Browsing by Author "Teles, Ana Moura"
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- Apical periodontitis and related risk factors: cross-sectional studyPublication . Correia-Sousa, Joana; Madureira, Ana Raquel; Carvalho, Manuel Fontes; Teles, Ana Moura; Pina-Vaz, IreneObjectives: The aim of this cross-sectional study was to investigate an association between the prevalence of root-filled teeth (RFT) or apical periodontitis (AP) and some systemic conditions or smoking habits in an adult Portuguese population. Methods: Medical histories, including age, gender, presence of cardiovascular disease (CVD), diabetes mellitus (DM), allergies, smoking status, and endodontic treatment data of 421 patients (10,540 teeth) were recorded. The prevalence of root filled teeth and the periapical status were assessed through panoramic radiographies. Periapical status was classified according to the Periapical index and AP was defined as PAI-score ≥3. Statistic analysis was performed with PASW Statistics 20.0 using qui-square tests, odds-ratio and confidence intervals (95%). Results: The overall prevalence of AP and RFT was 2.2% and 4.2%, respectively. RFT increased the possibility of having AP (p < 0.0001). Men’s group showed a higher percentage of teeth with AP (p < 0.0001), less RFT (p = 0.05) and more residual roots (2.3%). Smoking increased the probability of having AP (p = 0.002) and RFT (p = 0.045). A positive correlation was observed between RFT and DM (p = 0.040). No statistically significant difference was found between AP and CVD, DM or allergies neither between RTF and CVD or allergies. Conclusions: The higher prevalence of AP and/or RFT in smoker subjects and in diabetic patients can suggest a relationship between oral and systemic health. More epidemiological studies are required before definitive conclusions can be made.
- Bacterial contamination of gutta-percha points from different brands and the efficacy of a chairside disinfection protocolPublication . Bracciale, Francesca; Marino, Nicole; Noronha, Anariely; Manso, M. Conceição; Gavinha, Sandra; Cardoso, Inês Lopes; Pina, Cristina Maria San Román Gomes de; Teles, Ana MouraObjective: To evaluate the bacterial contamination of different brands of Gutta-Percha (GP) points routinely used in clinical practice and the efficacy of a chairside disinfection protocol with sodium hypochlorite. Methods: GP points (n=240), in sizes A, B, C, D, K15, K20, K25, K30, K35, K40, F1, F2, F3 (Dentsply®, Proclinic®, ProTaper® and R&S®), were randomly sampled from commercial packages already in use. These were added directly to Fluid Thioglycolate Medium (one GP point per tube) and incubated at 37ºC for 21 days. During this period, the presence/absence of turbidity was evaluated. To evaluate the efficacy of a chairside disinfection protocol, all detected contaminated GP points were immersed for 1 minute in 10 mL of 5.25% sodium hypochlorite, followed by 5 minutes in 10 mL of detergent solution (3% Tween 80 and 5% sodium thiosulfate) and a final rinse with 10 mL of sterile distilled water and incubated. The data was analysed using the chi-square test and differences between characteristics of dichotomic variables were performed using the binomial test. The significance level was set at P<0.05. Results: Bacterial growth was observed in 22.9% of the total study samples. Dentsply® and R&S® showed the highest level of contamination, 47.3% each, although without significant differences to the other commercial brands. The most contaminated GP point size was K30 (16.4%). The chairside disinfection protocol was effective in disinfection of 76.4% of GP points (P<0.001). Conclusion: A real small number of GP points in clinical use harboured bacteria, including after the Chairside Disinfection Protocol that, anyway, proved to be effective. No significant difference was observed between tested commercial brands.
- Effectiveness of two intracanal dressings in adult portuguese patients: a qPCR and anaerobic culture assessmentPublication . Teles, Ana Moura; Manso, M. Conceição; Loureiro, S.; Silva, R.; Madeira, I. G. C.; Pina, C.; Cabeda, José ManuelAim: To quantify bacterial equivalents before and after chemomechanical preparation using 3% sodium hypochlorite (NaOCl) and intracanal dressing with calcium hydroxide paste (Ca(OH)2 ) or 2% Chlorhexidine digluconate gel (CHX) in necrotic pulps associated or not with apical periodontitis and to further compare this quantification with counts of anaerobic microorganisms. Methodology: Prospective clinical trial in 69 single-rooted adult teeth (strict inclusion criteria); CHX group: 34; Ca(OH)2 group: 35. Bacteria samples were taken at baseline (S1), after chemomechanical preparation (S2) and after 14 days of intracanal dressing (S3). Bacterial equivalents were assessed by broad-range real-time polymerase chain reaction (qPCR), and live viable bacteria measured with conventional anaerobic culture (CFU/mL). Descriptive/inferential analysis was performed with spss vs. 20.0 (α = 0.05) using the Kruskal-Wallis, Mann-Whitney and chi-squared tests and Spearman's correlation coefficients. Results: Both groups showed a significant decrease between S1 and S2 (Mann-Whitney U-test; P < 0.001) both in qPCR and in culture. In the Ca(OH)2 -group, no variation was observed between S2 and S3 by qPCR and culture. In contrast, the CHX group showed a significant increase from S2 to S3 by both techniques. The two groups were only significantly different in S3 (Mann-Whitney U-test; P ≤ 0.001), with a worse performance in the CHX group. Again, these results were congruent by both approaches. Data from both approaches correlate reasonably (rS < 0.5). Conclusions: Infected root canals contained a high bacterial load, and the chemomechanical root canal preparation reduced bacterial equivalents by 99.1% and anaerobic counts by 98.5%. Intracanal dressings were not efficient at reducing bacterial load, but the 14-day intracanal dressing with Ca(OH)2 performed significantly better than CHX, particularly in cases with apical periodontitis.
