Clinical Investigation of Microbial Profile and Levels of Endotoxins and Lipoteichoic Acid at Different Phases of the Endodontic Treatment in Teeth with Vital Pulp and Associated Periodontal Disease

IntroductionThe aim of this in vivo study was to investigate the microbial profile as well as the levels of lipopolysaccharide (LPS) and lipoteichoic acid (LTA) at different phases of endodontic treatment in teeth with vital pulp and associated periodontal disease.MethodsTen patients were selected for this clinical study. Samples were taken from periodontal pockets (PPs) and root canals (RCs) using sterile paper points before and after chemomechanical preparation and after intracanal medication. For microbiological analysis, nested polymerase chain reaction and checkerboard DNA-DNA hybridization were used. Levels of LPS and LTA were assessed using limulus amebocyte lysate and enzyme-linked immunosorbent assays, respectively. Data were statistically analyzed at a significance level of 5%.ResultsBacterial DNA from 17 of the 17 species investigated was detected in samples of PPs, whereas 6 of the 17 species were not present in the initial samples of RCs using nested polymerase chain reaction. In the initial samples, 38 of 40 probes were detected in PPs, whereas 12 of 40 probes were detected in RCs using checkerboard DNA-DNA hybridization. Overall, endodontic procedures were efficient in modifying the microbiota of PPs and RCs. Levels of LPS and LTA were reduced after the endodontic procedures, although higher concentrations of both had been found in PPs compared with RCs.ConclusionsThe microbiota of PPs and RCs in teeth with vital pulp and associated periodontal disease is polymicrobial, with the presence of gram-negative, gram-positive, facultative, and strict anaerobes. Chemomechanical preparation and calcium hydroxide–based intracanal medication allowed the reduction of infectious content in both sites.     

Prognosis of permanent teeth with internal resorption: a clinical review

Abstract This study was performed in order to report the clinical features of internal resorption cases and evaluate their prognosis after endodontic treatment. Twenty-seven patients with 28 teeth with internal resorption were referred to our clinic and 20 teeth were treated endodontically. Sixteen teeth had non-perforating internal resorption and were treated by conventional root canal therapy. The remaining 4 teeth had perforating internal resorption and were initially treated by remineralization therapy with calcium hydroxide. The teeth treated by conventional root canal therapy showed clinical and radiographic evidence of healing. However, the remineralization therapy was successful in only one case. The three failed cases were subsequently treated by endodontic surgery. The surgical therapy was unsuccessful in one case due to extensive loss of marginal alveolar bone and increased tooth mobility.     

Effectiveness of different anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis: a systematic review and meta-analysis

Clinical Oral Investigations - This systematic review aimed to assess the effectiveness of anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis, comparing to the...     

Comparison of the in vivo antimicrobial effectiveness of sodium hypochlorite and chlorhexidine used as root canal irrigants: a molecular microbiology study

Introduction

The purpose of this clinical study was to compare the antimicrobial effects of 2.5% sodium hypochlorite (NaOCl) and 0.12% chlorhexidine digluconate (CHX) when used as irrigants during treatment of teeth with apical periodontitis.

Methods

Forty-seven single-rooted single-canal teeth with necrotic pulps and asymptomatic apical periodontitis were selected for this study according to stringent inclusion/exclusion criteria. Bacterial samples were taken at the baseline (S1) and after (S2) chemomechanical preparation using 2.5% NaOCl (n = 30) or 0.12% CHX (n = 17) as the irrigant. Bacterial, archaeal, and fungal presence was evaluated by broad-range polymerase chain reaction (PCR), whereas bacterial identifications were performed by a closed-ended reverse-capture checkerboard approach targeting 28 candidate endodontic pathogens.

Results

All S1 samples were PCR positive for bacterial presence but negative for both archaea and fungi. Both NaOCl- and CHX-based protocols were significantly effective in reducing the bacterial levels and number of taxa. No significant differences were observed between them in all tested parameters including the incidence of negative PCR results in S2 (40% for NaOCl vs 47% for CHX, p = 0.8), reduction in the number of taxa per canal (p = 0.3), and reduction in the bacterial levels (p = 0.07). The most prevalent taxa in S2 samples from the NaOCl group were Propionibacterium acnes, Streptococcus species, Porphyromonas endodontalis, and Selenomonas sputigena. In the CHX group, the most prevalent taxa in S2 were Dialister invisus, Actinomyces israelii, Prevotella baroniae, Propionibacterium acidifaciens, and Streptococcus species.

Conclusions

Treatment protocols using irrigation with either NaOCl or CHX succeded in significantly reducing the the number of bacterial taxa and their levels in infected root canals, with no significant difference between these substances.     

