis bacteria were present in biofilm fluoresced red in NaOCl+2% QAS group. There was reduction of 484cm-1 Raman band and its intensity reached lowest with NaOCl+2% QAS. There was an increase in 1350-1420cm-1 intensity in the NaOCl+2% CHX groups. Gradual decrease in 1639cm-1 and 1609cm-1 Raman signal ratios were seen in the resin-depth region of 17μm>, 14.1μm> and 13.2μm for NaOCl+2% QAS, NaOCl+2% CHX and control groups respectively. All obturated groups showed an intact sealer/dentine interface with a few notable differences. 0.771 and 83.5% creep indentation distance for NaOCl+2% QAS ultrasonic groups were observed. Highest proportion of polar component was significantly found in the NaOCl+2% QAS groups which was significantly higher as compared to other groups. Mineralized nodules were increased in NaOCl+2% QAS. SIGNIFICANCE Favorable antimicrobial and endodontic profile of the NaOCl+2% QAS solution might suggest clinical use for it for more predictable reduction of intracanal bacteria.
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Comparison of intraoral biofilm reduction on silver-coated and silver ion-implanted stainless steel bracket material : Biofilm reduction on silver ion-implanted bracket material. J Orofac Orthop 2018; 80:32-43. [PMID: 30535568 PMCID: PMC6334737 DOI: 10.1007/s00056-018-00165-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective of this in situ study was to quantify the intraoral biofilm reduction on bracket material as a result of different surface modifications using silver ions. In addition to galvanic silver coating and physical vapor deposition (PVD), the plasma immersion ion implantation and deposition (PIIID) procedure was investigated for the first time within an orthodontic application. MATERIALS AND METHODS An occlusal splint equipped with differently silver-modified test specimens based on stainless steel bracket material was prepared for a total of 12 periodontally healthy patients and was worn in the mouth for 48 h. The initially formed biofilm was fluorescently stained and a quantitative comparative analysis of biofilm volume, biofilm surface coverage and live/dead distribution of bacteria was performed by confocal laser scanning microscopy (CLSM). RESULTS Compared to untreated stainless steel bracket material, the antibacterial effect of the PIIID silver-modified surface was just as significant with regard to reducing the biofilm volume and the surface coverage as the galvanically applied silver layer and the PVD silver coating. Regarding the live/dead distribution, however, the PIIID modification was the only surface that showed a significant increase in the proportion of dead cells compared to untreated bracket material and the galvanic coating. CONCLUSIONS Orthodontic stainless steel with a silver-modified surface by PIIID procedure showed an effective reduction in the intraoral biofilm formation compared to untreated bracket material, in a similar manner to PVD and galvanic silver coatings applied to the surface. Additionally, the PIIID silver-modified surface has an increased bactericidal effect.
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Novel Calcium Zirconate Silicate Cement Biomineralize and Seal Root Canals. MATERIALS 2018; 11:ma11040588. [PMID: 29641475 PMCID: PMC5951472 DOI: 10.3390/ma11040588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 01/22/2023]
Abstract
This study evaluated the sealing ability of gutta-percha (GP) with a calcium silicate-based sealer and a novel calcium zirconate containing calcium silicate cement (ZC). The root canals of the extracted premolars were prepared, which were then randomly allocated to three experimental groups (12 root canals per group) for obturation by continuous wave of condensation with the GP and AH 26 sealer (CW); obturation using a single GP with a calcium silicate-based EndoSequence BC sealer (SC); or obturation with ZC. The roots were inserted into sterile Eppendorf tubes, which were inoculated coronally with Porphyromonas gingivalis. The amount of endotoxin leakage into the apical reservoirs were measured using the Limulus Amebocyte Lysate (LAL) assay over 21 days, with comparisons made using one-way ANOVA and Scheffe’s tests (α = 0.05). After 21 days, 75% of the canals that had been obturated by SC, 50% of those obturated by CW and 42% of those obturated by ZC showed endotoxin leakage. The amount of leakage was higher in the SC canals than in the CW (p = 0.031) or ZC (p = 0.03) canals, although there was no significant difference in the amount of leakage for CW and ZC (p > 0.05). X-ray diffraction revealed the presence of tricalcium silicate (Ca3SiO5) and calcium zirconate (CaZrO3) in the synthesized ZC. Scanning electron microscopy revealed mineralized precipitates on the dentin of canals obturated by ZC. The novel calcium zirconate silicate cement appears to promote biomineralization and seal root canals at least as effectively as the conventional sealer.
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Illumina MiSeq Sequencing for Preliminary Analysis of Microbiome Causing Primary Endodontic Infections in Egypt. Int J Microbiol 2018; 2018:2837328. [PMID: 29849646 PMCID: PMC5903297 DOI: 10.1155/2018/2837328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/01/2018] [Accepted: 02/26/2018] [Indexed: 12/26/2022] Open
Abstract
The use of high throughput next generation technologies has allowed more comprehensive analysis than traditional Sanger sequencing. The specific aim of this study was to investigate the microbial diversity of primary endodontic infections using Illumina MiSeq sequencing platform in Egyptian patients. Samples were collected from 19 patients in Suez Canal University Hospital (Endodontic Department) using sterile # 15K file and paper points. DNA was extracted using Mo Bio power soil DNA isolation extraction kit followed by PCR amplification and agarose gel electrophoresis. The microbiome was characterized on the basis of the V3 and V4 hypervariable region of the 16S rRNA gene by using paired-end sequencing on Illumina MiSeq device. MOTHUR software was used in sequence filtration and analysis of sequenced data. A total of 1858 operational taxonomic units at 97% similarity were assigned to 26 phyla, 245 families, and 705 genera. Four main phyla Firmicutes, Bacteroidetes, Proteobacteria, and Synergistetes were predominant in all samples. At genus level, Prevotella, Bacillus, Porphyromonas, Streptococcus, and Bacteroides were the most abundant. Illumina MiSeq platform sequencing can be used to investigate oral microbiome composition of endodontic infections. Elucidating the ecology of endodontic infections is a necessary step in developing effective intracanal antimicrobials.
