Bacterial diversity in primary infected root canals of a Chinese cohort: analysis of 16 S rDNA sequencing.

PURPOSE: To characterize the bacterial community in the primarily infected root canals. METHODS: A total of 13 samples were collected from the primarily infected root canals. 16 S rDNA sequencing was performed to define bacterial community. Taxonomic annotation, bacterial hierarchical structures, community richness and diversity, and inter-subject variability of the bacterial community in the root canal samples were analyzed. Gender, age, and duration of the toothache-specific bacterial community associated with the patient groups were analyzed. RESULTS: A total of 359 Species were annotated and identified in the whole study cohort. The Alpha diversity analysis showed that the species diversity and detection rate of the 13 samples were high, which reflected the authenticity of sequencing results. The Beta diversity analysis was used to compare the degree of difference between different root canal samples. The 13 samples were divided into two groups according to the results, group A was samples I1-I12, and group B was samples I13. The bacterial species of group A samples were analyzed with the clinical characteristics of patients, and it was found that gender, and duration specific differences in bacterial species, and there was no significant difference in species types among different ages of patients. CONCLUSION: There were a wide diversity and inter-subject variability in the bacterial community in the primary infected root canals. While Porphyromonas gingivalis was the most abundant species, Fusobacterium nucleatum was the most variable species in the bacterial community of the root canal. The bacterial community at different taxonomic levels varied from sample to sample, despite consistent disease diagnoses. There was gender, duration-specific differences in the bacterial species in the primary infected root canals.

Immediate implant placement in single mandibular molar with chronic periapical periodontitis.

INTRODUCTION: The present study aims to assess and compare the clinical outcomes of immediate implant placement in the mandibular molar region with or without the presence of chronic periapical periodontitis. MATERIALS AND METHODS: Employing a case-control design, this study encompassed a cohort of patients necessitating implant surgery to supplant a single, failed mandibular molar. Participants exhibiting periapical lesions measuring between > 4 mm and < 8 mm were assigned to the test group, while those without periapical lesions to the control group. Subsequent to flap surgery and tooth extraction, extraction sockets were debrided thoroughly, and implants were immediately implanted (baseline). Permanent restorative procedures were carried out three months post-operation, with follow-up conducted one year post-surgery. During the study period, parameters including implant survival rate, Cone Beam Computer Tomography (CBCT) data, implant stability quotient (ISQ), insertional torque values (ITV), and potential complications were closely monitored. RESULTS: Throughout the yearlong observation period subsequent to implant placement, both groups exhibited a 100% implant survival rate. None of the participants experienced any complications. Both groups demonstrated significant decreases in the height and width of the alveolar bone (P < 0.05). However, there were no statistically discernible differences between corresponding areas in the two groups (P > 0.05). The differences in ITV between the test group (37.94 ± 2.12 N•cm) and the control group (38.55 ± 2.71 N•cm) were not statistically significant at baseline (P > 0.05). A significant rise in ISQ was noted within the same group between baseline and three months post-operation (P < 0.05), while no significant variations in ISQ changes were noted between the two groups (P > 0.05). CONCLUSION: Given the constraints of this investigation, the preliminary clinical outcomes of immediate implant placement in the mandibular molar region with chronic periapical periodontitis do not significantly differ from those observed in instances devoid of chronic periapical periodontitis.

Evaluation of postoperative pain and healing following regenerative endodontics using platelet-rich plasma versus conventional endodontic treatment in necrotic mature mandibular molars with chronic periapical periodontitis. A randomized clinical trial.

AIM: To evaluate the post-operative pain and the healing of necrotic mature permanent mandibular molar teeth with peri-apical periodontitis after conventional endodontic treatment versus after platelet-rich plasma (PRP) revascularization. METHODOLOGY: The protocol of this randomized clinical trial was registered at www. CLINICALTRIALS: gov with identification number NCT03350841. Twenty-eight patients were included in the study after confirming the diagnosis clinically and radiographically. In the first visit, mandibular molar teeth of both groups were mechanically prepared. Double antibiotic paste was prepared and injected then the cavity that was sealed with glass ionomer. At the second visit, the patients were randomized either to control group where standard endodontic treatment was completed by lateral condensation technique or assigned to intervention group where PRP revascularization technique. The degree of spontaneous pain was assessed using numerical rating scale (NRS) pre-operatively, then post-operatively after 6, 12 h and daily for 5 days. Patients were given a placebo to be administrated in case of pain. An analgesic (ibuprofen 400mg) was prescribed in case of persistent pain. Clinical and radiographic healing was assessed after 6 and 12 months. All demographic, baseline and outcome data were collected and statistically analysed. RESULTS: Regarding the post revascularization/obturation pain, there was no statistically significant difference between severity of pain in the two groups at all time intervals except after 12 h, revascularization group showed statistically significantly higher prevalence of no pain than endodontic treatment group. Regarding the healing; the periapical lesions decrease in size significantly from the pre-operative lesion size in both groups without significant difference between the both groups. CONCLUSION: Within the limitation of this study, PRP revascularization could be an alternative treatment to root canal treatment but further randomized clinical trials with standardized techniques and long follow up periods are recommended for more reliable results.

