A Microleakage Study Of Gutta-percha/ah Plus And Resilon/real Self-etch Systems After Different Irrigation Protocols

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin. Objective: The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-Etch systems. Material and Methods: One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+EDTA; NaOCl+H3PO4; NaOCl+EDTA+chlorhexidine (CHX); NaOCl+H3PO4+CHX; CHX+EDTA; CHX+ H3PO4; CHX+EDTA+CHX and CHX+H3PO4+CHX. Gutta-percha/AH Plus or Resilon/Real Seal SE were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests. Results: No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by EDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage. Conclusion: A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE.223174179Adamo, H.L., Buruiana, R., Schertzer, L., Boylan, R.J., A comparison of MTA, Super EBA, comparison of MTA, Super EBA, composite and amalgam as root end filling materials using a bacterial microleakage model (1999) Int Endod J, 32, pp. 197-203Akisue, E., Tomita, V.S., Gavini, G., de Poli, F.J.A., Effect of the combination of sodium hypochlorite and chlorhexidine on dentinal permeability and scanning electron microscopy precipitate observation (2010) J Endod, 36, pp. 847-850Assis, D.F., Prado, M., Simão, R.A., Evaluation of the interaction between endodontic sealers and dentin treated with different irrigant solutions (2011) J Endod, 37, pp. 1550-1552Baumgartner, G., Zehnder, M., Paqué, F., Enterococcus faecalis type strain leakage through root canals filled with Gutta-Percha/ AH Plus or Resilon/Epiphany (2007) J Endod, 33, pp. 45-47Berber, V.B., Gomes, B.P., Sena, N.T., Vianna, M.E., Ferraz, C.C., Zaia, A.A., Efficacy of various concentrations of NaOCl and instrumentation techniques in reducing Enterococcus faecalis within root canals and dentinal tubules (2006) Int Endod J, 39, pp. 10-17Carrilho, M.R., Carvalho, R.M., Goes, M.F., di Hipólito, V., Geraldeli, S., Tay, F.R., Chlorhexidine preserves dentin bond in vitro (2007) J Dent Res, 86, pp. 90-94Chailertvanitkul, P., Saunders, W.P., Mackenzie, D., Coronal leakage of obturated root canals after long-term storage using a polymicrobial marker (1997) J Endod, 23, pp. 610-613De-Deus, G., Namen, F., Galan Jr., J., Zehnder, M., Soft chelating irrigation protocol optimizes bonding quality of Resilon/Epiphany root fillings (2008) J Endod, 34, pp. 703-705Fransen, J.N., He, J., Glickman, G.N., Rios, A., Shulman, J.D., Honeyman, A., Comparative assessment of ActiV GP/glass ionomer sealer, Resilon/Epiphany, and gutta-percha/AH plus obturation: A bacterial leakage study (2008) J Endod, 34, pp. 725-727Gomes, B.P., Sato, E., Ferraz, C.C., Teixeira, F.B., Zaia, A.A., Souza-Filho, F.J., Evaluation of time required for recontamination of coronally sealed canals medicated with calcium hydroxide and chlorhexidine (2003) Int Endod J, 36, pp. 604-609Hashem, A.A., Ghoneim, A.G., Lutfy, R.A., Fouda, M.Y., The effect of different irrigating solutions on bond strength of two root canalfilling systems (2009) J Endod, 35, pp. 537-540Hirai, V.H., Silva, N.U.X., Westphalen, V.P., Perin, C.P., Carneiro, E., Fariniuk, L.F., Comparative analysis of leakage in root canal fillings performed with gutta-percha and Resilon cones with AH Plus and Epiphany sealers (2010) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 109, pp. e131-e135Imura, N., Otani, S.M., Campos, M.J., Jardim Jr., E.G., Zuolo, M.L., Bacterial penetration through temporary restorative materials in root-canal-treated teeth in vitro (1997) Int Endod J, 23, pp. 1-5Jacobovitz, M., Vianna, M.E., Pandolfelli, V.C., Oliveira, I.R., Rossetto, H.L., Gomes, B.P., Root canal filling with cements based on mineral aggregates: An in vitro analysis of bacterial microleakage (2009) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 108, pp. 140-144Malone III, K.H., Donnelly, J.C., In vitro evaluation of coronal microleakage in obturated root canals without restorations (1997) J Endod, 23, pp. 35-38Nair, U., Ghattas, S., Saber, M., Natera, M., Walker, C., Pileggi, R., A comparative evaluation of the sealing ability of 2 root-end filling materials: An in vitro leakage study using Enterococcus faecalis (2011) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 112, pp. e74-e77Neelakantan, P., Subbarao, C., Subbarao, C.V., De-Deus, G., Zehnder, M., The impact of root dentine conditioning on sealing ability and push-out bond strength of an epoxy resin root canal sealer (2011) Int Endod J, 44, pp. 491-498Park, D.S., Torabinejad, M., Shabahang, S., The effect of MTAD on the coronal leakage of obturated root canals (2004) J Endod, 30, pp. 890-892Prado, M., Gusman, H., Gomes, B.P., Simão, R.A., Scanning electron microscopic investigation of the effectiveness of phosphoric acid in smear layer removal when compared with EDTA and citric acid (2011) J Endod, 37, pp. 255-258Prado, M., Simão, R.A., Gomes, B.P., Effect of different irrigation protocols on resin sealer bond strength to dentin (2013) J Endod, 39, pp. 689-692Rosenthal, S., Spångberg, L., Safavi, K., Chlorhexidine substantivity in root canal dentin (2004) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 98, pp. 488-492Saleh, I.M., Ruyter, I.E., Haapasalo, M., ørstavik, D., Bacterial penetration along different root canal filling materials in the presence or absence of smear layer (2008) Int Endod J, 41, pp. 32-40Sharifian, M.R., Shokouhinejad, N., Aligholi, M., Jafari, Z., Effect of chlorhexidine on coronal microleakage from root canals obturated with Resilon/Epiphany Self-Etch (2010) J Oral Sci, 52, pp. 83-87Shemesh, H., Wu, M.K., Wesselink, P.R., Leakage along apical root fillings with and without smear layer using two different leakage models: A two-month longitudinal ex vivo study (2006) Int Endod J, 39, pp. 968-976Shipper, G., ørstavik, D., Teixeira, F.B., Trope, M., An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon) (2004) J Endod, 30, pp. 342-347Shokouhinejad, N., Sharifian, M.R., Aligholi, M., Assadian, H., Tabor, R.K., Nekoofar, M.H., The sealing ability of resilon and gutta-parcha following different smear layer removal methods: An ex vivo study (2010) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 110, pp. e45-e49Stratton, R.K., Apicella, M.J., Mines, P., A fluid filtration comparison of gutta-percha versus Resilon, a new soft resin endodontic obturation system (2006) J Endod, 32, pp. 642-645Vianna, M.E., Gomes, B.P., Sena, N.T., Zaia, A.A., Ferraz, C.C.R.F., Souza-Filho, F.J., In vitro evaluation of the susceptibility of endodontic pathogens to calcium hydroxide combined with different vehicles (2005) Braz Dent J, 16, pp. 175-180Wedding, J.R., Brown, C.E., Legan, J.J., Moore, B.K., Vail, M.M., An in vitro comparison of microleakage between Resilon and guttapercha with a fluid filtration model (2007) J Endod, 33, pp. 1447-1449Zehnder, M., Root canal irrigants (2006) J Endod, 32, pp. 389-39