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Aw V. Discuss the role of microorganisms in the aetiology and pathogenesis of periapical disease. AUST ENDOD J 2017; 42:53-9. [PMID: 27506189 DOI: 10.1111/aej.12159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The literature indicates that microorganisms have a critical role in the aetiology and pathogenesis of apical periodontitis. The advancement in microbiological study methods has allowed for the identification of newer species associated with the disease process. At our current understanding, however, the exact roles of specific microorganisms in apical periodontitis are not fully understood but the poly-microbial aetiology of the disease appears to be supported by the literature. The endodontic microbiota is comprised of a subset of microbiota present in the oral cavity, consisting of predominantly anaerobic bacterial species, some fungal and viral species. The pathogenesis of apical periodontitis is essentially the result of a complex interplay between bacterial and host factors, giving rise to a range of presentations depending on the balance of the interaction. The role of endodontic microbiota in the initiation and persistence of apical periodontitis means that the mainstay of endodontic treatment is the elimination of such bacteria. A challenge to the resolution of apical periodontitis after treatment lies in the inadequacy of treatment protocol in completely eradicating the pathogenic species and the inherent ability of certain species to survive the treatment. This issue should be the focus of future research as we continually search for more predictable treatment methods of achieving the resolution of apical periodontitis.
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Affiliation(s)
- Vincent Aw
- Dentistry and Oral Health, La Trobe University, Bendigo, Victoria, Australia
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de Almeida NF, Brasil SDC, Ferreira DDC, Armada L. Aging effects in the expression of macrophages in post-treatment apical periodontitis lesions. SPECIAL CARE IN DENTISTRY 2017; 37:230-235. [PMID: 28873244 DOI: 10.1111/scd.12234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the CD68 immunoexpression in post-treatment apical periodontitis lesions of older patients and compare them with lesions of younger/middle age adults. METHODS Biopsy specimens from 21 apical periodontitis lesions (12 granulomas and 9 cysts) were selected from older patients and 25 apical periodontitis lesions from younger/middle age adults (12 cysts and 13 granulomas) were selected and analyzed by immunohistochemistry using silanized slides with anti-CD68 antibody. The slides were subdivided in five high-power fields and the images were observed under an optical microscope to evaluate the epithelial and connective tissues. RESULTS The results showed that there was no statistical difference for the CD68 expression in epithelial tissue of cysts between younger/middle age adults and older patients. However, for the connective tissue of both cysts and granulomas, there was a statistical difference between the two age groups. There was a statistical difference between the epithelial and the connective tissues in cysts of younger/middle age adults, and also when the epithelial tissue of the cysts was compared with connective tissue of the granuloma. In the group of older patients, there was no statistical difference between the connective tissue of the cysts and granulomas. CONCLUSION The intensity of the macrophage staining was greater in the connective tissue of cysts and granulomas alike in the younger/middle age adult patients, suggesting that these cells participate actively in this tissue. Immune responses in older patients may be compromised, suggesting that there is a greater tendency for the endodontic treatment of these patients to fail.
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Affiliation(s)
| | | | - Dennis de Carvalho Ferreira
- Faculty of Dentistry, Department of Endodontics, Universidade Estacio de Sa, 37873, Rio de Janeiro, RJ, Brazil.,Faculty of Dentistry, Universidade Veiga de Almeida, RJ, Brazil
| | - Luciana Armada
- Faculty of Dentistry, Department of Endodontics, Universidade Estacio de Sa, 37873, Rio de Janeiro, RJ, Brazil
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Reis AL, Oliveira RR, Tavares WLF, Saldanha TDS, Farias LDM, Vieira LQ, Ribeiro AP. Murine Experimental Root Canal Infection: Cytokine Expression in Response to F. nucleatum and E. faecalis. Braz Dent J 2017; 27:578-583. [PMID: 27982237 DOI: 10.1590/0103-6440201600926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/08/2016] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to evaluate the gene expression of proinflammatory (RANKL, TNF-a and IFN-g) and regulatory (TGF-b and IL-10) cytokines as reaction to experimental infection by mono or bi-association of Fusobacterium nucleatum (ATCC 10953) and Enterococcus faecalis (ATCC 19433). F. nucleatum and E. faecalis, either in mono- or bi-association were inoculated into the root canal system (RCS) of Balb/c mice. Animals were sacrificed at 10 and 20 days after infection and periapical tissues surrounding the root were collected. The mRNA expression of the cytokines RANKL, TNF-a, IFN- g, TGF-b and IL-10 was assessed using real-time PCR. The Kruskal-Wallis test was used for statistical analysis. F. nucleatum mono-infection induced high expression of RANKL and TNF-a, while its modulation was due to IL-10. High expression of IFN-g at day 20 was up-regulated by E. faecalis and RANKL; TNF-a was up-regulated by an independent mechanism via IL-10 and TGF-b. Bi-association (F. nucleatum and E. faecalis) stimulated high expression of RANKL, TNF-a and IFN-g, which seemed to be modulated by TGF-b 20 days later. The gene expression of proinflammatory cytokines was more prominent in the earlier periods of the experimental periapical infection, which concomitantly decreased in the later period. This expression may be regulated by IL-10 and TGF-b in an infection-specific condition.
