Effect of chemo-mechanical preparation in the levels of endotoxin in primary endodontic infections and inflammatory potential of the infectious content regarding the production of pro-inflammatory cytokines

Author(s)

Ariane Cassia Salustiano Marinho

• Document type: Master's Dissertation
• Press: Piracicaba, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba
• Defense date: 2013-02-25

Examining board members

Brenda Paula Figueiredo de Almeida Gomes; Daniel Pinto de Oliveira; Caio Cezar Randi Ferraz

• Advisor: Brenda Paula Figueiredo de Almeida Gomes

Abstract

Lipopolysaccharide (LPS)-endotoxin are able to stimulate cells to produce proinflammatory cytokines involved in the periapical tissue destruction. The aims of this study were: 1) To verify and quantify endotoxin in infected root canals of teeth with apical periodontitis and correlate the levels with clinical signs and symptoms of the primary endodontic infections; 2) To assess the effectiveness of chemo-mechanical preparation (CMP) with 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) and saline solution (SS), as negative control, for the elimination of endotoxins; 3) To evaluate the inflammatory potential of endodontic content before (C1) and after the CMP (C2) with 2.5% NaOCl, 2% CHX or SS and after final rinse with 17% EDTA (C3) in macrophage cell culture regarding the production of proinflammatory cytokines - IL-1 ? and TNF-?- via the enzyme-linked immunosorbent assay (ELISA). Samples were collected from 30 canals with pulpal necrosis and apical periodontitis in C1, C2 and C3 using sterile non-pyrogenic/paper points. Endotoxin was detected in 100% of root canals studied, represented by the median of 18.70 EU/mL. Teeth with tenderness to percussion and intracanal exudate were related to high levels of endotoxin (p< 0.05). After CMP, significant reduction of endotoxin was obtained in root canals instrumented with 2.5% NaOCl + 17% EDTA (99.75%), CHX 2% + 17% EDTA (98.27%) and SS + EDTA 17% (98,71%) (p< 0.05). IL1-? and TNF-? were produced by the macrophages in response to the endodontic content (C1>C2>C3). It was possible to conclude that 1) Endotoxin were present in all cases investigated, showing higher levels in the teeth with tenderness to percussion and intracanal exudate; 2) CMP was effective in reducing the endotoxic content, regardless of the auxiliary chemical substance; 3) The inflammatory potential of endodontic content was demonstrated by the production of IL1-? and TNF-? in all cases. The infectious content present in the root canal in the initial samples exerted greater inflammatory activity against macrophages compared to the residual content after CMP (AU)

• FAPESP's process: 10/13743-3 - Microbiological and endotoxins analysis in primarily infected root canals with apical periodontitis and their antigenic potencial against macrophages to produce IL1-beta e TNF-alfa during endodontic treatment.
• Grantee: Ariane Cássia Salustiano Marinho
• Support Opportunities: Scholarships in Brazil - Master