Pulp revascularization on an adult mandibular right second premolar: A case report.

BACKGROUND: Pulp revascularization has become a new method for the treatment of periapical diseases in young permanent teeth in recent years. Through root canal flushing and disinfection, avoiding mechanical preparation, guiding apical stem cells into the root canal and promoting the continuous development of tooth roots, it has achieved good clinical curative effects. But in adult patients with chronic periapical periodontitis with immature roots and open apices, apical barrier technology is often used to treat these teeth. CASE SUMMARY: Pulp revascularization of a 26-year-old patient's tooth was performed using cefaclor instead of minocycline and iRoot BP instead of mineral trioxide aggregate as intracanal medication. The case was followed up for 36 mo. Observations showed evidence of regression of clinical signs and symptoms, resolution of apical periodontitis and no discolouration of affected teeth. CONCLUSION: For adult patients with chronic periapical periodontitis with immature roots and open apices, pulp revascularisation showed favourable results in treating these teeth.

CAMPANELLIProgrammed Death 1 (PD-1) and PD-1 Ligand (PD-L1) Expression in Chronic Apical Periodontitis.

OBJECTIVE: This study aimed to examine programmed death protein 1 (PD-1) and programmed death lig-and 1 (PD-L1) expression on leukocytes from chronic apical periodontitis, and to determine the levels of cytokines in the apical periodontitis lesions. METHODS: Leukocytes from healthy gingival tissue (n=16) and chronic apical periodontitis (n=10) were eval-uated using flow cytometry. The PD-1 and PDL-1 expressions were evaluated using flow cytometry. The cy-tokine levels were evaluated by enzyme-linked immunosorbent assay. Data were analyzed using one-way ANOVA. The statistical significance level was set at P<0.05. RESULTS: Results showed that the apical periodontitis lesions are more infiltrated by PD-1+ and PDL1+ lym-phocytes than the control samples. In addition, the PDL-1 expression was detected on macrophages in the apical periodontitis lesions, and was significantly higher compared to leukocytes from healthy gingival tis-sue. The IFN-γ, TGF-ß, IL-10, and TNF-α levels were significantly higher in the apical periodontitis lesions com-pared to control samples. CONCLUSION: The PD-1, PD-L1, and CTLA-4 molecules are evident in apical periodontitis, and can be an impor-tant immune checkpoint in chronic periapical periodontitis.

Macrophage IL-33 expression in macrophages of human chronic periapical periodontitis and apical cyst / 口腔疾病防治

Objective@#To observe the expression of interleukin-33 (IL-33) in macrophages of chronic periapical periodontitis and apical cyst tissue, and to provide a basis for the study of the pathogenesis of IL-33 in periapical diseases.@*Methods @#The apical tissues of 20 normal control group, 15 chronic periapical periodontitis group and 15 apical cyst group were collected for HE staining and optical microscopy respectively. CD14 was used as the marker of macrophages and double immunofluorescence staining was used to observe the changes of periapical tissues under fluorescence microscopy. The expression of IL-33 in CD14-positive macrophages was observed.@*Results@#The macrophage density (cell/mm 2) of IL-33 and CD14 positive expression in normal control group, chronic periapical periodontitis group and root cyst group were（23.81 ± 5.16,62.97 ± 8.54,119.83 ± 14.61) respectively, and there were significant differences among the three groups（F=87.17,P < 0.01）. The density of IL-33 and CD14 positive macrophages in root cyst group was significantly higher than that in chronic periapical periodontitis group and control group（P < 0.01）.@*Conclusion@#IL-33 and CD14 positive macrophages increased in normal apical tissue, chronic periapical periodontitis tissue and apical cyst tissue in turn.

