Efectos antirresortivos y antimicrobianos de los antiinflamatorios no esteroideos en lesiones periapicales / Antiresorptive and antimicrobial effects of nonsteroidal anti-inflammatory drugs in periapical lesion

Los antiinflamatorios no esteroideos (AINE) son un grupo de fármacos que han sido comúnmente prescritos por sus propiedades antiinflamato- rias, antipiréticas y analgésicas, mismas que se deben a la inhibición de la formación de prostaglandinas. Este mecanismo ha sido ampliamente respaldado en la literatura; sin embargo, en la actualidad poco se co- noce sobre las propiedades adicionales de estos medicamentos como el efecto antirresortivo y antimicrobiano. La función antirresortiva se debe principalmente al bloqueo de la producción de prostaglandinas en específico la PGE2, que posee gran potencial osteoclastogénico, esencial para la aparición de lesiones periapicales; asimismo, la acción antimicrobiana de los AINE está relacionada con la afectación directa de la perpetuación de biopelícula, potencian la acción de los antibióticos, entre otros. Dichos efectos combinados podrían contribuir en la cura- ción de lesiones periapicales. El objetivo de este estudio es recopilar información actualizada sobre estas funciones agregadas de los AINE, con el fin de dar a conocer a los profesionales estos beneficios en la terapéutica de las lesiones periapicales (AU)

Non-steroidal anti-inflammatory (NSAIDs) are a group of drugs that have been commonly prescribed for their anti-inflammatory, antipyretic and analgesic properties, which are due to the inhibition of prostaglandin formation. This mechanism has been widely supported in the literature; however, currently little is known about the additional properties of these drugs such as the antiresorptive and antimicrobial effect. The antiresorptive function is mainly due to the blockage of prostaglandin production, specifically PGE2, which has great osteoclastogenic potential, and is essential for the appearance of periapical lesions; likewise, the antimicrobial action of NSAIDs is related to the fact that they directly affect the perpetuation of biofilms, enhance the action of antibiotics, among others. These combined effects could contribute to the healing of periapical lesions. The aim of this study is to gather updated information on these added functions of NSAIDs, in order to inform professionals about these benefits in the therapy of periapical lesion (AU)

Tratamiento no quirúrgico de lesión periapical de gran tamaño: Reporte de caso / Non-surgical Therapeutics of large size periapical injury: Clinical case report

Resumen Se describe un caso clínico sobre una mujer de 21 años de edad la cual sufrió trauma dental a los 6 años que comprometió al incisivo superior izquierdo lo cual con el tiempo generó o se formó una gran lesión periapical en esta región. Radiográficamente se observa la formación incompleta de la raíz, las paredes del conducto radicular delgadas, y una extensa lesión periapical. Se realizó el desbridamiento químico-mecánico con limas K y se ejecutó la desinfección del conducto radicular con clorhexidina al 2%. El conducto se deja medicado con hidróxido de calcio (Vitapex®), el cual se reemplaza periódicamente con dicho material hasta los nueve meses, finalmente se obtura con Biodentine®. Se da seguimiento al caso a través de cuatro años, pasando por blanqueamiento interno, carilla de resina hasta llegar a poste intra radicular con corona completa de porcelana en lo concerniente al aspecto estético. En cuanto a la lesión periapical de gran tamaño, se llega a observar por medio de tomografías, disminución de la lesión al mínimo y genera cicatrización ósea. En relación con la observación clínica hay desaparición de la fístula y ausencia de sintomatología.

Abstract This report describes a clinical case involving a 21-year-old woman, who suffered dental trauma at age 6, compromising left tooth 2.1. On time she developed a large periapical injury in this area. Radiographically, incomplete root formation, thin walls of the root canal, and extensive periapical damage is clearly shown. Chemo- mechanical debridement was performed with K files and disinfection of the root canal using 2% chlorhexidine. The root canal was left medicated with calcium hydroxide (Metapex), which was replaced periodically until 9 months. Finally, the root canal was completely sealed with Biodentine. The case had a follow up for over four years and concerning esthetical aspects, through this period of time an internal whitening, resin veneer, intra radicular post and complete crown were provided. Regarding the considerable periapical injury, tomography shows that it has been drastically reduced and generated bone healing. Clinical observations also show that the fistula and symptomatology disappeared.

Residual antibacterial activity of chlorhexidine digluconate and camphorated p-monochlorophenol in calcium hydroxide-based root canal dressings

The purpose of this study was to evaluate the residual antibacterial activity of several calcium hydroxide [Ca(OH)2]-based pastes, placed in root canals of dogs' teeth with induced chronic periapical lesions. Root canals were instrumented with the ProFile rotary system and filled with 4 pastes: G1 (n=16): Ca(OH)2 paste + anesthetic solution; G2 (n=20): Calen® paste + camphorated p-monochlorophenol (CMCP); G3 (n=18): Calen®; and G4 (n=18): Ca(OH)2 paste + 2 percent chlorhexidine digluconate. After 21 days, the pastes were removed with size 60 K-files and placed on Petri plates with agar inoculated with Micrococcus luteus ATCC 9341. Pastes that were not placed into root canals served as control. After pre-diffusion, incubation and optimization, the inhibition zones of bacterial growth were measured and analyzed by Mann-Whitney U test at 5 percent significance level. All pastes showed residual antibacterial activity. The control samples had larger halos (p<0.05). The mean residual antibacterial activity halos in G1, G2, G3 and G4 were 7.6; 10.4; 17.7 and 21.4 mm, respectively. The zones of bacterial growth of G4 were significantly larger than those of G1 and G2 (p<0.05). In conclusion, regardless of the vehicle and antiseptic, all Ca(OH)2-based pastes showed different degrees of measurable residual antibacterial activity. Furthermore, unlike CMCP, chlorhexidine increased significantly the antibacterial activity of Ca(OH)2.

Este estudo objetivou mensurar a atividade anti-bacteriana residual de várias pastas à base de hidróxido de cálcio [Ca(OH)2], após permanecerem em canais radiculares de cães com lesões periapicais crônicas induzidas. Os canais radiculares foram instrumentados com o sistema Profile e preenchidos com quatro diferentes pastas: G1-Ca(OH)2 p.a./solução anestésica (n=16), G2-Calen®/PMCC (n=20), G3-Calen® (n=18) e G4-Ca(OH)2 p.a./solução de digluconato de clorexidina a 2 por cento (n=18). Transcorridos 21 dias, amostras foram recuperadas dos canais radiculares com limas Kerr #60 e colocadas em placas de Petri com ágar semeado com Micrococcus luteus ATCC 9341. Pastas não aplicadas nos canais radiculares serviram como controle. Após pré-difusão, incubação e otimização, as zonas de inibição do crescimento bacteriano foram mensuradas e analisadas pelo teste de Mann-Whitney (a<0.05). Verificou-se que todas as pastas apresentaram ação antibacteriana residual, com maiores halos para as amostras-controles. As médias dos halos de inibição para G1, G2, G3 e G4 foram 7,6; 10,4; 17,7 e 21,4 mm, respectivamente. Os halos de inibição de G4 foram significativamente superiores as de G1 e G2 (p<0.05). Portanto, independentemente do veículo, todas as pastas à base de Ca(OH)2 determinaram, em diferentes magnitudes, atividade anti-bacteriana residual mensurável. Ademais, diferentemente do PMCC, a solução de digluconato de clorexidina a 2 por cento ampliou significativamente, a atividade anti-bacteriana residual do hidróxido de cálcio.