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Affiliation(s)
- Andressa Lamari Reis
- School of Dentistry, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ricardo Reis Oliveira
- School of Dentistry, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Luiz de Macêdo Farias
- Institute of Biological Sciences, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Leda Quércia Vieira
- Institute of Biological Sciences, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Antônio Paulino Ribeiro
- School of Dentistry, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Donyavi Z, Ghahari P, Esmaeilzadeh M, Kharazifard M, Yousefi-Mashouf R. Antibacterial Efficacy of Calcium Hydroxide and Chlorhexidine Mixture for Treatment of Teeth with Primary Endodontic Lesions: A Randomized Clinical Trial. IRANIAN ENDODONTIC JOURNAL 2016; 11:255-260. [PMID: 27790252 PMCID: PMC5069899 DOI: 10.22037/iej.2016.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study compared the root canal microbial count of necrotic teeth after irrigation with 6% sodium hypochlorite (NaOCl) (single session treatment) and two-session root canal treatment with two-week application of calcium hydroxide (CH) mixed with 0.2% chlorhexidine (CHX) as intracanal medicament. METHODS AND MATERIALS In this randomized clinical trial, single-rooted necrotic teeth were divided into two groups. Root canal was irrigated with 2 mL of 6% NaOCl in one group, and a mixture of 0.2% CHX and CH powder as an intracanal medicament for two weeks, in the other group. Root canal samples were obtained before and after the intervention and number of colony forming units (CFUs) was counted in each phase. RESULTS The reduction of Enterococcus faecalis CFU was not significantly different between the two groups (P=0.233) but the CFU of aerobic and anaerobic bacteria was significantly lower in CH+CHX group (P<0.001). CONCLUSION Two-week application of CH+CHX caused significant reduced the aerobic, anaerobic and E. faecalis colony counts. Thus, it may be beneficial to carry out primary root canal treatment of necrotic teeth with endodontic lesions in two sessions with intracanal medicaments to achieve predictable results.
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Affiliation(s)
- Zakiyeh Donyavi
- Department of Endodontics, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Parastoo Ghahari
- Department of Endodontics, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Esmaeilzadeh
- Department of Pediatric Dentistry, Dental School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammadjavad Kharazifard
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Yousefi-Mashouf
- Department of Medical Microbiology, Hamadan University of Medical Sciences, Hamadan, Iran
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Bartolo A, Koyess E, Camilleri J, Micallef C. Model assessing thermal changes during high temperature root canal irrigation. Healthc Technol Lett 2016; 3:247-251. [PMID: 27733934 DOI: 10.1049/htl.2016.0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022] Open
Abstract
The main aim of root canal irrigation is to eliminate micro-organisms. Sodium hypochlorite (NaOCl) is considered to be the ideal material and raising its temperature potentiates the antimicrobial activity. NaOCl may lead to localised tissue necrosis when extruded past the root apex. This study analyses the use of high temperature root canal irrigation as an alternative process for the elimination of microorganisms from the root canal system. An experimental set-up was designed where a constant supply of heat was passed from a heat source through a copper wire inside the root canal. The data acquired together with known constants pertaining to enamel and dentine was used to numerically model the thermal changes in a tooth using a finite element method. Results obtained from the finite element thermal model of the tooth were repeatable and were validated with the experimental results. The thermo-physical properties of the tooth were varied and convergence criteria met. The temperatures reached were below what has been reported to cause irreversible damage to the bone. This was further confirmed from a series of simulations that were undertaken. The temperatures achieved were suitable for the elimination of microorganisms during root canal therapy.
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Affiliation(s)
- Analise Bartolo
- Department of Mechanical Engineering, Faculty of Engineering , University of Malta , Msida , Malta
| | - Edmond Koyess
- Department of Endodontics , Lebanese University , Beirut , Lebanon
| | - Josette Camilleri
- Department of Restorative Dentistry, Faculty of Dental Surgery , University of Malta , Msida , Malta
| | - Christopher Micallef
- Department of Mechanical Engineering, Faculty of Engineering , University of Malta , Msida , Malta
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Berditsch M, Lux H, Babii O, Afonin S, Ulrich AS. Therapeutic Potential of Gramicidin S in the Treatment of Root Canal Infections. Pharmaceuticals (Basel) 2016; 9:ph9030056. [PMID: 27618065 PMCID: PMC5039509 DOI: 10.3390/ph9030056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/17/2016] [Accepted: 08/23/2016] [Indexed: 01/19/2023] Open
Abstract
An intrinsic clindamycin-resistant Enterococcus faecalis, the most common single species present in teeth after failed root canal therapy, often possesses acquired tetracycline resistance. In these cases, root canal infections are commonly treated with Ledermix(®) paste, which contains demeclocycline, or the new alternative endodontic paste Odontopaste, which contains clindamycin; however, these treatments are often ineffective. We studied the killing activity of the cyclic antimicrobial peptide gramicidin S (GS) against planktonic and biofilm cells of tetracycline-resistant clinical isolates of E. faecalis. The high therapeutic potential of GS for the topical treatment of problematic teeth is based on the rapid bactericidal effect toward the biofilm-forming, tetracycline-resistant E. faecalis. GS reduces the cell number of planktonic cells within 20-40 min at a concentration of 40-80 μg/mL. It kills the cells of pre-grown biofilms at concentrations of 100-200 μg/mL, such that no re-growth is possible. The translocation of the peptide into the cell interior and its complexation with intracellular nucleotides, including the alarmon ppGpp, can explain its anti-biofilm effect. The successful treatment of persistently infected root canals of two volunteers confirms the high effectiveness of GS. The broad GS activity towards resistant, biofilm-forming E. faecalis suggests its applications for approval in root canal medication.
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Affiliation(s)
- Marina Berditsch
- Institute of Organic Chemistry, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 6, Karlsruhe 76131, Germany.
| | - Hannah Lux
- Institute of Organic Chemistry, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 6, Karlsruhe 76131, Germany.
| | - Oleg Babii
- Institute of Organic Chemistry, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 6, Karlsruhe 76131, Germany.
| | - Sergii Afonin
- Institute of Biological Interfaces (IBG-2), KIT, P. O. Box 3640, Karlsruhe 76021, Germany.
| | - Anne S Ulrich
- Institute of Organic Chemistry, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 6, Karlsruhe 76131, Germany.
