Evaluation of the effect of endodontic and periodo... - BV FAPESP
Advanced search
Start date
Betweenand


Evaluation of the effect of endodontic and periodontal therapy against infectious content in teeth with necrotic pulps compromised by chronic periodontal disease

Full text
Author(s):
Rafaela Casadei Chapola
Total Authors: 1
Document type: Doctoral Thesis
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; Vanessa Bellocchio Berber Haddad; José Flávio Affonso de Almeida; Karina Gonzales Silverio; Francisco Montagner
Advisor: Brenda Paula Figueiredo de Almeida Gomes
Abstract

The close relationship between pulp and periodontium is justified due to the existence of different access routes that anatomically connect the two tissues to each other. The main inflammatory events of endodontic and periodontal pathologies are associated with the presence of bacterial lipopolysaccharide (LPS), which is the main virulence factor of Gram-negative bacteria. Due to the scarcity of scientific studies aimed to analyze the infectious content of teeth with pulp necrosis and associated periodontal disease, as well as the scarcity of findings about the effect of endodontic treatment (ET) on pathologically compromised periodontal sites, the objectives of the present study were: to study the microbiota present in root canals (RC's) and periodontal pockets (PP's), of teeth with necrotic pulp and associated periodontal disease, through Nested-PCR; to verify the susceptibility of these microorganisms to different endodontic clinical protocols and periodontal therapy (PT), through the counting of Colony Forming Units (UFC's), in addition to analyze their effect on LPS reduction, in RC's and PP's. Clinical samples were collected from 40 teeth with pulp necrosis and associated periodontal pocket, divided into four groups, in the RC's (ES) and PP's (PS), in the different phases of the treatment: GI (n=10; Auxiliary chemical substance ACS= chlorhexidine CLX 2% gel) – initial [ES1/PS1], after chemical-mechanical preparation CMP [ES2/PS2], after 30 days of obturation OBT [PS4] and after 45 days of PT [PS5]. GII (n=10; ACS= sodium hypochlorite SH 6%) - ES1/PS1, ES2/PS2, PS4, PS5. GIII (n=10; ACS= CLX 2% gel; IM= calcium hydroxide CH+CLX 2% gel) - ES1/PS1, ES2/PS2, after 30 days of IM [ES3/PS3], PS4, PS5. GIV (n=10; ACS=SH 6%; IM=CH+saline water SW) - ES1/PS1, ES2/PS2, ES3/PS3, PS4, PS5. The susceptibility of the microbiota to ET and PT was performed by counting the UFC's. Nested-PCR was used to identify the following species: A. actinomycetemcomitans (Aa), A. naeslundii (Anae), D. pneumosintes (Dpneu), E. faecalis (Ef), F. alocis (Falo), F. nucleatum (Fnu), G. morbillorum (Gm), P. micra (Pm), P. endodontalis (Pe), P. gingivalis (Pg), P. intermedia (Pi), P. nigrescens (Pn), P. tannerae (Pt), S sobrinus (Sso), T. forsythia (Tf), T. denticola (Td) and T. socranskii (Ts). To quantify the LPS, the Amebocyte Lysate Limulus (LAL) test was performed. The results demonstrated a high initial microbial load inside the PP's, however, there were reductions in these microbiological levels in all stages of treatment and in all groups, especially after PT (PS4) (p <0.05). In the RC's there were also statistically significant reductions, mainly when comparing ES1 and ES2 (p <0.05). Td (GI 100%; GII 90%; GIII 90%; GIV 100%), Ts (GI 90%), Tf (GI 80%; GIII 80%; GIV 70%), Aa (GI 80%; GII 90%; GIV 80%), Pe (GI 80%; GII 70%), Pt (GI 80%; GII 90%), Pn (GI 90%; GII 100%), Fn (GI 90%; GII 100%; GIII 80%; GIV 100%), Pm (GI 100%; GII 80%; GIII 80%; GIV 90%), Ef (GI 90%; GII 100%; GIII 100%; GIV 90%), Pi (GI 70%; GII 70%) and Pg (GIII 80%; GIV 70%) were predominantly detected in PS1. In ES1 Ts (GI 60%; GIV 60%), Pe (GI 60%; GIII 60%), Pt (GI 60%; GIII 80%), Pn (GI 60%; GII 70%; GIII 60%; GIV 60%), Fn (GI 60%), Ef (GI 80%; GII 70%; GIII 90%; GIV 100%) and Td (GIII 60%) were the most frequent. Beside that it was possible to observe alteration of the microbiota, in the different times, in the PP's and RC's. In PP's, there were reductions in the endotoxins levels in all stages of treatment and in all groups, mainly after PT (PS5), in GIII and GIV (IM) (p <0.05). In the RC's there were also statistically significant reductions, mainly after the IM in GIII (p <0.05). In view of the results and the methodologies used, it was concluded that the microbiota of PP's and RC's was composed of potent periodontopathogens, and the majority of the microorganisms present in PP's also constituted the microbiota of RC's. modulation in the microbial profile was observed after the various stages of treatment, in both sites. The PP's showed significant reductions in the count of CFU's, especially after PT, in all groups. In the RC's, there were higher reductions after the CMP, with no difference between the ACS's used. CLX gel 2% and CH (IM GIII) showed higher antimicrobial effect in endodontic sites. GIII and GIV showed higher reductions in LPS in PP's and RC's. CLX gel 2% and CH (IM GIII) resulted in lower levels in RC's (AU)

FAPESP's process: 17/14912-2 - Evaluation of the effect of endodontic and periodontal therapy on infectious and inflammatory contents in teeth with combined endo-periodontal lesions
Grantee:Rafaela Casadei Chapola
Support Opportunities: Scholarships in Brazil - Doctorate