Abstract
Introduction
This clinical study has investigated the antigenic activity of bacterial contents
from exudates of acute apical abscesses (AAAs) and their paired root canal contents
regarding the stimulation capacity by levels of interleukin (IL)-1 beta and tumor
necrosis factor alpha (TNF-α) throughout the root canal treatment against macrophage
cells.
Methods
Paired samples of infected root canals and exudates of AAAs were collected from 10
subjects. Endodontic contents were sampled before (root canal sample [RCS] 1) and
after chemomechanical preparation (RCS2) and after 30 days of intracanal medication
with calcium hydroxide + chlorhexidine gel (Ca[OH]2 + CHX gel) (RCS3). Polymerase chain reaction (16S rDNA) was used for detection of
the target bacteria, whereas limulus amebocyte lysate was used to measure endotoxin
levels. Raw 264.7 macrophages were stimulated with AAA exudates from endodontic contents
sampled in different moments of root canal treatment. Enzyme-linked immunosorbent
assays were used to measure the levels of TNF-α and IL-1 beta.
Results
Parvimonas micra, Porphyromonas endodontalis, Dialister pneumosintes, and Prevotella nigrescens were the most frequently detected species. Higher levels of endotoxins were found
in samples from periapical exudates at RCS1 (P < .005). In fact, samples collected from periapical exudates showed a higher stimulation
capacity at RCS1 (P < .05). A positive correlation was found between endotoxins from exudates with IL-1
beta (r = 0.97) and TNF-α (r = 0.88) production (P < .01). The significant reduction of endotoxins and bacterial species achieved by
chemomechanical procedures (RCS2) resulted in a lower capacity of root canal contents
to stimulate the cells compared with that at RCS1 (P < .05). The use of Ca(OH)2 + CHX gel as an intracanal medication (RCS3) improved the removal of endotoxins and
bacteria from infected root canals (P < .05) whose contents induced a lower stimulation capacity against macrophages cells
at RCS1, RCS2, and RCS3 (P < .05).
Conclusions
AAA exudates showed higher levels of endotoxins and showed a greater capacity of macrophage
stimulation than the paired root canal samples. Moreover, the use of intracanal medication
improved the removal of bacteria and endotoxins from infected root canals, which may
have resulted in the reduction of the inflammatory potential of the root canal content.
Key Words
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Article info
Publication history
Published online: September 06, 2014
Identification
Copyright
© 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
