Estudo comparativo de sistemas rotatório, reciprocante e híbrido no preparo de canais radiculares em dentes com infecção endodôntica primária: perfil microbiano e quantificação de endotoxinas
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Data
2016-12-16
Autores
Cavalli, Daiana [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Os objetivos deste trabalho são: 1) Quantificar por checkerboard a carga microbiana e pelo método de LAL endotoxinas (EU/mL) nas infecções endodônticas primárias; 2) Realizar o monitoramento dos níveis de endotoxinas (EU/mL) e de carga microbiana antes do tratamento, após o preparo biomecânico com sistemas de instrumentação rotatória, reciprocante e híbrida e após o uso da medicação intracanal; 3) Relacionar sinais e sintomas clínicos com níveis de endotoxinas, micro-orgnismos e com complexos bacterianos; 4) Relacionar volumetria dos canais radiculares por meio de TCFC com níveis de endotoxina, micro-organismos e complexos bacterianos. Trinta dentes com infecção endodôntica primária e presença de lesão periapical foram submetidos a TCFC antes do tratamento e avaliados quanto a presença de sinais e sintomas clínicos. Após abertura coronária, foi realizada a coleta inicial nos canais radiculares, e em seguida, procedeu-se com o tratamento endodôntico, sendo os dentes divididos em diferentes grupos experimentais de acordo com o sistema de instrumentação utilizado (n=10): rotatório Mtwo (MTWO), reciprocante Reciproc (REC), e híbrido Genius (GEN). Durante o preparo biomecânico, os canais foram irrigados com 24 mL de NaOCl 2,5%. Foram realizadas coletas do conteúdo dos canais radiculares: logo após a abertura coronária (1 col), após a instrumentação (2 col), e após a MIC por 14 dias, realizada com pasta de hidróxido de cálcio associada a solução salina fisiológica (3 col). A detecção de micro-organimos foi realizada pelo teste checkerboard DNA-DNA hybridization. A quantificação de endotoxinas foi realizada pelo teste cinético cromogênio do lisado de amebócito de Limulus. As volumetrias dos canais radiculares foram realizadas com auxílio do software Nemotec®. Todos os dados foram analisados estatisticamente. Os resultados mostraram a detecção de micro-organismos e endotoxinas em 100% das amostras iniciais, sendo as bactérias C. ochracea e F. nucleatum as mais prevalentes (53%). Após o PBM, os micro-organismos mais encontrados foram F. nucleatum e L. buccalis (50%); e após a MIC C. gracilis (53,3%). Não houve diferença estatística entre os grupos quanto à redução da carga microbiana. Quanto as endotoxinas, logo após o PBM, o grupo que mais reduziu foi o MTWO, seguido por GEN e REC; após a MIC, o grupo que mais reduziu foi o GEN, seguido pelo MTWO e REC, porém todos os grupos se comportaram de maneira semelhante. Dor espontânea foi relacionada com P. nigrescens; dor a percussão com P. gingivalis, V. parvula, S. sputigena, P. nigrescens e E. saburreum; presença de fístula foi relacionada com o complexo laranja, Gram-positivas e anaeróbios facultativos, e micro-organismos E. corrodens, P. micra, C. showae e E. saburreum. O maior volume do canal radicular foi correlacionado fortemente com anaeróbios estritos, com o complexo laranja e o micro-organismo P. micra. O PBM foi efetivo na redução de bactérias e endotoxinas do canal radicular, mas sem diferença estatística entre os três sistemas utilizados. Conclui-se que o PBM com NaOCl 2,5% é eficaz na redução de endotoxinas e na remoção de micro-organimos do canal radicular; sinais e sintomas são relacionados com micro-organismos, assim como a volumetria do canal radicular.