Effectiveness of XP-endo finisher in the reduction of bacterial load in oval-shaped root canals

This study investigated the effectiveness of XP-Endo Finisher (XPF) associated with XP-Endo Shaper (XPS) or Reciproc Blue (RB) files in reducing bacterial load in oval-shaped root canals (RC) during chemomechanical preparation (CMP) using 0.9% saline solution (NaCl) or 2.5% sodium hypochlorite (NaOCl). Eighty mandibular incisors with single oval-shaped RC were contaminated with Enterococcus faecalis. The teeth were randomly assigned to eight experimental groups (n = 10) according to the CMP, as follows: G1: XPS, G2: XPS + XPF, G3: RB, and G4: RB + XPF. CMP was performed with NaCl or NaOCl. The reduction of bacterial load was assessed by colony-forming unit count before (S1) and after (S2) CMP. Data normality was verified by using Shapiro-Wilk test. ANOVA, Tukey's test, and Bonferroni post-hoc test were used at a 5% significance level. Culturable bacteria were present in all S1 samples (p>0.05). All instrumentation techniques were effective in reducing bacterial load, irrespective of the irrigating solution (p < 0.05). With the use of NaCl, RB was more effective than XPS (p = 0.035). With the use of NaOCl, XPS and RB presented similar effectiveness (p = 0.779). XPF enhanced the bacterial reduction of both systems tested (p < 0.05). The use of NaOCl improved the CMP, irrespective of the instrumentation technique used (p < 0.05). In conclusion, XPS and RB files are effective in reducing bacterial levels in oval-shaped RC. The use of XPF as a method of agitation of the irrigating solution improved the cleaning efficiency of both file systems tested. Mechanical preparation performed with saline solution decreased culturable bacteria from the root canal, but antimicrobial substances such as NaOCl should be used to achieve a significantly better disinfection33CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP308162/2014-5não tem2015/23479-

The Multidisciplinary Management Of Avulsed Teeth: A Case Report

This paper reports multidisciplinary treatment of a dental trauma case to achieve a favorable prognosis. A healthy 14-year-old girl reported avulsion of teeth 11 and 21 which had occurred three months earlier. The initial treatment consisting of replantation with a semi-rigid splint was performed in hospital. At presentation, the patient was still using the semi-rigid splint. The clinical examination revealed the presence of increased mobility in teeth 11 and 21, and absence of vitality in both. Radiographic examination showed the presence of inflammatory external root resorption in both teeth. The treatment proposed consisted of teeth extraction, a temporary prosthesis followed by adhesive prosthesis, and finally, implant surgery associated with porcelain crowns.74203206Koca, H., Topaloglu-Ak, A., Sutekin, E., Koca, O., Acar, S., Delayed replantation of an avulsed tooth after 5 hours of storage in saliva: A case report (2010) Dent Traumatol, 26 (4), pp. 370-373Lux, H.C., Goetz, F., Hellwig, E., Case report: Endodontic and surgical treatment of an upper central incisor with external root resorption and radicular cyst following a traumatic tooth avulsion (2010) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 110 (5), pp. e61-7Flores, M.T., Andersson, L., Andreasen, J.O., Bakland, L.K., Malmgren, B., Barnett, F., Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth (2007) Dent Traumatol, 23 (3), pp. 130-136Roskamp, L., Westphalen, V.P., Carneiro, E., Fariniuk, L.F., Silva, N.U.X., The positive influence of atopy on the prognosis of avulsed and replanted teeth despite differences in post- trauma management (2011) J Endod, 37 (4), pp. 463-465Andreasen, J.O., Andreasen, F., (2007) Textbook and Color Atlas of Traumatic Injuries to The Teeth, p. 912. , 4th Edition, Copenhagen: Denmark: MunksgaardMajorana, A., Bardellini, E., Conti, G., Keller, E., Pasini, S., Root resorption in dental trauma: 45 cases followed for 5 years (2003) Dent Traumatol, 19 (5), pp. 262-265Andreasen, J.O., Borum, M.K., Jacobsen, H.L., Andreasen, F.M., Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications (1995) Endod Dent Traumatol, 11 (2), pp. 51-58Soares, A.J., Gomes, B.P., Zaia, A.A., Ferraz, C.C., de Souza-Filho, F.J., Relationship between clinical-radiographic evaluation and outcome of teeth replantation (2008) Dent Traumatol, 24 (2), pp. 183-188Heithersay, G.S., Management of tooth resorption (2007) Aust Dent J, 52 (1 SUPPL.), pp. S105-S121Gold, S.I., Hasselgren, G., Peripheral inflammatory root resorption. A review of the literature with case reports (1992) J Clin Periodontol, 19 (8), pp. 523-534Emerich, K., Czerwinska, M., Ordyniec-Kwasnica, I., Immediate self-replantation of an avulsed permanent mandibular incisor - a case report (2010) Dent Traumatol, 26 (5), pp. 443-446Guzeler, I., Uysal, S., Cehreli, Z.C., Management of trauma-induced inflammatory root resorption using mineral trioxide aggregate obturation: Two-year follow up (2010) Dent Traumatol, 26 (6), pp. 501-504Drummond, S., Pessica, L.S., Monnerat, A.B., Monnerat, A.F., de Oliveira, A.M.A., Multidisciplinary solution for an avulsed upper central incisor: Case report (2011) Dent Traumatol, 27 (3), pp. 241-246Estevez, R., Aranguren, J., Escorial, A., de Gregorio, C., De La Torre, F., Vera, J., Invasive cervical resorption Class III in a maxillary central incisor: Diagnosis and follow-up by means of cone-beam computed tomography (2010) J Endod, 36 (12), pp. 2012-2014Vitale, M.C., Caprioglio, C., Martignone, A., Marchesi, U., Botticelli, A.R., Combined technique with polyethylene fibers and composite resins in restoration of traumatized anterior teeth (2004) Dent Traumatol, 20 (3), pp. 172-177Iseri, H., Solow, B., Growth displacement of the maxilla in girls studied by the implant method (1990) Eur J Orthod, 12 (4), pp. 389-398Odman, J., Grondahl, K., Lekholm, U., Thilander, B., The effect of osseointegrated implants on the dento-alveolar development. A clinical and radiographic study in growing pigs (1991) Eur J Orthod, 13 (4), pp. 279-286Graber, T.M., Vanarsdall, R., (2000) Orthodontics: Current Principles and Techniques, p. 1040. , 3th Edition. St Louis, Missouri: MosbyPolat, Z.S., Tacir, I.H., Restoring of traumatized anterior teeth: A case report (2008) Dent Traumatol, 24 (3), pp. e390-