- Estudo comparativo da capacidade de selamento de três técnicas de obturação de canais radicularesPublication . Teles, Ana Moura; Paulo, Manuel Fonseca; Capelas, José António; Melo, Paulo; Cunha, Luís MiguelO objectivo deste estudo in vitro foi avaliar, subjacente à observação da infiltração apical, a capacidade de selamento de três técnicas de obturação: “condensação lateral”, “thermafil” e “soft-core” e, em função dos resultados, poder concluir qual proporciona melhores garantias de isolamento hermético do sistema de canais radiculares. Nesse sentido, foram preparados 49 dentes monorradiculares, dos quais, 45 foram divididos, aleatoriamente, em três grupos e, alternadamente, obturados por cada uma das técnicas referidas. Nos grupos de controlo positivo e negativo, constituídos por 2 dentes cada um, não se fez a obturação dos canais, embora todas as cavidades de acesso tenham sido restauradas. Cada dente foi isolado pela aplicação de verniz das unhas até cerca de 2mm do ápice radicular, à excepção do grupo de controlo negativo que foi totalmente envernizado. A capacidade de selamento inerente a cada metodologia foi avaliada pela medição das infiltração apical, após 7 dias de exposição a uma solução de azul de metileno a 2%, a 37°C. Os dados registados foram analisados estatisticamente para um nível de significância de 0,05, isto é, para um grau de confiança de 95 %. Nas condições do estudo, nenhuma das técnicas evitou a infiltração. A análise estatística dos resultados deste trabalho demonstrou uma diferença significativa entre os valores médios de infiltração apical das três técnicas de obturação: a técnica “thermafil” apresentou a menor quantidade de infiltração, com valores significativamente diferentes comparativamente com as técnicas da “condensação lateral” e “soft-core”. Contudo, entre os resultados destas duas técnicas não houve diferenças significativas.
- Identification of yeast and non-pigmented cultivable endodontic bacteria in adult portuguese patientsPublication . Teles, Ana Moura; Manso, M. Conceição; Loureiro, Sara Manuela Marinho; Silva, Ricardo; Madeira, Inês; Pina, Cristina Maria San Román Gomes de; Cabeda, José ManuelIntroduction This study has focused on the identification of the yeasts and non-pigmented bacteria present on adult patients with necrosis or apical periodontitis and the ones who resisted chemomechanical preparation and intracanal dressing with calcium hydroxide paste (Ca(OH)2) or 2% chlorohexidine digluconate gel (CHX). Methods 69 single-rooted teeth of adult patients with necrosis associated or not with apical periodontitis were selected (strict inclusion criteria); CHX group: 34 teeth; Ca(OH)2 group: 35 teeth. Bacteria samples were taken at baseline (S1), after chemo-mechanical preparation (S2) and after 14 days of intracanal dressing (S3). Bacteria and fungal presence was evaluate by means of culture in three atmospheres (aerobic, anaerobic, microaerofilic) in appropriate culture broads. Strict techniques were used for serial dilution, plating, incubation and identification. Results The most represented, abundant and prevalent strains of non-pigmented bacteria were Propionibacterium acnes (detected in S1, S2 and S3), Gemella morbillorum and Clostridium difficile. Candida albicans was found in 9 patients. The higher number of isolates proceeded from S1, being S2 the moment with lowest number of isolates. CHX had a worst performance in disinfection of the root canal system; consequently the number of isolates from S3 samples was bigger compared to Ca(OH)2. The number of identified bacterial species per canal/moment of sampling, varied from zero till 5, including yeasts (Candida albicans). Conclusions: Our findings confirm that the microbiota from primary endodontic infections is polymicrobial, and the anaerobes Gram-positive non-pigmented bacteria are well represented. CHX performed worse, consequently the number of isolates from S3 samples was bigger when compared to Ca(OH)2 as well as with diagnosis of necrosis.
