Abstract
Objective
The aim of the present study was to investigate the effects of a calcium hydroxide-based intracanal medication (ICM) on periodontal and endodontic infectious/inflammatory contents and on periodontal clinical parameters in teeth with primary periodontal lesion and secondary endodontic involvement.
Materials and methods
Ten patients with abnormal pulp test results and deep probing depth derived from primary periodontal disease with secondary endodontic involvement were included. Samples were collected from root canals (RC) and periodontal pockets (PP) in order to investigate the microbiological status, levels of endotoxin (LPS), cytokines, and matrix metalloproteinases (MMP), before and after ICM. PCR was used for microbiological assessment. The kinetic-chromogenic LAL assay was used for LPS quantification. Quantikine ELISA kits were used for measurement of IL-1 α, IL-1 β, TNF-α, PGE2, MMP-2, MMP-3, MMP-8, MMP-9, and MMP-13 levels. The statistical analyses were made using the Friedman and Wilcoxon tests (p < 0.05). T test was used to compare data on periodontal characteristics.
Results
ICM did not reduce the number of microorganisms in PP and RC, except for Fusobacterium nucleatum in RC. There was a significant reduction in LPS, MMPs, IL-1 β, and TNF-α levels in PP after ICM. In RC, LPS, MMP13, PGE2, and IL-1β levels remained unaltered (p > 0.05); however, the levels of the other MMPs and cytokines were reduced (p < 0.05). After 1 year of the root canal treatment, tooth mobility was significantly reduced (p ≤ 0.05).
Conclusions
The use of a calcium hydroxide-based ICM showed positive effects for periodontal treatment prognosis, as it reduced LPS, cytokine, and MMP levels in periodontal pockets.
Clinical significance
Patients presenting deep probing depth and undergoing periodontal treatment for at least 6 months, with no positive response to periodontal therapy, might benefit with the endodontic treatment.
Similar content being viewed by others
References
Sunitha VR, Emmadi P, Namasivayam A, Thyegarajan R, Rajaraman V (2008) The periodontal—endodontic continuum: a review. J Conserv Dent 11:54–62
Gomes BP, Montagner F, Berber VB, Zaia AA, Ferraz CC, de Almeida JF, Souza-Filho FJ (2009) Antimicrobial action of intracanal medicaments on the external root surface. J Dent 37:76–81
Langeland K, Rodrigues H, Dowden W (1974) Periodontal disease, bacteria and pulpal histopathology. Oral Surg Oral Med Oral Pathol 37:257–270
Kwon EY, Cho Y, Lee JY, Kim SJ, Choi J (2013) Endodontic treatment enhances the regenerative potential of teeth with advanced periodontal disease with secondary endodontic involvement. J Periodontal Implant Sci 43:136–140
Gomes BP, Berber VB, Kokaras AS, Chen T, Paster BJ (2015) Microbiomes of endodontic-periodontal lesions before and after chemomechanical preparation. J Endod 41:1975–1984
Bergenholtz G, Lindhe J (1978) Effect of experimentally induced marginal periodontitis and periodontal scaling on the dental pulp. J Clin Periodontol 5:59–73
Garcia de Aquino S, Manzolli Leite FR, Stach-Machado DR, Francisco da Silva JA, Spolidorio LC, Rossa C Jr (2009) Signaling pathways associated with the expression of inflammatory mediators activated during the course of two models of experimental periodontitis. Life Sci 84:745–754
Reife RA, Coats SR, Al-Qutub M, Dixon DM, Braham PA, Billharz RJ, Howald WN, Darveau RP (2006) Porphyromonas gingivalis lipopolysaccharide lipid a heterogeneity: differential activities of tetra- and penta-acylated lipid a structures on E-selectin expression and TLR4 recognition. Cell Microbiol 8:857–868
Martinho FC, Chiesa WM, Leite FR, Cirelli JA, Gomes BP (2012) Correlation between clinical/radiographic features and inflammatory cytokine networks produced by macrophages stimulated with endodontic content. J Endod 38:740–745
Herrera DR, Silva EJ, Santos CC, Zaia AA, Ferraz CC, Almeida JF, Gomes BP (2015) Root canal content from primary endodontic infection and upregulation of gelatinases in fibroblast cells. Int Endod J 48:1168–1174
Paula-Silva FW, da Silva LA, Kapila YL (2010) Matrix metalloproteinase expression in teeth with apical periodontitis is differentially modulated by the modality of root canal treatment. J Endod 36:231–237
Gomes BP, Rôças IN, Siqueira JF Jr (in press) Endodontic infections and therapeutical approaches. In: Lamont RJ, Hajishengallis GN, Jenkinson HF, Koo H (eds) Microbiology and immunology, 3rd edn. ASM Press, Washington, DC
Rotstein I, Simon JHS (2009) Endodontic and periodontal interrelationship. In: Torabinejad M, Walton RE (eds) Endodontics: principles and practice, 4th edn. St Louis, Saunders/Elsevier, pp 94–107
Gonçalves PF, Klepac-Ceraj V, Huang H, Paster BJ, Aukhil I, Wallet SM, Shaddox LM (2013) Correlation of aggregatibacter actinomycetemcomitans detection with clinical/immunoinflammatory profile of localized aggressive periodontitis using a 16S rRNA microarray method: a cross-sectional study. PLoS One 8:e85066
Martinho FC, Chiesa WM, Marinho AC, Zaia AA, Ferraz CC, Almeida JF, Souza-Filho FJ, Gomes BP (2010) Clinical investigation of the efficacy of chemomechanical preparation with rotary nickel-titanium files for removal of endotoxin from primarily infected root canals. J Endod 36:1766–1769
