Monitoring the effectiveness of root canal procedures on endotoxin levels found in teeth with chronic apical periodontitis

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 ...

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

Objective This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation. Material and Methods The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test. Results The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth]. Conclusions The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics. .

Intracanal medications versus placebo in reducing postoperative endodontic pain – a double – blind randomized clinical trial

This prospective randomized, double-blind factorial study aimed to compare the efficacy of three different intracanal medicaments with the placebo in controlling the postoperative pain after complete root canal preparation. The study was performed on 64 mandibular molars of 64 patients with diagnosis of pulp necrosis and acute apical periodontitis. After chemomechanical procedures using the stepback technique and 1% sodium hypochlorite, the teeth were randomized into four treatment groups (n=16). In group I, canals were filled with calcium hydroxide paste mixed with 2% chlorhexidine gel, group II received 2% chlorhexidine gel, group III was treated with calcium hydroxide paste, and group IV received no dressing (control). Before dismissal, preoperative pain experience was recorded using a visual analog pain scale. Patients were then instructed to quantify the degree of pain experienced 4 h after treatment and daily for a further 24, 48, 72 and 96 h. Two-way repeated measures ANOVA test and post hoc Tukey's HSD test revealed that at each time interval groups I and II were significantly more effective in reducing the postoperative pain values than groups III and IV (p<0.05). Dunnett's test showed that groups I and II differed significantly from control whereas difference between group III and control was not significant (p>0.05). Patients with pulp necrosis and acute apical periodontitis that had been dressed with chlorhexidine alone and calcium hydroxide plus chlorhexidine gave rise to less pain than that experienced by patients who had a calcium hydroxide dressing alone or no dressing at all.

Este estudo prospectivo randomizado, duplo-cego, fatorial teve como objetivo comparar a eficácia de três diferentes medicamentos intracanal com o placebo no controle da dor pós-operatória após a preparação completa do canal radicular. O estudo foi realizado em 64 molares inferiores de 64 pacientes com diagnóstico de necrose pulpar e periodontite apical aguda. Após os procedimentos químico-mecânicos com a técnica escalonada (stepback) e hipoclorito de sódio a 1%, os dentes foram divididos aleatoriamente em quatro grupos de tratamento (n=16 por grupo). No grupo I, os canais foram preenchidos com pasta de hidróxido de cálcio misturado com 2% de clorexidina gel, grupo II receberam 2% de clorexidina gel, grupo III foi tratado com uma pasta de hidróxido de cálcio e do grupo IV não receberam curativo (controle). Antes de liberar o paciente, a sensação de dor pré-operatória foi registrada com uma escala visual analógica. Os pacientes foram instruídos para quantificar o grau de dor experimentada após 4 h de tratamento e diariamente após 24, 48, 72 e 96 h. Os testes ANOVA a dois critérios para medidas repetidas e teste de Tukey post hoc HSD revelaram que, a cada intervalo de tempo, o grupo I e grupo II foram significativamente mais (p<0,05) eficazes na redução da dor pós-operatória que os grupos III e IV. Além disso, o teste de Dunnett mostrou que o grupo I e grupo II diferiram significativamente com o controle enquanto que a diferença entre o grupo III e controle foi não significativo. Pacientes com necrose pulpar e periodontite apical aguda que receberam curativos de demora de clorexidina e hidróxido de cálcio mais clorexidina apresentaram menos dor do que aqueles que receberam curativo de hidróxido de cálcio ou não receberam qualquer curativo.

Frecuencia de periodontitis apical en tratamientos endodónticos de pregrado / Frequency of apical periodontitis in endodontic treatment in undergraduate