- Institute of Biological Interfaces (IBG-2), KIT, P. O. Box 3640, Karlsruhe 76021, Germany.
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BACTERIAL PROFILE OF NECROTIC PULPS IN CHEETAH (ACINONYX JUBATUS) CANINE TEETH. J Zoo Wildl Med 2016; 47:98-105. [PMID: 27010269 DOI: 10.1638/2014-0221.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The role of microbes and their antimicrobial susceptibilities in both acute and chronic infections of the dental pulp in humans has been well studied. Presently, no data are available on endodontic pathogens in cheetahs (Acinonyx jubatus). The aim of this study was to isolate and identify the bacteria found in the canine teeth of cheetahs, where the pulp was necrotic and exposed due to a complicated crown fracture. Thirty-six microbiologic samples were taken from root canals (RCs) of the canine teeth of 19 cheetahs: one pulp sample was taken from 10 cheetahs, four samples from 2 cheetahs, two samples from 3 cheetahs, and three samples from 4 cheetahs. Exposed pulps were cultured for aerobic and anaerobic bacteria; an additional screening with a 16S rRNA-specific polymerase chain reaction (PCR) was used for the last six samples. Antimicrobial susceptibility of isolates was determined by use of the Kirby-Bauer diffusion test. In total, 59 cultivable isolates belonging to 19 microbial species and 13 genera were recovered from the 36 RCs sampled. Only two samples yielded no cultivable bacteria. Thirty-two (54.49%) of the cultivable isolates were Gram positive and 27 (45.71%) were Gram negative. The maximum number of isolates cultivated from an individual RC was six. Facultative anaerobes (62.72%) were the most common bacteria of the RCs that yielded cultivable bacteria. Of the isolates, 28.81% were aerobic and 8.47% were strict anaerobes. The antimicrobials that showed the greatest efficacy in vitro against the different bacteria isolates were amikacin and gentamicin. The more common bacterial species isolated by PCR were anaerobes (60.8%), facultative anaerobes (30.2%), and aerobes (8.6%).
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Binoy D, Sajjan GS, Peddireddi S, Kumar MSR, Bhavana V, Raju SR. A Comparitive Evaluation of Sealing Ability, pH and Rheological Properties of Zinc Oxide Eugenol Sealer Combined with Different Antibiotics: An In Vitro Study. J Clin Diagn Res 2015; 8:ZC05-8. [PMID: 25584296 DOI: 10.7860/jcdr/2014/8398.5095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 09/03/2014] [Indexed: 11/24/2022]
Abstract
AIM The objective of this study was to evaluate and compare the sealing ability, pH & viscosity of Zinc oxide eugenol sealer mixed with different antibiotics (Amoxicillin, Ciprofloxacin, Clindamycin and Doxycycline). MATERIALS AND METHODS Ninety single rooted anterior teeth were randomly divided into four experimental groups of 15 teeth each and 3 control groups of 10 each. Sealer-antibiotic combination was used as a sealer in experimental group. Teeth were sectioned longitudinally to assess linear dye penetration. pH and viscosity of the experimental groups were evaluated with Elico pH Meter and Brook Field Viscometer respectively. RESULTS (Amoxicillin+ ZOE) Group II and (Clindamycin + ZOE) Group IV have shown minimum linear dye leakage of 1.07mm & 1.22 mm respectively & (Ciprofloxacin + ZOE) Group III and (Doxycycline + ZOE) Group V 2.69 mm & 2.59 mm respectively. There was decrease in the viscosity of the experimental group. pH was found to be 8.55 for Group II sealer which was greater than control group. CONCLUSION Amoxicillin and sealer combination can improve the success rate of endodontic therapy by enhancing the antimicrobial activity, alkaline environment and reducing apical microleakage.
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Affiliation(s)
- D Binoy
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, Sri Sai College Of Dental Surgery , Vikarabad, Telangana, India
| | - Girija S Sajjan
- Professor & Head, Department of Conservative Dentistry and Endodontics, Vishnu Dental College , Bhimavaram, Andhra Pradesh, India
| | - Suresh Peddireddi
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, Lenora Dental College , Rajamundry, Andhra Pradesh, India
| | - M Sita Rama Kumar
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, Vishnu Dental College , Bhimavaram, Andhra Pradesh, India
| | - V Bhavana
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, Sri Sai College Of Dental Surgery , Vikarabad, Telangana, India
| | - Sita Rama Raju
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, Vishnu Dental College , Bhimavaram, Andhra Pradesh, India
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Yap B, Zilm PS, Briggs N, Rogers AH, Cathro PC. The effect of sodium hypochlorite onEnterococcus faecaliswhen grown on dentine as a single- and multi-species biofilm. AUST ENDOD J 2014; 40:101-10. [DOI: 10.1111/aej.12073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Benlee Yap
- Oral Microbiology Laboratory; School of Dentistry; The University of Adelaide; Adelaide South Australia Australia
| | - Peter S. Zilm
- Oral Microbiology Laboratory; School of Dentistry; The University of Adelaide; Adelaide South Australia Australia
| | - Nancy Briggs
- Data Management and Analysis Centre; The University of Adelaide; Adelaide South Australia Australia
| | - Anthony H. Rogers
- Oral Microbiology Laboratory; School of Dentistry; The University of Adelaide; Adelaide South Australia Australia
| | - Peter C. Cathro
- Discipline of Endodontics; School of Dentistry; The University of Adelaide; Adelaide South Australia Australia
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20
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Misuriya A, Bhardwaj A, Bhardwaj A, Aggrawal S, Kumar PP, Gajjarepu S. A comparative antimicrobial analysis of various root canal irrigating solutions on endodontic pathogens: an in vitro study. J Contemp Dent Pract 2014; 15:153-160. [PMID: 25095835 DOI: 10.5005/jp-journals-10024-1506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Evolution in understanding the poly-microbial environment of both endodontic infections and that of failed root canal treatments has been debatable over the years. The present study was designed to compare and analyze the effect of various root canal irrigation solutions on certain endodontic pathogens in vitro. MATERIALS AND METHODS To analyze in vitro the zone of inhibition of the micro-organisms the following irrigating solutions were employed: a. Sodium hypochlorite (NaOCl) 5% b. Sodium hypochlorite (NaOCl) 3% c. Chlorhexidine 2% d. Chlorhexidine (CHX) 0.12% e. Doxycycline 0.01% f. Doxycycline 0.005% g. MTAD. An agar culture plate inoculated with four endodontic pathogens was used namely 1. Enterococcus faecalis (MTCC-439) 2. Candida albicans (MTCC-183) 3. Fusobacterium nucleatum (ATCC-25586) 4. Peptostreptococcus anaerobius (ATCC-27337) The inoculums were streaked out on the trypticase soy agar plate for discrete colonies with a wire loop using standard method. The inoculated