Prophylactic intraligamentary injection of piroxicam (feldene) for the management of post‐endodontic pain in molar teeth with irreversible pulpitis

The purpose of this prospective research was to evaluate the post‐endodontic pain‐reducing effect of piroxicam (feldene), a non‐selective non‐steroidal anti‐inflammatory drug. Pain following endodontic treatment is often linked to the inflammatory process as well as additional central mechanisms. The effects of intraligamentary injection of piroxicam have not previously been studied. Sixty‐five patients with irreversible pulpitis were randomly divided into two groups. The active group received intraligamentary injections totalling 0.4 mL of piroxicam, while the placebo group received the same amount of lidocaine. One‐appointment endodontic therapy was performed by a single endodontist. Visual Analogue Scale was used to record pain before treatment and 4, 8, 12, 24 and 48 h postoperatively. The decrease in the intensity of post‐treatment pain between the two groups was very significant. Intraligamentary injection of piroxicam can be considered an effective method for reducing post‐endodontic pain.     

Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial

Clinical Oral Investigations - To investigate the effect of calcium hydroxide mixed with lidocaine HCl on postoperative spontaneous pain. Sixty patients having irreversible pulpitis and symptomatic...     

Cultivable microbial flora associated with persistent periapical disease and coronal leakage after root canal treatment: a preliminary study

AIM: To identify the cultivable bacterial flora in root filled teeth with persistent periapical lesions and to locate their distribution within the root canal system using an in vitro sampling protocol. METHODOLOGY: Eight freshly extracted root filled teeth were collected from the Oral and Maxillo-facial Surgery Department, Eastman Dental Hospital. Seven teeth were associated with persistent apical periodontitis and also showed evidence of coronal leakage. Teeth were transferred to an anaerobic chamber immediately after careful extraction and sectioned transversely to give a crown (in all but one case) and two root segments (coronal and apical). Two samples were obtained from each segment, one from dentine and the other from the restoration or gutta-percha (GP) root filling (46 sites in total). The samples were dispersed, serially diluted and cultured on blood agar and fastidious anaerobic agar (with 5% defibrinated horse blood). The primary growth was subcultured to obtain pure isolates, which were identified by routine microbiological techniques and commercial enzyme tests. RESULTS: A total of 252 strains were isolated from all the teeth. Of all the isolates, the most prevalent bacteria were Gram-positive facultative anaerobes 189/252 (75%) with staphylococci (48/252, 19%), streptococci (44/252, 17%), enterococci (20/252, 8%) and Actinomyces species (20/252, 8%) being found in most of the teeth (6/8, 6/8, 5/8, 5/8 and 7/8, respectively). Of the obligate anaerobes (17%), peptostreptococci (7%) were also present in most teeth (7/8). A statistical association between bacterial flora and site (crown/coronal/apical) or surface (dental/GP/restoration) could not be shown. CONCLUSIONS: The predominant group of bacteria in root filled teeth with persistent apical periodontitis and coronal leakage was Gram-positive facultative anaerobes of which staphylococci followed by streptococci and enterococci were the most prevalent.     

Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial

Objective: This study sought to assess the success rate, effect on blood pressure, and pain of intraosseous injection (IO) and inferior alveolar nerve block (IANB) for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis as the primary anaesthetic technique.

Materials and methods: This randomized clinical trial (IRCT2013022712634N1) was conducted on 60 patients between 18 and 65 years suffering from symptomatic irreversible pulpitis of a mandibular posterior tooth. Patients were randomly divided into two groups. Group one received IO while group two received IANB with 3% mepivacaine. After anaesthetic injection, success rate of pulpal anaesthesia was assessed by pulp testing in the two groups. Systolic and diastolic blood pressures of patients were compared before and after the anaesthetic injections. Level of pain during injection was scored using a visual analogue scale. The data were analyzed using SPSS version 20, t-test and chi square test at p?=?.05 level of significance.

Results: Success rate of IO (56.7%) was significantly higher than that of IANB (23.3%) (p?=?.008). There was no significant difference in pain during anaesthetic injection (p?=?.304) or change in systolic (p?=?.80) and diastolic (p?=?.28) blood pressures following injection between the two techniques.

Conclusions: IO had a higher success rate than IANB for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis. Neither technique provided profound pulpal anaesthesia.     

Prevalence of apical periodontitis, crowned teeth and teeth with posts in a Swedish population

Abstract A longitudinal radiological study was carried out of 200 consecutive patients in a Swedish population. The aims of the investigation were to study the prevalences of crowned teeth, pontics and posts on two occasions with an interval of 5–7 years and, furthermore, to study apical periodontitis in connection with teeth with crowns and posts to see if such treatments affected this prevalence. 417 (mean 2.1) teeth were crowned at the first examination and 529 (mean 2.6) at the second. For pontics, the corresponding figures were 93 (mean 0.5) and 141 (mean 0.7). Crowns and pontics were more common in the upper jaw. 59.4% of the endodontically treated teeth had posts at the first examination and 64.4% at the second. 34.5% of the 255 teeth with apical periodontitis found at the first examination and 41.0% of the 268 at the second were in connection with posts. It was concluded that both crowns and pontics were common treatment procedures in the studied population. Crown therapy did not seem to impair the apical status while teeth with posts more often had apical periodontitis than other teeth and, furthermore, teeth with screw posts were lost more frequently than other teeth.