La periodontitis apical es una enfermedad de los tejidos periapicales de etiología bacteriana. Su tratamiento requiere erradicar los microorganismos del conducto radicular y obturarlo para lograr la reparación posterior. El objetivo de éste trabajo fue determinar la frecuencia de periodontitis apical en la población que asiste a la clínica de Endodoncia de la Facultad de Odontología de la Universidad de Chile y su relación con diferentes variables: diagnóstico específico, edad, sexo, agudas vs. crónicas, éxito/fracaso del tratamiento y rehabilitación post-tratamiento. Se recolectó información de 292 dientes de pacientes tratados en dicha clínica, analizándose la información de aquellos con dientes diagnosticados con algún tipo de periodontitis apical clasificándolo según la nueva nomenclatura de la asociación de endodoncia americana. La frecuencia de periodontitis apical fue de un 36.7 por ciento (92 pacientes), de los cuales un 77.8 por ciento presentaron patologías de tipo crónicas. Un 75 por ciento de los pacientes pertenecieron al sexo femenino y la 5ta década representó un 34.8 porciento de los pacientes. El 100 por ciento de los pacientes que acudieron a control presentó éxito en sus tratamientos según variables clínico-radiográficas, mientras que la restauración más frecuente post-tratamiento fue la resina compuesta (52.4 por ciento). Dado el pequeño número de pacientes que concurrieron a la citación de control para determinar el éxito del tratamiento, esta variable debe ser considerada como preliminar. Nuestros resultados mostraron que la condición mas frecuente fue la periodontitis apical de tipo crónica, afectando más a mujeres y a la 5ta década.

Apical periodontitis is a microbially induced inflammatory disease of the periapical tissues. Its treatment requires eliminating microorganism from root canal and sealing it properly to induce further tissue repair. The aim of this study was to determine the frequency of apical periodontitis and its distribution by gender, age, range, acute vs. chronic, treatment success and rehabilitation in the population attended at the undergraduate clinic of Endodontic at the Faculty of Dentistry, Universidad de Chile. Information was collected from 292 teeth of patients treated at the clinic, recording data of those with teeth diagnosed with some type of apical periodontitis and related to different variables: specific diagnosis, age, gender, acute vs. chronic, successful or failed treatment and post-treatment restoration. The frequency of apical periodontitis was 36.7 percent (92 patients). 77.8 percent of the teeth with apical periodontitis had a chronic disease. 75 percent of the patients were female. The 5th decade represented a 34.8 percent. There was a 100 percent success rate in their treatments, while the most common restoration was the composite (52.4 percent). The low number of patients who responded to the dental revision to determine the success of the treatment, despite the 100 percent rate, cannot be evaluated as a significant result. Our data showed that the most frequent condition was chronic apical periodontitis, affecting more female patients, and the 5th decade and incisors.

Analysis of Enterococcus faecalis in samples from Turkish patients with primary endodontic infections and failed endodontic treatment by real-time PCR SYBR green method

OBJECTIVE: The aims of this study were to investigate the presence of Enterococcus faecalis in primary endodontic infections and failed endodontic treatments using real-time PCR and to determine the statistical importance of the presence of E. faecalis in a Turkish population with endodontic infections. MATERIAL AND METHODS: E. faecalis was investigated from 79 microbial samples collected from patients who were treated at the Endodontic Clinic of the Dental School of Atatürk University (Erzurum, Turkey). Microbial samples were taken from 43 patients (Group 1) with failed endodontic treatments and 36 patients (Group 2) with chronic apical periodontitis (primary endodontic infections). DNA was extracted from the samples by using a QIAamp® DNA mini-kit and analyzed with real-time PCR SYBR Green. RESULTS: E. faecalis was detected in 41 out of 79 patients, suggesting that it exists in not less than 61 percent of all endodontic infections when the proportion test (z= -1.645,

Avaliaçäo histomicrobiológica após curativo de demora com pastas à base de hidróxido de cálcio por diferentes períodos de tempo / Histomicrobiologic evaluation after intracanal dressing with pastes based on calcium hydroxide in different periods of time

O objetivo deste trabalho foi avaliar o efeito antimicrobiano da pasta à base de hidróxido de cálcio empregada como curativo de demora em pré-molares de cäes com lesäo periapical crônica, sendo utilizados 80 canais radiculares. Após comprovaçäo radiográfica da formaçäo de lesöes periapicais induzidas e preparo biomecânico, os canais radiculares foram preenchidos com pasta à base de hidróxido de cálcio associada ao p-monoclorofenol canforado (Calen-PMCC). Decorridos os períodos de 7, 15 e 30 dias, os animais foram sacrificados e os cortes histológicos obtidos corados pelo método de Brown&Bren. O resultado da avaliaçäo histomicrobiológica demonstrou maior efeito antimicrobiano no período de 30 dias. O período de 15 dias apresentou melhores resultados quando comparado ao de sete dias