Vianna ME, Horz HP, Conrads G, Zaia AA, Souza-Filho FJ, Gomes BP (2008) Comparative analysis of endodontic pathogens using checkerboard hybridization in relation to culture. Oral Microbiol Immunol 23:282–290
Abi-Rached GP, Herrera DR, Zaia AA, Ferraz CC, Almeida JF, Gomes BP (2014) Efficacy of ethylene-diamine-tetra-acetic acid associated with chlorhexidine on intracanal medication removal: a scanning electron microscopy study. Microsc Res Tech 77:735–739
Giuliana G, Ammatuna P, Pizzo G, Capone F, D'Angelo M (1997) Occurrence of invading bacteria in radicular dentin of periodontally diseased teeth: microbiological findings. J Clin Periodontol 24:478–485
Blomlöf L, Lindskog S, Hammarström L (1988) Influence of pulpal treatments on cell and tissue reactions in the marginal periodontium. J Periodontol 59:577–583
Corbet EF (2012) Oral diagnosis and treatment planning: part 3. Periodontal disease and assessment of risk. Br Dent J 213:111–121
Love RM, Tanner ACR (2017) Microbiology of dental caries and dentinal tubule infection. In: Fouad AF (ed) Endodontic microbiology, 2nd edn. Wiley-Blackwell, Hoboken, pp 25–49
Gomes BP, Montagner F, Jacinto RC, Zaia AA, Ferraz CC, Souza-Filho FJ (2007) Polymerase chain reaction of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia in primary endodontic infections. J Endod 33:1049–1052
Tanner AC, Izard J (2006) Tannerella forsythia, a periodontal pathogen entering the genomic era. Periodontol 2000 42:88–113
Jacinto RC, Montagner F, Signoretti FG, Almeida GC, Gomes BP (2008) Frequency, microbial interactions, and antimicrobial susceptibility of fusobacterium nucleatum and fusobacterium necrophorum isolated from primary endodontic infections. J Endod 34:1451–1456
Perez F, Rochd T, Lodter JP, Calas P, Michel G (1993) In vitro study of the penetration of three bacterial strains into root dentine. Oral Surg Oral Med Oral Pathol 76:97–103
Kakoli P, Nandakumar R, Romberg E, Arola D, Fouad AF (2009) The effect of age on bacterial penetration of radicular dentin. J Endod 35:78–81
Ruan Y, Shen L, Zou Y, Qi Z, Yin J, Jiang J, Guo L, He L, Chen Z, Tang Z, Qin S (2015) Comparative genome analysis of Prevotella intermedia strain isolated from infected root canal reveals features related to pathogenicity and adaptation. BMC Genomics 16:122
Gomes BP, Pinheiro ET, Gadê-Neto CR, Sousa EL, Ferraz CC, Zaia AA, Teixeira FB, Souza-Filho FJ (2004) Microbiological examination of infected dental root canals. Oral Microbiol Immunol 19:71–76
Gomes BP, Vianna ME, Zaia AA, Almeida JF, Souza-Filho FJ, Ferraz CC (2013) Chlorhexidine in endodontics. Braz Dent J 24:89–102
Sousa EL, Martinho FC, Nascimento GG, Leite FR, Gomes BP (2014) Quantification of endotoxins in infected root canals and acute apical abscess exudates: monitoring the effectiveness of root canal procedures in the reduction of endotoxins. J Endod 40:177–181
Endo MS, Ferraz CC, Zaia AA, Almeida JF, Gomes BP (2013) Quantitative and qualitative analysis of microorganisms in root-filled teeth with persistent infection: monitoring of the endodontic retreatment. Eur J Dent 7:302–309
Buck RA, Cai J, Eleazer PD, Staat RH, Hurst HE (2001) Detoxification of endotoxin by endodontic irrigants and calcium hydroxide. J Endod 27:325–327
Champagne CM, Buchanan W, Reddy MS, Preisser JS, Beck JD, Offenbacher S (2003) Potential for gingival crevice fluid measures as predictors of risk for periodontal diseases. Periodontol 2000 31:167–180
Cohen JS, Reader A, Fertel R, Beck M, Meyers WJ (1985) A radioimmunoassay determination of the concentrations of prostaglandins E2 and F2 alpha in painful and asymptomatic human dental pulps. J Endod 11:330–335
Pozo P, Valenzuela MA, Melej C, Zaldívar M, Puente J, Martínez B, Gamonal J (2005) Longitudinal analysis of metalloproteinases, tissue inhibitors of metalloproteinases and clinical parameters in gingival crevicular fluid from periodontitis-affected patients. J Periodontal Res 40:199–207
Shin SJ, Lee JI, Baek SH, Lim SS (2002) Tissue levels of matrix metalloproteinases in pulps and periapical lesions. J Endod 28:313–315
Andrade AL, Santos EM, Carmo AF, Freitas RA, Galvão HC (2017) Analysis of tryptase-positive mast cells and immunoexpression of MMP-9 and MMP-13 in periapical lesions. Int Endod J 50:446–454
Teles R, Teles F, Frias-Lopez J, Paster B, Haffajee A (2013) Lessons learned and unlearned in periodontal microbiology. Periodontol 2000 62:95–162
Funding
This work was supported by the Brazilian agencies FAPESP (2015/23479-5), CNPq (308162/2014-5), and CAPES. We are thankful to Maicon R Z Passini, from the Piracicaba Dental School-UNICAMP for the technical support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The present study was approved by the Research Ethics Committee of the Piracicaba Dental School. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Duque, T.M., Prado, M., Herrera, D.R. et al. Periodontal and endodontic infectious/inflammatory profile in primary periodontal lesions with secondary endodontic involvement after a calcium hydroxide-based intracanal medication. Clin Oral Invest 23, 53–63 (2019). https://doi.org/10.1007/s00784-018-2401-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-018-2401-6