plates carrying the antibiotic disks were incubated in an anaerobic jar in the following way-Anaerobic incubation-the following procedure was used to provide anaerobiosis with an increased concentration of carbon dioxide. By this method the zone of inhibition obtained by different irrigating solutions against different pathogens could be compared. RESULTS MTAD showed maximum antibacterial activity. In case of C. albicans MTAD was less effective than 5% NaOCl, 3% NaOCl and 2% CHX, 0.12% CHX. However, it was more effective against E. faecalis, F. nuleatum and P. anaerobicus. In any case, antimicrobial activity is not the only prerequisite for an endodontic irrigant. E. faecalis strain used in this study showed resistance to doxycycline; also doxycycline was ineffective against C. albicans at 0.01% and 0.005% concentrations. CONCLUSION It was found that MTAD was more antimicrobial than 5% NaOCl for some of the test micro-organisms; however the ability of MTAD to dissolve pulp tissue is not comparable to 5% NaOCl. In addition, 5 and 3% NaOCl showed signifcant antimicrobial activity against all test micro-organisms. The best option for a primary endodontic irrigant therefore is 5% NaOCl.
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Affiliation(s)
- Abhinav Misuriya
- Reader, Department of Endodontics, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
| | - Archana Bhardwaj
- Reader, Department of Endodontics, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
| | - Abhishek Bhardwaj
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
| | - Sanjay Aggrawal
- Professor, Department of Endodontics, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
| | - Ps Pawan Kumar
- Senior Lecturer, Department of Endodontics, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
| | - Satyanarayana Gajjarepu
- Reader, Department of Endodontics, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
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Anderson AC, Al-Ahmad A, Elamin F, Jonas D, Mirghani Y, Schilhabel M, Karygianni L, Hellwig E, Rehman A. Comparison of the bacterial composition and structure in symptomatic and asymptomatic endodontic infections associated with root-filled teeth using pyrosequencing. PLoS One 2013; 8:e84960. [PMID: 24386438 PMCID: PMC3875544 DOI: 10.1371/journal.pone.0084960] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/20/2013] [Indexed: 02/07/2023] Open
Abstract
Residual microorganisms and/or re-infections are a major cause for root canal therapy failure. Understanding of the bacterial content could improve treatment protocols. Fifty samples from 25 symptomatic and 25 asymptomatic previously root-filled teeth were collected from Sudanese patients with periradicular lesions. Amplified 16S rRNA gene (V1-V2) variable regions were subjected to pyrosequencing (FLX 454) to determine the bacterial profile. Obtained quality-controlled sequences from forty samples were classified into 741 operational taxonomic units (OTUs) at 3% dissimilarity, 525 at 5% dissimilarity and 297 at 10% dissimilarity, approximately corresponding to species-, genus- and class levels. The most abundant phyla were: Firmicutes (29.9%), Proteobacteria (26.1%), Actinobacteria (22.72%), Bacteroidetes (13.31%) and Fusobacteria (4.55%). Symptomatic patients had more Firmicutes and Fusobacteria than asymptomatic patients, while asymptomatic patients showed more Proteobacteria and Actinobacteria. Interaction of disease status and age was observed by two-way ANOSIM. Canonical correspondence analysis for age, tooth restoration and disease status showed a correlation of disease status with the composition and prevalence of different members of the microbial community. The pyrosequencing analysis revealed a distinctly higher diversity of the microbiota compared to earlier reports. The comparison of symptomatic and asymptomatic patients showed a clear association of the composition of the bacterial community with the presence and absence of symptoms in conjunction with the patients’ age.
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Affiliation(s)
- Annette Carola Anderson
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
- * E-mail:
| | - Fadil Elamin
- Khartoum Center for Research and Medical Training, Khartoum, Sudan
| | - Daniel Jonas
- Institute of Environmental Medicine and Hospital Hygiene, Albert-Ludwigs-University, Freiburg, Germany
| | - Yousra Mirghani
- Khartoum Center for Research and Medical Training, Khartoum, Sudan
| | - Markus Schilhabel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Lamprini Karygianni
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
| | - Ateequr Rehman
- Institute of Environmental Medicine and Hospital Hygiene, Albert-Ludwigs-University, Freiburg, Germany
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Bohn S, Ilie N. Wetting behaviour of silicone- and resin-based root canal sealers. Int Endod J 2013; 47:542-9. [DOI: 10.1111/iej.12184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S. Bohn
- Department of Restorative Dentistry; Dental School Ludwig-Maximilians-University; Munich Germany
| | - N. Ilie
- Department of Restorative Dentistry; Dental School Ludwig-Maximilians-University; Munich Germany
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Navarro-Escobar E, Baca P, González-Rodríguez MP, Arias-Moliz MT, Ruiz M, Ferrer-Luque CM. Ex vivo microbial leakage after using different final irrigation regimens with chlorhexidine. J Appl Oral Sci 2013; 21:74-9. [PMID: 23559116 PMCID: PMC3881817 DOI: 10.1590/1678-7757201302322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 01/30/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: To assess the influence of final irrigation protocols with chlorhexidine in the
coronal leakage of Enterococcus faecalis in filled root
canals. Material and Methods: Seventy single-root canals from extracted teeth were prepared using ProTaper
instruments. The irrigation protocol accomplished an alternating irrigation with 5
mL of 2.5% sodium hypochlorite (NaOCl) and 17% EDTA between each file. The teeth
were randomly divided into four experimental groups (n=15) according to the final
irrigation regimen: group 1, without final irrigation; group 2, irrigation with 10
mL 2.0% chlorhexidine (CHX); group 3, with a final application of
EC40TM; and group 4, irrigation with the combination (1:1) of 0.2%
CHX + 0.1% cetrimide (CTR). All the teeth were mounted in a two-chamber apparatus
and the coronal access was exposed to E. faecalis. The presence
of turbidity in the BHI broth over a period of 180 days was observed. The Friedman
test was used for statistical analysis. Results: EC40TM varnish showed the least leakage at 180 days, and was
statistically similar to 2% CHX. No significant differences were observed between
the group without final irrigation and the 2% CHX group or 0.2% CHX + 0.1%
CTR. Conclusions: In this ex vivo study, EC40TM showed the longest
delayed coronal leakage of E. faecalis, although without
significant differences from 2% CHX.