The aims of this study are: 1) Quantify by checkerboard test the microbial load and endotoxins through LAL method (EU/ml) in primary endodontic infections; 2) To monitore levels of endotoxin (EU/ml) and microbial load before treatment, after biomechanical preparation with rotatory, reciprocating and hybrid instrumentation systems, and after use of intracanal medication; 3) To associate clinical signs and symptoms with endotoxin levels, microorganism and bacterial complexes; 4) To relate volumes of root canals through cone beam computed tomography (CBCT), with endotoxin levels, microorganisms and bacterial complexes. Thirty teeth with primary endodontic infection and periapical lesion were submitted to endodontic treatment after CBCT and evaluated the presence of clinical signs and symptoms. After coronary opening, the initial samples were collected to verify the presence of infection in root canals. Then, teeth were divided into different experimental groups according to the instrumentation system used (n=10): rotatory Mtwo (MTWO), reciprocating Reciproc (REC), and hybrid Genius (GEN). During biomechanical preparation, the canals were irrigated with 24 mL of 2.5% NaOCl. Samples were collected: after coronary opening (S1), after the instrumentation (S2) and after intracanal medication for 14 days with calcium hydroxide paste and physiological saline solution (S3). The detection of microorganisms was performed by checkerboard DNA-DNA hybridization technique. The endotoxin quantification was performed by chromogenic kinetic test of the Limulus amoebocyte lysate. The root canal volumetries were performed by Nemotec® software. All data were analyzed statistically. The results showed the detection of microorganisms and endotoxins in 100% of the S1, with the most prevalent bacteria being C. ochracea and F. nucleatum (53%). After biomechanical preparation, the most found microorganisms were F. nucleatum and L. buccalis (50%); And after intracanal medication C. gracilis (53.3%). There was no statistical difference between the groups regarding the reduction of the microbial load. In relation to endotoxins, after biomechanical preparation, the group with greatest reduction was MTWO, followed by GEN and REC; after intracanal medication, the group with greatest reduction was GEN, followed by MTWO and REC, but there was no statistical difference between them. Spontaneous pain was associated to P. nigrescens; tenderness to percussion with P. gingivalis, V. parvula, S. sputigena, P. nigrescens and E. saburreum; sinus tract was related to the orange complex, Gram-positive and facultative anaerobes, and microorganisms E. corrodens, P. micra, C. showae and E. saburreum. The root canal volume was strongly correlated with strict anaerobes, with the orange complex and the P. micra microorganism. Biomechanical preparation was effective in decreasing bacteria and endotoxin, but with no statistical difference were found between the three systems. Microorganisms are related to signs and symptoms and to root canal volume. In conclusion, biomechanical preparation with 2.5% NaOCl was effective on reducing endotoxins and decreasing microorganisms from root canals; signs and symptoms are related to microorganisms as well as root canal volumetry.
The aims of this study are: 1) Quantify by checkerboard test the microbial load and endotoxins through LAL method (EU/ml) in primary endodontic infections; 2) To monitore levels of endotoxin (EU/ml) and microbial load before treatment, after biomechanical preparation with rotatory, reciprocating and hybrid instrumentation systems, and after use of intracanal medication; 3) To associate clinical signs and symptoms with endotoxin levels, microorganism and bacterial complexes; 4) To relate volumes of root canals through cone beam computed tomography (CBCT), with endotoxin levels, microorganisms and bacterial complexes. Thirty teeth with primary endodontic infection and periapical lesion were submitted to endodontic treatment after CBCT and evaluated the presence of clinical signs and symptoms. After coronary opening, the initial samples were collected to verify the presence of infection in root canals. Then, teeth were divided into different experimental groups according to the instrumentation system used (n=10): rotatory Mtwo (MTWO), reciprocating Reciproc (REC), and hybrid Genius (GEN). During biomechanical preparation, the canals were irrigated with 24 mL of 2.5% NaOCl. Samples were collected: after coronary opening (S1), after the instrumentation (S2) and after intracanal medication for 14 days with calcium hydroxide paste and physiological saline solution (S3). The detection of microorganisms was performed by checkerboard DNA-DNA hybridization technique. The endotoxin quantification was performed by chromogenic kinetic test of the Limulus amoebocyte lysate. The root canal volumetries were performed by Nemotec® software. All data were analyzed statistically. The results showed the detection of microorganisms and endotoxins in 100% of the S1, with the most prevalent bacteria being C. ochracea and F. nucleatum (53%). After biomechanical preparation, the most found microorganisms were F. nucleatum and L. buccalis (50%); And after intracanal medication C. gracilis (53.3%). There was no statistical difference between the groups regarding the reduction of the microbial load. In relation to endotoxins, after biomechanical preparation, the group with greatest reduction was MTWO, followed by GEN and REC; after intracanal medication, the group with greatest reduction was GEN, followed by MTWO and REC, but there was no statistical difference between them. Spontaneous pain was associated to P. nigrescens; tenderness to percussion with P. gingivalis, V. parvula, S. sputigena, P. nigrescens and E. saburreum; sinus tract was related to the orange complex, Gram-positive and facultative anaerobes, and microorganisms E. corrodens, P. micra, C. showae and E. saburreum. The root canal volume was strongly correlated with strict anaerobes, with the orange complex and the P. micra microorganism. Biomechanical preparation was effective in decreasing bacteria and endotoxin, but with no statistical difference were found between the three systems. Microorganisms are related to signs and symptoms and to root canal volume. In conclusion, biomechanical preparation with 2.5% NaOCl was effective on reducing endotoxins and decreasing microorganisms from root canals; signs and symptoms are related to microorganisms as well as root canal volumetry.
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Palavras-chave
Endotoxina, Instrumentação, Microbiota, Endotoxin, Instrumentation