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Effectiveness of calcium hydroxide-based intracanal medication on infectious/inflammatory contents in teeth with post-treatment apical periodontitis

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Abstract

Objective

The objective of this work was to investigate in vivo the effects of calcium hydroxide-based intracanal medication (ICM) on the levels of bacteria, pro-inflammatory cytokines (PICs), and matrix metalloproteinases (MMPs) in root canals and periradicular tissues of teeth with failure of the root canal treatment and apical periodontitis.

Materials and methods

Twenty infected root canals of single-rooted teeth were randomly assigned into two groups according to the irrigant used for chemomechanical preparation (CMP) (n = 10 per group): G1 – 2% chlorhexidine (CHX) gel and G2 – 6% sodium hypochlorite (NaOCl). Root canal contents were taken by using paper points before CMP (S1) and after 30 days of calcium hydroxide-based ICM (S2). Microbial reduction was calculated by means of colony-forming unit count (CFU/mL), with PICs and MMPs (pg/mL) being measured by using enzyme-linked immunosorbent assay (ELISA).

Results

Culturable bacteria (101.2 ± 79.2), PICs (IL-1β 1.2 ± 0.4 and TNF-α 8.8 ± 4.7), MMP-2 (803.7 ± 96.4), MMP-3 (453.9 ± 229.3), MMP-8 (245.9 ± 122.4), MMP-9 (129.4 ± 29.6), and MMP-13 (70.8 ± 12.8) were present in all S1 samples. After 30 days of ICM (S2), a 99.5% microbial reduction was observed, together with a significant reduction of PICs in all groups. Overall, it was observed a decrease in the levels of MMPs (S2), except MMP-13, which was found in increased levels after ICM (P < .05), independently of the groups.

Conclusions

Calcium hydroxide-based intracanal medications have had a positive effect on the microbial reduction by decreasing the levels of PICs and MMPs. Both auxiliary chemical substances (i.e., 2% CHX and 6% NaOCl) presented similar effects when calcium hydroxide was used as intracanal medication.

Clinical relevance

Teeth with failure of the root canal treatment and apical periodontitis, and consequently with high levels of bacteria, PIC, and MMP, may present a better prognosis after a 30 days of a calcium hydroxide-based ICM.

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Funding

This work was supported by the Brazilian agencies São Paulo Research Foundation (FAPESP, grant no. 2015/23479-5), National Council for Scientific and Technological Development (CNPq, grant no. 308162/2014-5) and Coordination for the Improvement of Higher Education Personnel (CAPES). We are thankful to Maicon R Z Passini, from the Piracicaba Dental School-UNICAMP for the technical support.

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Authors and Affiliations

  1. Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School – State University of Campinas – UNICAMP, Av. Limeira 901. Bairro Areião, Piracicaba, São Paulo, Brazil

    Marlos Barbosa-Ribeiro, Rodrigo Arruda-Vasconcelos, Adriana de-Jesus-Soares, Alexandre Augusto Zaia, Caio Cezar Randi Ferraz, José Flávio Affonso de Almeida & Brenda P. F. A. Gomes

Authors
  1. Marlos Barbosa-Ribeiro
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  2. Rodrigo Arruda-Vasconcelos
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  3. Adriana de-Jesus-Soares
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  4. Alexandre Augusto Zaia
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  5. Caio Cezar Randi Ferraz
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  6. José Flávio Affonso de Almeida
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  7. Brenda P. F. A. Gomes
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Corresponding author

Correspondence to Brenda P. F. A. Gomes.

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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, State University of Campinas – UNICAMP, São Paulo, SP, Brazil. 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.

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Informed consent was obtained from all individual participants included in the study.

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Barbosa-Ribeiro, M., Arruda-Vasconcelos, R., de-Jesus-Soares, A. et al. Effectiveness of calcium hydroxide-based intracanal medication on infectious/inflammatory contents in teeth with post-treatment apical periodontitis. Clin Oral Invest 23, 2759–2766 (2019). https://doi.org/10.1007/s00784-018-2719-0

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  • DOI: https://doi.org/10.1007/s00784-018-2719-0

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