A Comparative Study Of The Smear Layer Removal Using Scanning Electronic Microscopy And Atomic Force Microscopy

Data obtained by two different imaging techniques, atomic force microscopy (AFM) and scanning electron microscopy (SEM), were compared for their ability to detect smear layer on the dentin surface. Three solutions commonly employed for smear layer removal were used: 17% EDTA, 10% citric acid and 37% phosphoric acid. The same samples were evaluated by AFM and SEM to determine similarity or differences between the techniques. When AFM images were analyzed, more smear layer and less opening tubules were observed compared to SEM images. AFM phase contrast images were also analyzed. The results indicated that AFM topographic analysis as well as phase contrast images were by far the best methods to detect the presence of smear layer compared to SEM. © 2012 American Scientific Publishers.712125Torabinejad, M., Handysides, R., A. Khademi, A., Bakland, L.K., (2002) Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 94, p. 658Mello, I., Robazza, R., Antoniazzi, H., Coil, J., Oral, O., Oral, M., Oral, P., Oral, R., (2008) Endod., 106, p. 40Calas, P., Rochd, T., Michel, G., (1994) J. Endod., 20, p. 71Love, R.M., (1996) J. Endod., 22, p. 290R. Buck, A., P. Eleazer, D., R. Staat, H., Scheetz, J.P., (2001) J. Endod., 27, p. 206McComb, D., Smith, D.C., (1975) J. Endod., 1, p. 238De-Deus, G., Paciornik, S., Pinho Mauricio, M.H., Prioli, R., (2006) Int. Endod. J., 39, p. 683Paciornick, S., De-Deus, G., Reis, M.C., Pinho Mauricio, M.H., Prioli, R., (2007) J. Microsc., 225, p. 236Meyer, E., (2003) Scanning Probe Microscopy-The Lab on the Tip, , 2nd edn. Springer, GermanySmith, W.F., (1998) Princípios de Ciěncia e Engenharia dos Materiais, , 3rd edn, McGraw-Hill, PortugalDe Deus, G., (2000) Microscopia de Força Atômica In Situ e Microdureza de Dentina Submetida a Substâncias Quelantes, , M.Sc. Dissertation, PUC/RJ, Rio de Janeiro, BrazilPoletti, G., Orsini, F., Lenardi, C., Barborini, E., (2003) J. Microsc., 211, p. 249Mader, C.L., Baumgartner, J.C., Peters, D.D., (1984) J. Endod., 10, p. 477Hanznedaroglu, F., (2003) Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 96, p. 340González-López, S., Camejo-Aguilar, D., Sanchez-Sanchez, P., Bolaños-Carmona, V., (2006) J. Endod., 32, p. 781Gesteira, M.F.M., (2003) Rev. Ci. Biol., 2, p. 208Cury, J.A., Bragotto, C., Valdrighi, L., (1981) Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 52, p. 446S. Dotto, R., R. Travassos, M., De Oliveira, E.P., Machado, M.E., Martins, J.L., (2007) Aust. Endod Journal, 33, p. 62S. Calt, Serper, A., (2002) J. Endod., 28, p. 17Sayim, C.T., Serper, A.Z., Cehreli, C., Kalayci, S., (2007) J. Endod., 33, p. 581Saleh, M., I. Ruyter, E., Haapasalo, M., Ørstavik, D., (2002) Int. Endod. J., (35), p. 859Machado-Silveiro, L.F., González-López, S., González, M.P., (2004) Int. Endod. J., 37, p. 365Peréz-Heredia, M., Ferrer-Luque, C.M., González- Rodríguez, M.P., (2006) J. Endod., 32, p. 99

