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- 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.
- 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.