Clinical Influence Of Different Intracanal Medications On Th1-type And Th2-type Cytokine Responses In Apical Periodontitis

Introduction This clinical study assessed the influence of different intracanal medications on Th1-type and Th2-type cytokine responses in apical periodontitis and monitored the levels of bacteria from primarily infection during endodontic procedures. Methods Thirty primarily infected teeth were randomly divided into 3 groups according to the medication selected: chlorhexidine (CHX), 2% CHX gel; Ca(OH)2/SSL, Ca(OH)2 + SSL; and Ca(OH)2/CHX, Ca(OH)2 + 2% CHX gel (all, n = 10). Bacterial sample was collected from root canals, and the interstitial fluid was sampled from lesions. Culture techniques were used to determine bacterial counts (colony-forming units/mL). Th1 (tumor necrosis factor-α, interferon-γ, and interleukin [IL]-2) and Th2 cytokines (IL-4, IL-5, and IL-13) were measured by enzyme-linked immunosorbent assay. Results All intracanal medication protocols were effective in reducing the bacterial load from root canals (all P .05). Both Ca(OH)2 treatment protocols significantly increased the levels of Th2-type cytokines (P .05). Thus, chlorhexidine medication showed the lowest effectiveness in increasing the levels of Th2-type cytokine. After treatment, regardless of the type of medication, the linear regression analysis indicated the down-regulation of Th2-type cytokines by Th1-type cytokines. Conclusions All intracanal medication protocols were effective in reducing bacterial load and lowering the levels of Th1-type cytokines. 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Endodontic Retreatment: Clinical Comparison Of Reciprocating Systems Versus Rotary System In Disinfecting Root Canals

Methods: Thirty endodontically treated teeth with post-treatment apical periodontitis were selected. The specimens were divided into three groups according to the system used: WaveOne (n = 10), Reciproc instrument (n = 10), and ProTaper Universal Retreatment system (n = 10). Samples were collected before and after chemomechanical preparation. The irrigation was performed by using 2.5 % sodium hypochlorite. A chromogenic limulus amebocyte lysate assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial colony-forming unit counts.Introduction: This clinical study was conducted to compare the effectiveness of single-file reciprocating systems and rotary systems in removing endotoxins and cultivable bacteria in endodontic retreatment.Results: At baseline, endotoxins and cultivable bacteria were recovered from 100 % of the root canal samples in a median value of 5.84 EU/mL and 4.98 × 103 CFU/mL, respectively. After CMP, no differences were found in the median percentage values of endotoxin reduction achieved with reciprocating systems—WaveOne [94.11 %] and Reciproc [93.29 %] and with rotary systems—ProTaper [94.98 %] (P > 0.05). Both single-file reciprocating systems [WaveOne (98.27 %) and Reciproc (99.54 %)] and rotary system [ProTaper (98.73 %)] were effective in reducing bacterial load (P > 0.05). Moreover, no differences were found among the systems tested.Conclusions: The Reciproc and WaveOne reciprocating systems were as effective as the ProTaper system for removal of endotoxins and bacteria in endodontic retreatment.Clinical relevance: All systems tested were effective to remove cultivable bacteria and endotoxin in endodontic retreatment. As no differences among systems were observed, it is possible to suggest that clinicians should choose the preferred technique to perform endodontic