Accuracy Of The Root Zx Ii Using Stainless-steel And Nickel-titanium Files

Objective: The aim of this in vitro study was to evaluate the accuracy of the Root ZX II electronic apex locator (EAL) using hand stainless-steel file, nickel-titanium hand file and nickel-titanium rotary file. Methods: Twenty straight single-rooted maxillary central teeth were used. The actual working length (AWL) was measured by inserting a #15 K-file until the file tip was visible at 4x magnification. The file was removed from the canal and its length was measured using a digital caliper. For the electronic measurements, samples were fixed in glass recipients with plastic cover, containing 0.9% saline solution. The measurements were carried out using the Root ZX II and they were performed using a #15 K-file, NiTi hand file and a rotary Mtwo file. The files were attached to the EAL and during their insertion into the root canal the measurements were monitored until the display indicated "zero". The corresponding values of the difference between the AWL and the electronic measurement were recorded and submitted to ANOVA and Tukey test (α=0.05). Results: No statistically significant differences (p<0.05) was found among the tested files. Conclusion: It can be concluded that both stainless steel files and NiTi hand or rotary files are adequate to determine the working length using the Root ZX II.134144Beltrame, A.P., Triches, T.C., Sartori, N., Bolan, M., Electronic determination of root canal working length in primary molar teeth: an in vivo and ex vivo study (2011) Int Endod J., 44 (5), pp. 402-406(2003), 7th ed. Chicago: American Association of EndodontistsRicucci, D., Apical limit of root canal instrumentation and obturation, part 1 (1998) Literature review. Int Endod J., 31 (6), pp. 384-393Stoll, R., Betke, K., Stachniss, V., The influence of different factors on the survival of root canal fillings: a 10-year retrospective study (2005) J Endod., 31 (11), pp. 783-790Kobayashi, C., Electronic canal root measurement (1995) Oral Surg Oral Med Oral Pathol., 79, pp. 226-231Stöber, E.K., Duran-Sindreu, F., Mercadé, M., Vera, J., Bueno, R., Roig, M., An evaluation of Root ZX and iPex apex locators: an in vivo study (2011) J Endod., 37 (5), pp. 608-610. , Epub 2011 Mar 22Williams, C.B., Joyce, A.P., Roberts, S., A comparison between in vivo radiographic working length determination and measurement after extraction (2006) J Endod., 32 (7), pp. 624-627Katz, A., Tamse, A., Kaufman, A.Y., Tooth length determination: a review (1991) Oral Surg Oral Med Oral Pathol., 72 (2), pp. 238-242Simon, J.H., The apex: how critical is it? (1994) Gen Dent., 42 (4), pp. 330-334Vaudt, J., Bitter, K., Neumann, K., Kielbassa, A.M., Ex vivo study on root canal instrumentation of two rotary nickel-titanium systems in comparison to stainless steel hand instruments (2009) Int Endod J., 42 (1), pp. 22-33Walia, H.M., Brantley, W.A., Gerstein, H., An initial investigation of the bending and torsional properties of Nitinol root canal files (1988) J Endod., 14 (7), pp. 346-351Guise, G.M., Goodell, G.G., Imamura, G.M., In vitro comparison of three electronic apex locators (2010) J Endod., 36 (2), pp. 279-281. , Epub 2009 Nov 10Briseño-Marroquín, B., Frajlich, S., Goldberg, F., Willershausen, B., Influence of instrument size on the accuracy of different apex locators: an in vitro study (2008) J Endod., 34 (6), pp. 698-702. , Epub 2008 Apr 11Jenkins, J.A., Walker, W.A., III, Schindler, W.G., Flores, C.M., An in vitro evaluation of the accuracy of the Root ZX in the presence of various irrigants (2001) J Endod., 27 (3), pp. 209-211Sadeghi, S., Abolghasemi, M., The accuracy of the Raypex5 electronic apex locator using stainless-steel hand K-file versus nickel-titanium rotary Mtwo file (2010) Med Oral Patol Oral Cir Bucal., 15 (5), pp. e788-e790Siu, C., Marshall, J.G., Baumgartner, J.C., An in vivo comparison of the Root ZX II, the Apex NRG XFR, and Mini Apex Locator by using rotary nickel-titanium files (2009) J Endod., 35 (7), pp. 962-965Azabal, M., Garcia-Otero, D., de la Macorra, J.C., Accuracy of the Justy II Apex locator in determining working length in simulated horizontal and vertical fractures (2004) Int Endod J., 37, pp. 174-177Silva, EJNL., Portella, I.R., Brito, P.R.R., Magalhães, K.M., Coutinho-Filho, T.S., Avaliação in vitro da eficiência de um localizador apical eletrônico em dentes com reabsorções radiculares simuladas (2011) Dental Press Endod., 1 (2), pp. 52-5

Clinical Investigation Of Bacterial Species And Endotoxin In Endodontic Infection And Evaluation Of Root Canal Content Activity Against Macrophages By Cytokine Production