- In vivo evaluation of microbial reduction after chemo-mechanical preparation of necrotic root canals with or without apical periodontitisPublication . Teles, Ana Moura; Manso, M. Conceição; Pina, Cristina Maria San Román Gomes de; Cabeda, José ManuelObjectives: Assessment of bacterial reduction after chemo-mechanical preparation (using 3% sodium hypochlorite) with or without intracanal dressing (calcium hydroxide paste (Ca(OH)2) or 2% chlorhexidine digluconate gel (CHX)) in necrotic pulps associated or not with apical lesion. Methods: Prospective clinical trial, in 69 adult patient’s teeth with pulpal necrosis associated or not with apical periodontitis. Microbiological root-canal-sampling occurred before treatment (S1), after chemo-mechanical preparation (S2) and after 14 days intracanal dressing (S3). Colony Forming Units (CFU) were counted after growth in aerobic, anaerobic and microaerofilic cultures. Comparison of the median CFUs treatments and culture media was done with the Friedman test. Comparison of the intracanal dressing effect at S3 was done with the Wilcoxon and the Mann–Whitney tests. Because of the huge differences in bacterial counts variations were expressed as log 10 to analyze differences among intracanal medication groups. S2 and S3 counts were expressed as percentage of CFU reduction regarding S1 counts. Results: Significant differences were detected between S1, S2 and S3 (Friedman test; p < 0.001), showing a significant decrease from S1 to S2 (Wilcoxon test; p < 0.004), followed by a significant increase from S2 to S3 (p < 0.001) for the CHX group, maintenance for the Ca(OH)2 group in aerobic/anaerobic (Wilcoxon test; p = 0.777/0.227), and increase in the microaerofilic culture (Wilcoxon test; p = 0.047). The two groups only differed significantly in S3 (Mann–Whitney test; p ≤ 0.001), with a worse performance in the CHX group. Conclusions: Treatment significantly reduced the number of bacteria but failed to render all root canals sterile. Ca(OH)2 performed better than CHX gel.
- Microorganisms: the reason to perform endodonticsPublication . Teles, Ana Moura; Manso, M. Conceição; Loureiro, Sara; Pina, Cristina Maria San Román Gomes de; Cabeda, José ManuelThat we perform Endodontics because there are microorganisms is now beyond doubt. Nevertheless, not only the microorganisms, but also the host response have a profound effect on the progression of the disease. Many papers confirmed the polymicrobial nature of pulpal and periapical diseases of endodontic origin and the efficiency of the chemo-mechanical procedures based on physical and chemical elimination of their etiologic factors, whose principles were first presented as far as 1928 by Hall. Since not only bacterial load may be related to the clinical outcome, but also the bacterial composition of the microbiological canal ecosystem, we aimed at the enumeration of the microorganisms present in the different types of endodontic infections. Although the emerging picture is clearly a complex one, not allowing clear-cut association of bacteria and clinical situation, only the further pursuit of elucidation of the many factors involved (including geographical variability) will ultimately lead to rational treatment solutions.
- Oral microbiome associated with peri-implant infections – a reviewPublication . Molina, Flávio; Cardoso, Inês Lopes; Teles, Ana Moura; Pina, Cristina Maria San Román Gomes deDental treatments using dental implants have been well documented over the past 40 years and with great success. The dental implant installed in the place of missing teeth should always involve proper forecasting by the dentist. Namely, it is important to know the microbiome surrounding the implant, from its planning till final rehabilitation. The exact time of microbiome formation, as well as microorganisms involved, are essential for the proper implementation and success of the implant. However, internal contaminations of the rehabilitated implants, the extracellular components of microorganisms, such as endotoxins, have a huge influence on implant success. In addition, it is also very important the knowledge concerning implants surfaces and associated microorganisms. This study conducted a literature review on the oral microbiome and its relationship with the peri-implant infection, with the discussion of several classical and current studies. Although it can be concluded that the peri-implant microbiome is characterized by the microbiome present before dental implant placing, more studies are required to better elucidate the planning and the longevity of dental implant treatment.
- A review of microbiologic root canal sampling: updating an emerging picturePublication . Teles, Ana Moura; Manso, M. Conceição; Pina, Cristina Maria San Román Gomes de; Cabeda, José ManuelObjectives: The significance of microorganisms in root canals with regard to the aetiology of periapical infection and the need for crucial bacteria control during treatment are undeniable. In this study, we report and discuss a review of the literature on Microbiological Root Canal Sampling (MRS). The procedure is analyzed in detail, discussing its powers, limitations and the influence of sample collection procedures on the incidence of true and false positive results. Data sources: MEDLINE/PUBMED, B-On and library files of Oporto University were accessed. Selection: Papers were selected using the keywords: “root canal sampling”; “apical periodontitis”; “endodontic pathogens”; “root canal infection”; “Culture”; “molecular biology”. The references were selected under inclusion criteria such as English language, accessibility, relevance to the theme and scientific rigor. Conclusions: This review illustrated the absolute need to adhere to strict methodology procedures if valid samples are to be obtained. A combination of Culture and molecular identification approaches have confirmed the polymicrobial nature of endodontic infections with a predominance of anaerobic bacteria. Nucleic acid-based techniques provide significant additional information particularly regarding the not-yet-cultivable species of the microbial community, but greatly increase the budget of the procedure. Thus, assessment of the endodontic microflora, in the context of a polymicrobial biofilm ecosystem, and its relevance to endodontic treatments must rely in the complementariness of Culture and Metagenomics approaches as they are neither mutually exclusive nor competitive, but strongly complementary.