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Affiliation(s)
- Esther Navarro-Escobar
- Department of Operative Dentistry, School of Dentistry. University of Granada, Campus de Cartuja, Colegio Máximo s/n, Granada, Spain
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Teles AM, Manso MC, Loureiro S, Silva R, Madeira IGC, Pina C, Cabeda JM. Effectiveness of two intracanal dressings in adult Portuguese patients: a qPCR and anaerobic culture assessment. Int Endod J 2013; 47:32-40. [PMID: 23647356 DOI: 10.1111/iej.12122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 04/03/2013] [Indexed: 12/20/2022]
Abstract
AIM To quantify bacterial equivalents before and after chemomechanical preparation using 3% sodium hypochlorite (NaOCl) and intracanal dressing with calcium hydroxide paste (Ca(OH)2 ) or 2% Chlorhexidine digluconate gel (CHX) in necrotic pulps associated or not with apical periodontitis and to further compare this quantification with counts of anaerobic microorganisms. METHODOLOGY Prospective clinical trial in 69 single-rooted adult teeth (strict inclusion criteria); CHX group: 34; Ca(OH)2 group: 35. Bacteria samples were taken at baseline (S1), after chemomechanical preparation (S2) and after 14 days of intracanal dressing (S3). Bacterial equivalents were assessed by broad-range real-time polymerase chain reaction (qPCR), and live viable bacteria measured with conventional anaerobic culture (CFU/mL). Descriptive/inferential analysis was performed with spss vs. 20.0 (α = 0.05) using the Kruskal-Wallis, Mann-Whitney and chi-squared tests and Spearman's correlation coefficients. RESULTS Both groups showed a significant decrease between S1 and S2 (Mann-Whitney U-test; P < 0.001) both in qPCR and in culture. In the Ca(OH)2 -group, no variation was observed between S2 and S3 by qPCR and culture. In contrast, the CHX group showed a significant increase from S2 to S3 by both techniques. The two groups were only significantly different in S3 (Mann-Whitney U-test; P ≤ 0.001), with a worse performance in the CHX group. Again, these results were congruent by both approaches. Data from both approaches correlate reasonably (rS < 0.5). CONCLUSIONS Infected root canals contained a high bacterial load, and the chemomechanical root canal preparation reduced bacterial equivalents by 99.1% and anaerobic counts by 98.5%. Intracanal dressings were not efficient at reducing bacterial load, but the 14-day intracanal dressing with Ca(OH)2 performed significantly better than CHX, particularly in cases with apical periodontitis.
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Affiliation(s)
- A M Teles
- Health Sciences Faculty, Fernando Pessoa University, Oporto, Portugal; Abel Salazar Institute for the Biomedical Sciences, Oporto University, Oporto, Portugal
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Campos K, Gomes CC, de Fátima Correia-Silva J, Farias LC, Fonseca–Silva T, Bernardes VF, Pereira CM, Gomez RS. Methylation Pattern of IFNG in Periapical Granulomas and Radicular Cysts. J Endod 2013; 39:493-6. [DOI: 10.1016/j.joen.2012.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/20/2012] [Accepted: 12/30/2012] [Indexed: 12/25/2022]
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Anderson AC, Hellwig E, Vespermann R, Wittmer A, Schmid M, Karygianni L, Al-Ahmad A. Comprehensive analysis of secondary dental root canal infections: a combination of culture and culture-independent approaches reveals new insights. PLoS One 2012; 7:e49576. [PMID: 23152922 PMCID: PMC3495864 DOI: 10.1371/journal.pone.0049576] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/10/2012] [Indexed: 01/11/2023] Open
Abstract
Persistence of microorganisms or reinfections are the main reasons for failure of root canal therapy. Very few studies to date have included culture-independent methods to assess the microbiota, including non-cultivable microorganisms. The aim of this study was to combine culture methods with culture-independent cloning methods to analyze the microbial flora of root-filled teeth with periradicular lesions. Twenty-one samples from previously root-filled teeth were collected from patients with periradicular lesions. Microorganisms were cultivated, isolated and biochemically identified. In addition, ribosomal DNA of bacteria, fungi and archaea derived from the same samples was amplified and the PCR products were used to construct clone libraries. DNA of selected clones was sequenced and microbial species were identified, comparing the sequences with public databases. Microorganisms were found in 12 samples with culture-dependent and -independent methods combined. The number of bacterial species ranged from 1 to 12 in one sample. The majority of the 26 taxa belonged to the phylum Firmicutes (14 taxa), followed by Actinobacteria, Proteobacteria and Bacteroidetes. One sample was positive for fungi, and archaea could not be detected. The results obtained with both methods differed. The cloning technique detected several as-yet-uncultivated taxa. Using a combination of both methods 13 taxa were detected that had not been found in root-filled teeth so far. Enterococcus faecalis was only detected in two samples using culture methods. Combining the culture-dependent and –independent approaches revealed new candidate endodontic pathogens and a high diversity of the microbial flora in root-filled teeth with periradicular lesions. Both methods yielded differing results, emphasizing the benefit of combined methods for the detection of the actual microbial diversity in apical periodontitis.