Introduction: This study investigated the presence of different Gram-negative bacterial species and the levels of endotoxins found in primary endodontic infection (PEI), determining their stimulation ability against macrophages through the levels of interleukin (IL)-1, IL-6, IL-10, and tumor necrosis factor alpha (TNF-α), and evaluated their relationship with clinical and radiographic findings.Material and methods: Samples were taken from 21 root canals with primary endodontic infection with apical periodontitis (PEIAP). Molecular techniques were used for bacterial detection. Limulus amebocyte lysate assay was used to measure endotoxins. Pro-inflammatory cytokines were measured by ELISA assay.Results: All samples were positive for bacterial DNA (21/21). Prevotella nigrescens (57.2 %) was the most frequent species. Higher levels of endotoxins were found in teeth with pain on palpation and exudation (all p < 0.05). Positive correlations were found between endotoxins and the levels of TNF-α and IL-1β, whereas a negative correlation was found between endotoxin and the amount of IL-10 (p < 0.05). Endotoxin levels were found to be a risk factor for exudation and increased the number of Gram-negative bacterial species for the presence of a larger area of bone destruction (all p < 0.05).Conclusion: A wide variety of Gram-negative bacterial species are involved in primary endodontic infection, with participation of different Treponema species. Thus, the levels of endotoxins and the number of Gram-negative bacteria species present in root canals were considered risk factors for the severity of endodontic infection.Clinical relevance: The present study revealed that Gram-negative bacterial species and endotoxins play an important role in the development of signs/symptoms and the severity of bone destruction, this knowledge is essential for the establishment of an effective therapy.18920952102Siqueira, J.F., Jr., Rocas, I.N., Microbiology and treatment of acute apical abscesses (2013) Clin Microbiol Rev, 26, pp. 255-273. , PID: 23554416Martinho, F.C., Chiesa, W.M., Leite, F.R., Cirelli, J.A., Gomes, B.P., Antigenic activity of bacterial endodontic contents from primary root canal infection with periapical lesions against macrophage in the release of interleukin-1beta and tumor necrosis factor alpha (2010) J Endod, 36, pp. 1467-1474. , PID: 20728711Montagner, F., Jacinto, R.C., Signoretti, F.G., Gomes, B.P., Treponema species detected in infected root canals and acute apical abscess exudates (2010) J Endod, 36, pp. 1796-1799. , PID: 20951290Rocas, I.N., Siqueira, J.F., Jr., Identification of bacteria enduring endodontic treatment procedures by a combined reverse transcriptase-polymerase chain reaction and reverse-capture checkerboard approach (2010) J Endod, 36, pp. 45-52. , PID: 20003934Rocas, I.N., Siqueira, J.F., Jr., Andrade, A.F., Uzeda, M., Oral treponemes in primary root canal infections as detected by nested PCR (2003) Int Endod J, 36, pp. 20-26. , PID: 12656510Gomes, B.P., Lilley, J.D., Drucker, D.B., Associations of endodontic symptoms and signs with particular combinations of specific bacteria (1996) Int Endod J, 29, pp. 69-75. , PID: 9206427Siqueira, J.F., Jr., Rocas, I.N., PCR-based identification of Treponema maltophilum, T amylovorum, T medium, and T lecithinolyticum in primary root canal infections (2003) Arch Oral Biol, 48, pp. 495-502. , PID: 12798152Metzger, Z., Macrophages in periapical lesions (2000) Endod Dent Traumatol, 16, pp. 1-8. , PID: 11202850Beutler, B., Cerami, A., The biology of cachectin/TNF—a primary mediator of the host response (1989) Annu Rev Immunol, 7, pp. 625-655. , PID: 2540776Keller, R., Fischer, W., Keist, R., Bassetti, S., Macrophage response to bacteria: induction of marked secretory and cellular activities by lipoteichoic acids (1992) Infect Immun, 60, pp. 3664-3672. , PID: 1500175Garcia de Aquino, S., Manzolli Leite, F.R., Stach-Machado, D.R., Francisco da Silva, J.A., Spolidorio, L.C., Rossa, C., Jr., Signaling pathways associated with the expression of inflammatory mediators activated during the course of two models of experimental periodontitis (2009) Life Sci, 84, pp. 745-754. , PID: 19285515Sousa, E.L., Martinho, F.C., Nascimento, G.G., Leite, F.R., Gomes, B.P., Quantification of endotoxins in infected root canals and acute apical abscess exudates: monitoring the effectiveness of root canal procedures in the reduction of endotoxins (2014) J Endod, 40 (2), pp. 177-181. , PID: 24461400Seymour, G.J., Gemmell, E., Cytokines in periodontal disease: where to from here? (2001) Acta Odontol Scand, 59, pp. 167-173. , PID: 11501886Martinho, F.C., Chiesa, W.M., Leite, F.R., Cirelli, J.A., Gomes, B.P., Correlation between clinical/radiographic features and inflammatory cytokine networks produced by macrophages stimulated with endodontic content (2012) J Endod, 38, pp. 740-745. , PID: 22595105Boyce, B.F., Li, P., Yao, Z., Zhang, Q., Badell, I.R., Schwarz, E.M., O’Keefe, R.J., Xing, L., TNF-alpha and pathologic bone resorption (2005) Keio J Med, 54, pp. 127-131. , PID: 16237274Huang, G.T., Do, M., Wingard, M., Park, J.S., Chugal, N., Effect of interleukin-6 deficiency on the formation of periapical lesions after pulp exposure in mice (2001) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 92, pp. 83-88. , PID: 11458250Tinsley, J.H., South, S., Chiasson, V.L., Mitchell, B.M., Interleukin-10 reduces inflammation, endothelial dysfunction, and blood pressure in hypertensive pregnant rats (2010) Am J Physiol Regul Integr Comp Physiol, 298, pp. R713-R719. , PID: 20053959Leon, L.R., Kozak, W., Kluger, M.J., Role of IL-10 in inflammation. Studies using cytokine knockout mice (1998) Ann N Y Acad Sci, 856, pp. 69-75. , PID: 9917866Gomes, B.P., Martinho, F.C., Vianna, M.E., Comparison of 2.5 % sodium hypochlorite and 2 % chlorhexidine gel on oral bacterial lipopolysaccharide reduction from primarily infected root canals (2009) J Endod, 35, pp. 1350-1353. , PID: 19801228Rocas, I.N., Siqueira, J.F., Jr., Debelian, G.J., Analysis of symptomatic and asymptomatic primary root canal infections in adult Norwegian patients (2011) J Endod, 37, pp. 1206-1212. , PID: 21846535Dixon, D.R., Darveau, R.P., Lipopolysaccharide heterogeneity: innate host responses to bacterial modification of lipid a structure (2005) J Dent Res, 84, pp. 584-595. , PID: 15972584Schein, B., Schilder, H., Endotoxin content in endodontically involved teeth (1975) J Endod, 1, pp. 19-21. , PID: 1061764Hong, C.Y., Lin, S.K., Kok, S.H., Cheng, S.J., Lee, M.S., Wang, T.M., Chen, C.S., Wang, J.S., The role of lipopolysaccharide in infectious bone resorption of periapical lesion (2004) J Oral Pathol Med, 33, pp. 162-169. , PID: 15128058Chung, Y.H., Chang, E.J., Kim, S.J., Kim, H.H., Kim, H.M., Lee, S.B., Ko, J.S., Lipopolysaccharide from Prevotella nigrescens stimulates osteoclastogenesis in cocultures of bone marrow mononuclear cells and primary osteoblasts (2006) J Periodontal Res, 41, pp. 288-296. , PID: 16827722Baumgartner, J.C., Khemaleelakul, S.U., Xia, T., Identification of spirochetes (treponemes) in endodontic infections (2003) J Endod, 29, pp. 794-797. , PID: 14686807Fenno, J.C., McBride, B.C., Virulence factors of oral treponemes (1998) Anaerobe, 4, pp. 1-17. , PID: 16887619Chan, E.C., McLaughlin, R., Taxonomy and virulence of oral spirochetes (2000) Oral Microbiol Immunol, 15, pp. 1-9. , PID: 11155157Asai, Y., Hashimoto, M., Ogawa, T., Treponemal glycoconjugate inhibits Toll-like receptor ligand-induced cell activation by blocking LPS-binding protein and CD14 functions (2003) Eur J Immunol, 33, pp. 3196-3204. , PID: 14579288Hertz, C.J., Kiertscher, S.M., Godowski, P.J., Bouis, D.A., Norgard, M.V., Roth, M.D., Modlin, R.L., Microbial lipopeptides stimulate dendritic cell maturation via Toll-like receptor 2 (2001) J Immunol, 166, pp. 2444-2450. , PID: 11160304Opitz, B., Schroder, N.W., Spreitzer, I., Michelsen, K.S., Kirschning, C.J., Hallatschek, W., Zahringer, U., Schumann, R.R., Toll-like receptor-2 mediates Treponema glycolipid and lipoteichoic acid-induced NF-kappaB translocation (2001) J Biol Chem, 276, pp. 22041-22047. , PID: 11285258Martinho, F.C., Leite, F.R.M., Chiesa, W.M.M., Nascimento, G.G., Feres, M., Gomes, B.P.F.A., Signaling pathways activation by primary endodontic infectious contents and production of inflammatory mediators (2014) J EndodJiang, J., Zuo, J., Hurst, I.R., Holliday, L.S., The synergistic effect of peptidoglycan and lipopolysaccharide on osteoclast formation (2003) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 96, pp. 738-743. , PID: 14676766Takahashi, K., Microbiological, pathological, inflammatory, immunological and molecular biological aspects of periradicular disease (1998) Int Endod J, 31, pp. 311-325. , PID: 982313

