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Characterization of microbiota and effect of chemo-mechanical preparation and intracanal medication in reducing microrganisms, endotoxins and proinflammatory cytokines in root-filled teeth persistent infection failure and the presence of apical periodontitis

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Author(s):
Marlos Barbosa Ribeiro
Total Authors: 1
Document type: Master's Dissertation
Press: Piracicaba, SP.
Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba
Defense date:
Examining board members:
Brenda Paula Figueiredo de Almeida Gomes; Fabíola Bastos de Carvalho; Alexandre Augusto Záia
Advisor: Brenda Paula Figueiredo de Almeida Gomes; Caio Cezar Randi Ferraz
Abstract

The knowledge of the microbial community and its antigenic potential is important for understanding the pathogenesis of apical periodontitis in endodontically treated teeth. The objectives of this study were: 1) Characterize the microbiota associated to endodontic failure through the biochemical test, Nested PCR and partial sequencing of gene 16S rRNA.; 2) Quantify endotoxin (LPS) by Limulus Amebocyte Lysate test and pro-inflammatory cytokines IL-1?, IL-1?, TNF-? and PGE2 by enzyme-linked immunosorbent assay, correlating them with the patients' clinical and radiographic features; 3) To evaluate the effect of chemo-mechanical preparation (CMP) and intracanal medications (ICM) in reducing microorganisms, LPS and pro-inflammatory cytokines. Samples of endodontic content of 20 single-rooted teeth were collected before (C1), after CMP (C2), after the use of 17% EDTA (C3) agitated with ultrasound, and after ICM (C4). Sterile/apyrogenic materials and a aseptic techniques were used during the samples' collection. After processing the samples, the data were tabulated and analyzed by statistical testes Chi-square, Spearman correlation, and analysis of variance (Tukey-Kramer). The results indicated the presence of a mixed microbiota presenting Gram positive and Gram negative bacteria. Four different phyla were identified: Actinobacteria, Firmicutes, Proteobacteria and Fusobacterium. Enterococcus faecalis was the most prevalent species, identified phenotypically (19/158) and genotypically (42/158). Sequencing was able to identify 10.12% of the samples at the genus level and 89.88% at the species level, whereas the biochemical test identified 13.29% and 51.26%, respectively. The most prevalent bacteria by Nested PCR were: Enterococcus faecalis (97.5%), followed by Porphyromonas gingivalis (88.75%), Fusobacterium nucleatum (56.25%) and Aggregatibacter actinomycetemcomitans (37.5%). CMP reduced bacteria in 96.69% (p<0.05), with a percentage reduction in 99.3% for 2% CLX gel and in 92.1% for 6% NaOCl (p>0.05). EDTA 17% showed only a further effect on bacterial reduction in the 6% NaOCl group (p<0.05). Only 2% CLX gel was effective in reducing endotoxin compared to 6% NaOCl and 17% EDTA (p<0.05). CMP regardless of chemical substance used, was effective in reducing the levels of pro-inflammatory cytokines IL-1? (88.14%), IL-1? (89.33%), TNF-? (89.85%) and PGE2 (48.60%) (p<0.05).The intracanal medication not show additive effect in reducing bacteria and proinflammatory cytokines in both groups (p<0.05); and only presented action against LPS in the Ca(OH)2 + 2% CLX gel group (p<0.05). There was a positive correlation between bacteria, LPS, pro-inflammatory cytokines and clinical and radiographic features (p<0.05). In conclusion, CMP presented a significant effect in reducing the infectious content of root canal of teeth with endodontic failure, while ICM showed no significant additive effect in reducing these levels (AU)

FAPESP's process: 12/23697-4 - Microbial diversity and quantification of endoxinas and proinflammatory cytokines in secondary/persistent infections with periapical lesions
Grantee:Marlos Barbosa Ribeiro
Support Opportunities: Scholarships in Brazil - Master