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| Author(s): |
Marcos Sergio Endo
Total Authors: 1
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| Document type: | Doctoral Thesis |
| Press: | Piracicaba, SP. |
| Institution: | Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba |
| Defense date: | 2012-12-14 |
| Examining board members: |
Brenda Paula Figueiredo de Almeida Gomes;
Marcia Carneiro Valera;
Flaviana Bombarda de Andrade Ferreira;
Francisco Montagner;
Mirian Marubayashi Hidalgo
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| Advisor: | Brenda Paula Figueiredo de Almeida Gomes |
| Abstract | |
Introduction: Microorganisms resistant to the endodontic therapy or that invaded the root canal system after clinical disinfection procedures are considered the main causes of endodontic failure. Aims: 1) to investigate the prevalence of E. faecalis in cases of endodontic retreatment with periapical lesions using culture technique, traditional PCR and nested PCR; and also to evaluate the antimicrobial susceptibility and virulence factors of E. faecalis isolates (Chapter 1); 2) to quantify cultivable bacteria and endotoxin in root canals with secondary endodontic infection correlating their levels with the presence of clinical features; and also to evaluate the effect of chemomechanical preparation (CMP) with 2% chlorhexidine-gel + 17% EDTA on bacterial and endotoxin removal. Moreover, it was also aimed to investigate the presence of target strict Gram-negative anaerobic bacteria by PCR/ nested PCR (Chapter 2). Methods: Microbial samples were collected from 30 root-filled canals of teeth with secondary endodontic infection after removal of gutta-percha (S1) and after CMP (S2). Microbial culture techniques, PCR (16S rDNA) and nested PCR were used to investigate the presence of E. faecalis. Target Gram-negative bacteria species were investigated by PCR. Levels of endotoxin and CFU were monitored in S1 and S2, using the LAL assay and culture, respectively. Clinical strains of E. faecalis were tested for their antimicrobial susceptibility to 12 types of antibiotics by E-test. The virulence factors (efaA, ace, asa, asa373, gelE, esp and cylA) of E. faecalis isolates were investigated by PCR technique. Results: E. faecalis was found by culture technique (7/30), traditional PCR (13/30) and nested PCR (23/30). The traditional PCR and nested PCR technique revealed higher sensitivity for detection of E. faecalis than culture (p<0.05, McNemar's test). P. nigrescens (4/15), P. intermedia (2/15), F. nucleatum (1/15) T. denticola (1/15) T. socranskii (1/15) and T. forsythia (2/15) were detected in the root canals investigated. Endotoxins were detected in all cases (S1 and S2). Positive correlation between endotoxin levels and periapical bone destruction was observed (p <0.05). All E. faecalis strains were susceptible to Amoxicillin, Amoxicillin + clavulanic acid, Benzylpenicillin, Vancomycin and Moxifloxacin, however some strains showed resistant to Erythromycin (3/12), Azithromycin (8/12), Rifampicin (4/12), Tetracycline (2/12) and Doxycycline (1/12). The virulence factors of the E. faecalis strains were ace and efaA (100%), gelE (91.6%), asa (83.3%), esp (25%) and cylA (16.6%). Conclusion: 1) The percentage of E. faecalis found varied according to the technique employed. All E. faecalis isolated showed virulence factors related to adherence (genes ace and efa). They also showed resistance to some antibiotics commonly used in dentistry (Chapter 1); 2) Microorganisms and endotoxins were found in all root canals investigated, before and after CMP. The endotoxin levels initially found in the infected root canals were associated with a larger size of periapical radiolucent area. CMP with 2% chlorhexidine-gel + 17% EDTA was effective in reducing both bacterial load and endotoxin contents in the post-treatment apical periodontitis (Chapter 2) (AU) | |