Proinflammatory Activity Of Primarily Infected Endodontic Content Against Macrophages After Different Phases Of The Root Canal Therapy

Introduction: This study investigated the presence of target bacterial species and the levels of endotoxins in teeth with apical periodontitis. Levels of inflammatory mediators (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) were determined after macrophage stimulation with endodontic content after different phases of endodontic therapy using different irrigants. Methods: Thirty primarily infected root canals were randomly assigned into 3 groups according to the irrigant used for root canal preparation (n=10 per group): GI: 2.5% sodium hypochlorite, GII: 2% chlorhexidine gel, and GIII (control group): saline solution. Root canal samples were taken by using paper points before (s1) and after root canal instrumentation (s2), subsequently to 17% EDTA (s3), after 30days of intracanal medication (Ca[OH]2 + saline solution) (s4), and before root canal obturation (s5). Polymerase chain reaction (16S recombinant DNA) and limulus amebocyte lysate assay were used for bacterial and endotoxin detection, respectively. Macrophages were stimulated with the root canal contents for IL-1β/TNF-α measurement using enzyme-linked immunosorbent assay. Results: Porphyromonas gingivalis (17/30), Porphyromonas endodontalis (15/30), and Prevotella nigrescens (11/30) were the most prevalent bacterial species. At s1, endotoxins were detected in 100% of the root canals (median = 32.43 EU/mL). In parallel, substantial amounts of IL-1β and TNF-α were produced by endodontic content-stimulated macrophages. At s2, a significant reduction in endotoxin levels was observed in all groups, with GI presenting the greatest reduction (P&lt;.05). After a root canal rinse with EDTA (s3), intracanal medication (s4), and before root canal obturation (s5), endotoxin levels reduced without differences between groups (P&lt;.05). IL-1β and TNF-α release decreased proportionally to the levels of residual endotoxin (P&lt;.05). Conclusions: Regardless of the use of sodium hypochlorite or CHX, the greatest endotoxin reduction occurs after chemomechanical preparation. Increasing steps of root canal therapy associated with intracanal medication enhances endotoxin reduction, leading to a progressively lower activation of proinflammatory cells such as macrophages

An In Vitro Assessment Of Type, Position And Incidence Of Isthmus In Human Permanent Molars