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Affiliation(s)
- Annette Carola Anderson
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
| | - Robin Vespermann
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
| | - Annette Wittmer
- Department of Hygiene and Microbiology, Albert-Ludwigs-University, Freiburg, Germany
| | - Michael Schmid
- Michael Schmid, Research Unit Microbe-Plant Interactions, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Lamprini Karygianni
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany
- * E-mail:
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Arias-Moliz MT, Baca P, Ordóñez-Becerra S, González-Rodríguez MP, Ferrer-Luque CM. Eradication of enterococci biofilms by lactic acid alone and combined with chlorhexidine and cetrimide. Med Oral Patol Oral Cir Bucal 2012; 17:e902-6. [PMID: 22549691 PMCID: PMC3482540 DOI: 10.4317/medoral.18133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 03/09/2012] [Indexed: 11/26/2022] Open
Abstract
Objective: The antimicrobial activity of lactic acid (LA) alone or in combination with chlorhexidine (CHX) and cetrimide (CTR) against three Enterococcus faecalis strains, E. faecalis ATCC 29212, E. faecalis EF-D1 and E. faecalis U-1765, one Enterococcus durans strain and one dual-species biofilm was investigated.
Study Design: The irrigating solutions tested were 20%, 15%, 10%, 5% and 2.5% LA, alone and in combination with 2% CHX and with 0.2% CTR. The biofilms were grown in the MBECTM high-throughput device for 24 hours and exposed to the solutions for 30 seconds and 1 minute. “Eradication” was defined as 100% bacterial kill.
Results: Twenty percent LA eradicated all enterococci biofilms after 30 seconds contact time. The association of LA + 0.2% CTR achieved better results than LA alone, in contrast with the results obtained using LA + 2% CHX. E. durans was eradicated by all the tested solutions at 1 minute. The dual-species biofilm, E. faecalis ATCC 29212 + E. durans, gave intermediate values of the pure cultures.
Conclusions: LA is capable of eradicating enterococci biofilm at a concentration of 20%. The combination of lower concentrations with 0.2% CTR achieved eradication after 1 minute.
Key words:Biofilm, cetrimide, chlorhexidine, enterococcus durans, enterococcus faecalis.
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Affiliation(s)
- María-Teresa Arias-Moliz
- Department of Microbiology, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo s/n, E-18071, Granada, Spain.
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Case PD, Bird PS, Kahler WA, George R, Walsh LJ. Treatment of root canal biofilms of Enterococcus faecalis with ozone gas and passive ultrasound activation. J Endod 2012; 38:523-6. [PMID: 22414842 DOI: 10.1016/j.joen.2011.12.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 12/14/2011] [Accepted: 12/19/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Biofilms of resistant species such as Enterococcus faecalis pose a major challenge in the treatment of root canals with established periapical disease. This study examined the effects of gaseous ozone delivered into saline on biofilms of E. faecalis in root canals of extracted teeth with and without the use of passive ultrasonic agitation. METHODS Biofilms of E. faecalis were established over 14 days in 70 single roots that had undergone biomechanical preparation followed by gamma irradiation. The presence and purity of biofilms were confirmed using scanning electron microscopy and culture. Biofilms were treated with saline (negative control), 1% sodium hypochlorite for 120 seconds (positive control), ozone (140 ppm ozone in air at 2 L/min delivered into saline using a cannula for 120 seconds), saline with passive ultrasonic activation (70 kHz and 200 mW/cm(2) applied to an ISO 15 file held passively within the canal, for 120 seconds), and ozone followed immediately by ultrasonic agitation. After treatment, samples were taken from the biofilm and serially diluted for plate counting. RESULTS Analysis revealed that 1% sodium hypochlorite was the most effective disinfecting agent followed by ozone combined with ultrasonic agitation, ozone alone, and finally ultrasonic alone. CONCLUSIONS Although none of the treatment regimes were able to reliably render canals sterile under the conditions used, ozone gas delivered into irrigating fluids in the root canal may be useful as an adjunct for endodontic disinfection.