Root canal anatomical complexities, such as isthmus, may limit the action of the endodontic instruments, irrigant solutions and intracanal medications, leading to endodontic treatment failure. Objectives: This in vitro study assessed the type, position and incidence of isthmus in human permanent molars. Material and Methods: One hundred and twenty eight upper and lower first and second permanent molars were analyzed. The roots were embedded in transparent resin, and then split at different distances from the apex (1.0-2.5-4.0-5.5-7.0 mm). Following the sample examination in stereomicroscope, the data were submitted to chi-square statistical test at a 5% significance level. Results: The highest isthmus incidence was at 7.0 mm from the root apex in all samples, except the distal root of lower molars (at 5.5 mm). In upper and lower molars, type V (complete isthmus with a continuous opening between the two main root canals) was the most common classification of isthmus (28.8%). In the mesial root of first and second mandibular molars, type IV had the highest incidence (36% and 23.9%, respectively). Conclusion: It was concluded that isthmus was widely found in flat roots, with a low percentage in areas close to the apex. In upper and lower molars, these structures were most frequently found at 7 mm from the apex.224274281Bolger, W., Schindler, W.G., A mandibular first molar with a C-shaped root configuration (1998) J Am Dent Assoc, 14, pp. 515-519Cambruzzi, J.V., Marshall, F.J., Molar endodontic surgery (1983) J Can Dent Assoc, 1, pp. 61-65Carr, G.B., Microscopes in endodontics (1992) J Calif Dent Assoc, 20, pp. 55-61Carrotte, P., Endodontics: Part 1. The modern concept of root canal treatment (2004) Br Dent J, 197, pp. 181-183Coutinho, F.T., la Cerda, R.S., Gurgel, F.E.D., de Deus, G.A., Magalhães, K.M., The influence of surgical operating microscope in locating the mesiolingual canal orifice: A laboratory analysis (2006) Braz Oral Res, 20, pp. 59-63Degerness, R.A., Bowles, W.R., Dimension, anatomy and morphology of the mesiobuccal root canal system in maxillary molars (2010) J Endod, 36, pp. 985-989Fan, B., Pan, Y., Gao, Y., Fang, F., Wu, Q., Gutmann, J.L., Threedimensional morphologic analysis of isthmuses in the mesial roots of mandibular molars (2010) J Endod, 36, pp. 1866-1869Green, D., Double canals in single roots (1973) Oral Surg, 35, pp. 689-696Gu, L., Wei, X., Ling, J., Huang, X., A microcomputed tomographic study of canal isthmuses in the mesial root of mandibular first molars in a Chinese population (2009) J Endod, 35, pp. 353-356Harris, S.P., Bowles, W.R., Fok, A., McClanahan, S.B., An anatomic investigation of the mandibular first molar using micro-computed tomography (2013) J Endod, 39, pp. 1374-1378Hsu, Y.Y., Kim, S., The resected root surface. The issue of canal isthmus (1997) Dent Clin North Am, 41, pp. 529-540Kontakiotis, E.G., Palamidakis, F.D., Farmakis, E.T., Tzanetakis, G.N., Comparison of isthmus detection methods in the apical third of mesial roots of maxillary and mandibular first molars: Macroscopic observation versus operating microscope (2010) Braz Dent J, 21, pp. 428-431Mannocci, F., Peru, M., Sherriff, M., Cook, R., Pitt Ford, T.R., The isthmuses of the mesial root of mandibular molars: A microcomputed tomographic study (2005) Int Endod J, 38, pp. 558-563Pécora, J.D., Estrela, C., Bueno, M.R., Porto, O.C., Alencar, A.H., Sousa-Neto, M.D., Detection of root canal isthmuses in molars by map-reading dynamic using CBCT images (2013) Braz Dent J, 24, pp. 569-574Pineda, F., Kuttler, Y., Mesiobuccal and buccolingual roentgenographic investigation of 7275 root canals (1972) Oral Surg, 33, pp. 101-110Sauáia, T.S., Gomes, B.P., Pinheiro, E.T., Zaia, A.A., Ferraz, C.C., Souza, Filho, F.J., Thickness of dentine in mesial roots of mandibular molars with different lengths (2010) Int Endod J, 43, pp. 555-559Seo, M.S., Park, D.S., C-shaped root canals of mandibular second molars in a Korean population: Clinical observation and in vitro analysis (2004) Int Endod J, 37, pp. 139-144Sicher, H., Dubrul, E.L., (1975) Oral Anatomy, pp. 236-239. , St Louis: VC MosbySomma, F., Leoni, D., Plotino, G., Grande, N.M., Plasschaert, A., Root canal morphology of the mesiobuccal root of maxillary first molars: A micro-computed tomographic analysis (2009) Int Endod J, 42, pp. 165-174Tam, A., Yu, D.C., Location of canal isthmus and accessory canals in the mesiobuccal root of maxillary first permanent molars (2002) J Can Dent Assoc, 68, pp. 28-33Teixeira, F.B., Sano, C.L., Gomes, B.P., Zaia, A.A., Ferraz, C.C., Souza, Filho, F.J., A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars (2003) Int Endod J, 36, pp. 276-280Vertucci, F.J., Root canal anatomy of the human permanent teeth (1984) Oral Surg, 58, pp. 589-599Villas-Bôas, M.H., Bernardineli, N., Cavenago, B.C., Marciano, M., Del Carpio-Perochena, A., Moraes, I.G., Micro-computed tomography study of the internal anatomy of mesial root canals of mandibular molars (2011) J Endod, 37, pp. 1682-1686von Arx, T., Frequency and type of canal isthmuses in first molars detected by endoscopic inspection during periradicular surgery (2005) Int Endod J, 38, pp. 160-168Weller, R.N., Niemczyk, S.P., Kim, S., Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of the maxillary first molar (1995) J Endod, 21, pp. 380-383Yu, D.C., Tam, A., Chen, M.H., The significance of locating and filling the canal isthmus in multiple root canal systems. A scanning electron microscopy study of the mesiobuccal root of maxillary first permanent molars (1998) J Can Dent Assoc, 29, pp. 261-26

Quantitative And Qualitative Analysis Of Microorganisms In Root-filled Teeth With Persistent Infection: Monitoring Of The Endodontic Retreatment

Objective: The aim of this study was to investigate in vivo microorganisms detected in root-filled teeth with post-treatment apical periodontitis and quantify colony-forming units (CFU) during endodontic retreatment. Materials and Methods: Fifteen root-filled teeth had their previous gutta-percha removed and were randomly instrumented before being divided into three groups and medicated with either [Ca (OH)2 + 2% CHX gel], [Ca (OH)2 + 0.9% NaCl] or 2% CHX gel. Samples were taken after removal of gutta-percha (S1), after chemomechanical preparation using 2% CHX gel (S2), and after inter-appointment dressing (S3) for 7 or 14 days later. Cultivable bacteria recovered from infected root canals at the three stages were counted and identified by means of culture and PCR assay (16S rDNA). Quantitative data were statistically analyzed by using Mann-Whitney test in which pairs of groups were compared (P &lt; 0.05). Results: CFU counts decreased significantly from S1 to S2 (P &lt; 0.05). No significant difference was found between S2 and S3 (P = 0.3093) for all three experimental groups. Chemomechanical preparation and intra-canal dressing promoted significant median reductions of 99.61% and 99.57%, respectively, in the number of bacteria compared to S1 samples. A total of 110 cultivable isolates were recovered by culture technique from 32 different species and 7 different genera. Out of the 13 target species-specific primer of bacteria analyzed, 11 were detected during endodontic retreatment. Conclusion: The great majority of taxa found in post-treatment samples were Gram-positive bacteria, although Gram-negative bacteria were found by molecular methods. Moreover, our results showed that gutta-percha removal and chemomechanical preparation are effective for root canal disinfection, whereas additional intra-canal dressing did not improve disinfection. © 2013 Dental Investigations Society.73302309Byström, A., Happonen, R.P., Sjögren, U., Sundqvist, G., Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis (1987) Endod Dent Traumatol, 3, pp. 58-63Sjögren, U., Figdor, D., Persson, S., Sundqvist, G., Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical peridontitis (1997) Int Endod J, 30, pp. 297-306Siqueira Jr., J.F., Aetiology of root canal treatment failure: Why well-treated teeth can fail (2001) Int Endod J, 34, pp. 1-10Salehrabi, R., Rotstein, I., Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment (2010) J Endod, 36, pp. 790-792Sundqvist, G., Figdor, D., Persson, S., Sjögren, U., Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment (1998) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 85, pp. 86-93Molander, A., Reit, C., Dahlén, G., Kvist, T., Microbiological status of root-filled teeth with apical periodontitis (1998) Int Endod J, 31, pp. 1-7Hancock, H.H., Sigurdsson, A., Trope, M., Moiseiwitsch, J., Bacteria isolated after unsuccessful endodontic treatment in a north american population (2001) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 91, pp. 579-586Pinheiro, E.T., Gomes, B.P., Ferraz, C.C., Teixeira, F.B., Zaia, A.A., Souza Filho, F.J., Evaluation of root canal microorganisms isolated from teeth with endodontic failure and their antimicrobial susceptibility (2003) Oral Microbiol Immunol, 18, pp. 100-103Gomes, B.P., Pinheiro, E.T., Gadê-Neto, C.R., Sousa, E.L., Ferraz, C.C., Zaia, A.A., Microbiological examination of infected dental root canals (2004) Oral Microbiol Immunol, 19, pp. 71-76Siqueira Jr., J.F., Rôças, I.N., PCR-based analysis of microorganisms associated with failed endodontic treatment (2004) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 97, pp. 85-94Fouad, A.F., Zerella, J., Barry, J., Spångberg, L.S., Molecular detection of Enterococcus species in root canals of therapy-resistant endodontic infections (2005) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 99, pp. 112-118Byström, A., Sundqvist, G., Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy (1981) Scand J Dent Res, 89, pp. 321-328Molander, A., Reit, C., Dahlén, G., The antimicrobial effect of calcium hydroxide in root canals pretreated with 5% iodine potassium iodide (1999) Endod Dent Traumatol, 15, pp. 205-209Möller, A.J., Microbiological examination of root canals and periapical tissues of human teeth. Methodological studies (1966) Odontol Tidskr, 74, pp. 1-380Zamany, A., Safavi, K., Spangberg, L.S., The effect of chlorhexidine as an endodontic disinfectant (2003) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 96, pp. 578-581Martinho, F.C., Chiesa, W.M., Leite, F.R., Cirelli, J.A., Gomes, B.P., Antigenic activity of bacterial endodontic contents from primary root canal infection with periapical lesions against macrophage in the release of interleukin-1beta and tumor necrosis factor alpha (2010) J Endod, 36, pp. 1467-1474Siqueira Jr., J.F., Rôças, I.N., PCR methodology as a valuable tool for identification of endodontic pathogens (2003) J Dent, 31, pp. 333-339Sathorn, C., Parashos, P., Messer, H.H., How useful is root canal culturing in predicting treatment outcome? (2007) J Endod, 33, pp. 220-225Peters, L.B., Wesselink, P.R., Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms (2002) Int Endod J, 35, pp. 660-667Shuping, G.B., Ørstavik, D., Sigurdsson, A., Trope, M., Reduction of intracanal bacteria using nickel-titanium rotary instrumentation and various medications (2000) J Endod, 26, pp. 751-755McGurkin-Smith, R., Trope, M., Caplan, D., Sigurdsson, A., Reduction of intracanal bacteria using GT rotary Instrumentation, 5.25% NaOCl, EDTA, and Ca (OH)2 (2005) J Endod, 21, pp. 359-363Ørstavik, D., Kerekes, K., Molven, O., Effects of extensive apical reaming and calcium hydroxide dressing on bacterial infection during treatment of apical periodontitis: A pilot study (1991) Int Endod J, 24, pp. 1-7Sjögren, U., Figdor, D., Spangberg, L., Sundqvist, G., The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing (1991) Int Endod J, 24, pp. 119-125Wang, C.S., Arnold, R.R., Trope, M., Teixeira, F.B., Clinical efficiency of 2% chlorhexidine gel in reducing intracanal bactéria (2007) J Endod, 33, pp. 1283-1289Waltimo, T., Trope, M., Haapasalo, M., Orstavik, D., Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing (2005) J Endod, 31, pp. 863-866Siqueira, J.F., Paiva, S., Rôcas, I.N., Reduction in the cultivable bacterial populations in infected root canals by a chlorhexidine-based antimicrobial protocol (2007) J Endod, 33, pp. 541-547Zerella, J.A., Fouad, A.F., Spangberg, L.S., Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases (2005) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 100, pp. 756-761Sathorn, C., Parashos, P., Messer, H.H., Effectiveness of single-versus multiple-visit endodontic treatment of teeth with apical periodontitis: A systematic review and meta-analysis (2005) Int Endod J, 38, pp. 347-355Manzur, A., González, A.M., Pozos, A., Silva-Herzog, D., Friedman, S., Bacterial quantification in teeth with apical periodontitis related to instrumentation and different intracanal medications: A randomized clinical trial (2007) J Endod, 33, pp. 114-118Saber, S.D., El-Hady, S.A., Development of an intracanal mature Enterococcus faecalis biofilm and its susceptibility to some antimicrobial intracanal medications: An in vitro study (2012) Eur J Dent, 6, pp. 43-50Ercan, E., Dalli, M., Dülgergil, C.T., In vitro assessment of the effectiveness of chlorhexidine gel and calcium hydroxide paste with chlorhexidine against Enterococcus faecalis and Candida albicans (2006) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102, pp. 27-3

Antigenicity Of Primary Endodontic Infection Against Macrophages By The Levels Of Pge2 Production

Introduction: Root canal contents are potent stimuli for proinflammatory cytokines involved in apical periodontitis. This study investigated target gram-negative bacterial species and endotoxins in primary endodontic infection with apical periodontitis, determined their antigenicity against macrophages through the levels of PGE2, and evaluated their relationship with clinical findings. Methods: Samples were taken from 21 root canals with primary infection and apical periodontitis by using paper points. Polymerase chain reaction (16S rDNA) was used for bacterial detection and limulus amebocyte lysate assay for endotoxin measurement. Levels of prostaglandin E2 (PGE 2) were measured by enzyme-linked immunosorbent assay (Duoset Kit; R&amp;D, Minneapolis, MN). Results: Prevotella nigrescens (13/21), Fusobacterium nucleatum (6/21), and Porphyromonas endodontalis (6/21) were the most frequently observed species. A positive association was found between F. nucleatum and P. endodontalis (P &lt; .05). A correlation was found between the number of gram-negative bacterial species and the levels of endotoxins, such as PGE2 (P &lt; .05). Higher levels of endotoxin were detected in teeth with exudation, whereas elevated levels of PGE2 were found in teeth with tenderness to percussion and pain on palpation. Conclusions: Our findings imply an additive effect between the number of gram-negative bacterial species involved in endodontic infection regarding the induction of proinflammatory cytokine by macrophage cells. Moreover, teeth with clinical symptomatology were related to higher levels of endotoxins and PGE2 secretion. 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