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Affiliation(s)
- Peter D Case
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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Dentinal Tubule Infection as the Cause of Recurrent Disease and Late Endodontic Treatment Failure: A Case Report. J Endod 2012; 38:250-4. [DOI: 10.1016/j.joen.2011.10.019] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/23/2022]
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Maciel KF, Neves de Brito LC, Tavares WLF, Moreira G, Nicoli JR, Vieira LQ, Ribeiro Sobrinho AP. Cytokine expression in response to root canal infection in gnotobiotic mice. Int Endod J 2012; 45:354-62. [DOI: 10.1111/j.1365-2591.2011.01983.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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The influence of cone-beam computed tomography and periapical radiographic evaluation on the assessment of periapical bone destruction in dog's teeth. ACTA ACUST UNITED AC 2011; 112:272-9. [DOI: 10.1016/j.tripleo.2011.01.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 10/30/2010] [Accepted: 01/19/2011] [Indexed: 11/22/2022]
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FIGDOR DAVID, GULABIVALA KISHOR. Survival against the odds: microbiology of root canals associated with post-treatment disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1601-1546.2011.00259.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rôças IN, Alves FRF, Santos AL, Rosado AS, Siqueira JF. Apical root canal microbiota as determined by reverse-capture checkerboard analysis of cryogenically ground root samples from teeth with apical periodontitis. J Endod 2010; 36:1617-21. [PMID: 20850664 DOI: 10.1016/j.joen.2010.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/04/2010] [Accepted: 07/05/2010] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Bacteria located in the apical root canal system potentially participate in the pathogenesis of apical periodontitis. Detection and identification of apical bacteria can be compromised because of limitations in conventional sampling and identification procedures. This study identified several bacterial taxa in the apical and middle/coronal segments of primarily infected root canal system by using pulverized root segments and a culture-independent molecular method. METHODS Seventeen extracted teeth with attached apical periodontitis lesions were sectioned to obtain 2 root fragments (apical and middle/coronal segments). Root fragments were cryogenically ground, and DNA was extracted from samples. After multiple displacement amplification, DNA from samples was used as template in a reverse-capture checkerboard hybridization assay targeting 28 bacterial taxa. RESULTS Bacterial DNA was detected in all samples. The most prevalent taxa in the apical root canal system were Olsenella uli (76.5%), Prevotella baroniae (71%), Porphyromonas endodontalis (65%), Fusobacterium nucleatum (53%), and Tannerella forsythia (47%). O. uli, P. endodontalis, and Propionibacterium acnes were as frequently detected in apical samples as they were in middle/coronal samples. P. baroniae, T. forsythia, and F. nucleatum were found more frequently in the apical part of the canal as compared with matched coronal segments. Streptococcus species were more prevalent in middle/coronal samples. The median and mean of shared bacterial taxa between matched apical and middle/coronal segments were 27% and 41%, respectively. CONCLUSIONS Several candidate endodontic pathogens were very prevalent in the apical root canal system. The apical microbiota was usually complex and differed in species composition when compared with the microbiota of middle/coronal samples from the same tooth.
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Affiliation(s)
- Isabela N Rôças
- Department of Endodontics and Molecular Microbiology Laboratory, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
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Influence of a Passive Sonic Irrigation System on the Elimination of Bacteria from Root Canal Systems: A Clinical Study. J Endod 2010; 36:1315-8. [DOI: 10.1016/j.joen.2010.04.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 11/18/2022]
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Bacterial leakage in obturated root canals—part 2: a comparative histologic and microbiologic analyses. ACTA ACUST UNITED AC 2010; 109:788-94. [DOI: 10.1016/j.tripleo.2009.11.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 11/12/2009] [Accepted: 11/14/2009] [Indexed: 11/18/2022]
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36
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Galler KM, D'Souza RN, Hartgerink JD. Biomaterials and their potential applications for dental tissue engineering. ACTA ACUST UNITED AC 2010. [DOI: 10.1039/c0jm01207f] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Yazdi KA, Sabeti M, Jabalameli F, Eman eini M, Kolahdouzan SA, Slots J. Relationship between human cytomegalovirus transcription and symptomatic apical periodontitis in Iran. ACTA ACUST UNITED AC 2009; 23:510-4. [PMID: 18954359 DOI: 10.1111/j.1399-302x.2008.00471.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Apical periodontitis of endodontic origin may develop as a result of cooperative interactions among herpesviruses, specific pathogenic bacteria and tissue-destructive inflammatory mediators. This study sought to identify the presence of Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) transcripts in symptomatic and asymptomatic periapical lesions of individuals living in Iran. MATERIAL AND METHODS Fifty endodontic patients (28 with symptomatic periapical lesions and 22 with asymptomatic periapical lesions) were included in the study. In each study subject, a microbiological periapical sample was collected using a curette in conjunction with periapical surgery. A reverse transcription-polymerase chain reaction assay was used to identify transcripts of EBV and HCMV. RESULTS Human cytomegalovirus transcript was detected in 15 of the 28 (53.6%) symptomatic and in six of the 22 (27.3%) asymptomatic periapical study lesions (significant difference between symptomatic and asymptomatic lesions; P = 0.03, chi-square test). Epstein-Barr virus transcript was identified in one symptomatic and in two asymptomatic periapical lesions. CONCLUSION This study establishes that HCMV transcription is common in apical periodontitis and is most frequent in symptomatic lesions. The high frequency of active herpesvirus infections in severe apical periodontitis changes the pathogenic paradigm of the disease and may also have preventive and therapeutic implications.
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Affiliation(s)
- K A Yazdi
- Department of Endodontics, School of Dentistry/Dental Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Clinical Implications and Microbiology of Bacterial Persistence after Treatment Procedures. J Endod 2008; 34:1291-1301.e3. [DOI: 10.1016/j.joen.2008.07.028] [Citation(s) in RCA: 510] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 07/29/2008] [Accepted: 07/29/2008] [Indexed: 11/19/2022]
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Siqueira Jr JF, Rôças IN. Bacterial pathogenesis and mediators in apical periodontitis. Braz Dent J 2007; 18:267-80. [DOI: 10.1590/s0103-64402007000400001] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 11/12/2007] [Indexed: 01/20/2023] Open
Abstract
Apical periodontitis is a group of inflammatory diseases caused by microorganisms (mainly bacteria) infecting the necrotic root canal system. The pathogenesis of different types of apical periodontitis and even the same type in different individuals is unlikely to follow a stereotyped fashion with regard to the involved bacterial mediators. Disease pathogenesis is rather complex and involves a multitude of bacteria- and host-related factors. This review article discusses the bacterial pathogenesis of acute and chronic apical periodontitis, with the main focus on the bacterial mediators conceivably involved in the different stages of the infectious process, including secreted products (enzymes, exotoxins, N-formyl-methionyl-leucyl-phenylalanine peptides, heat-shock proteins and metabolic end-products) and structural components (lipopolysaccharide, peptidoglycan, lipoteichoic acid, lipoproteins, fimbriae, flagella, outer membrane proteins and vesicles, DNA, and exopolysaccharides). Knowledge of the bacterial factors involved in the pathogenesis of apical periodontitis is important to the understanding of the disease process and to help establishing proper therapeutic measures to inactivate this bacterial "artillery".
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