Effect evaluation on application of gallnut extract in root canal therapy of patients with chronic periapical periodontitis / 吉林大学学报(医学版)

Objective: To explore the influence of gallnut extract as a root canal irrigants in the curative effect of chronic periapical periodontitis, and to clarify its mechanism. Methods: A total of 192 patients diagnosed with chronic periapical periodontitis were selected and randomly divided into control group (distilled water), hydrogen peroxide group, sodium hypochlorite group and gallnut extract group (n=48). In the process of root canal treatment, four irrigants were used respectively, then the curative effects 1 week, 6 months, 12 months after treatment were observed and compared. Results: After root filling treatment, the cold and heat stimulation of the tooth was insensitive in clinical examination, percussion (-), loose degree≤ I°, no swollen gums, bleeding on probing (-), no fistula, normal function of the exercise of chewing, decreased or disappeared transmission area in periapical bone in X-ray photo, and those metioned above were considered effective treatment. After 6 months of treatment, the effective rate in gallnut group was 89.4%, and there were no statistically significant differences compared with hydrogen peroxide group (91. 1%) and sodium hypochlorite group (91. 5%) (P>0. 05), but there was significant difference compared with control group (67.4%) (P0. 05), but the ratio of tooth from improvement to recovery in gallnut group was higher than those in hydrogen peroxide group and sodium hypochlorite group. Conclusion: Gallnut extract as a root canal irrigants has good antibacterial and cleaning effect, and can achieve the aim of curing the chronic root periapical inflammation and preventing the infection.

Effect evaluation on application of gallnut extract in root canal therapy of patients with chronic periapical periodontitis / 吉林大学学报(医学版)

Objective:To explore the influence of gallnut extract as a root canal irrigants in the curative effect of chronic periapical periodontitis,and to clarify its mechanism.Methods:A total of 192 patients diagnosed with chronic periapical periodontitis were selected and randomly divided into control group (distilled water),hydrogen peroxide group,sodium hypochlorite group and gallnut extract group (n=48).In the process of root canal treatment,four irrigants were used respectively,then the curative effects 1 week,6 months,12 months after treatment were observed and compared.Results:After root filling treatment,the cold and heat stimulation of the tooth was insensitive in clinical examination,percussion (-),loose degree≤ Ⅰ °,no swollen gums,bleeding on probing (-),no fistula,normal function of the exercise of chewing,decreased or disappeared transmission area in periapical bone in X-ray photo,and those metioned above were considered effective treatment.After 6 months oftreatment,the effective rate in gallnut group was 89.4％,and there were no statistically significant differences compared with hydrogen peroxide group (91.1％) and sodium hypochlorite group (91.5 ％) (P＞0.05),but there was significant difference compared with control group (67.4％) (P＜0.05).After root filling treatment for 12 months,the effective rate in gallnut group was 83.7％ and there were no statistically significant differences compared with hydrogen peroxide group (83.3％)and sodium hypochlorite group (87.8％) (P＞0.05),but the ratio of tooth from improvement to recovery in gallnut group was higher than those in hydrogen peroxide group and sodium hypochlorite group.Conclusion:Gallnut extract as a root canal irrigants has good antibacterial and cleaning effect,and can achieve the aim of curing the chronic root periapical inflammation and preventing the infection.

Clinical observation of diode laser for the treatment of fistula chronic apical periodontitis in elderly people / 口腔疾病防治

Objective@#The present study investigated the role of a diode laser in the treatment of fistula chronic periapical periodontitis in elderly people. @*Methods @#A total of 114 cases of fistula chronic periapical periodontitis in the elderly were randomly divided into an experimental group and control group. In the experimental group, a diode laser was used to disinfect the root canal and the internal wall of the fistula after root canal preparation, and Vitapex paste was used in both groups for root canal disinfection. The control group was treated with conventional root canal therapy without laser treatment. The fistula healing rate was calculated, and root canal filling was performed in both groups two weeks later if the fistula was healed. A curative effect was observed at 3 months and 12 months.@*Results @#The fistula healing rate was 90.0% in the experimental group and 75.8% in the control group after 2 weeks. There was a significant difference between the two groups at 2 weeks (χ2 = 4.19, P < 0.05) but not at 3 months and 12 months (P > 0.05). @*Conclusion @#The use of a diode laser to disinfect the root canal and fistula of teeth in the elderly with fistula periapical periodontitis can significantly shorten the healing time of fistula.

Clinical effect of microscopic periapical surgery combined with MTA apical filling in treatment of chronic apical periodontitis / 口腔疾病防治

Objective @#To observe the clinical effect of microscopic periapical surgery combined with (mineral trioxide aggregate (MTA) apical filling in treatment of chronic apical periodontitis. @*Methods@#A total of 64 patients with 91 teeth of chronic apical periodontitis, which couldn't be treated with root canal treatment, were selected and randomly assigned into two groups. 32 patients with 43 teeth in the control group were treated with traditional surgery combined with amalgam filling. 32 patients with 48 teeth in the experimental group were treated with microsurgical apical surgery combined with MTA apical filling. Patients were followed for 12 months. The healing of periapical lesionwere assessed by clinical symptoms and X-ray examination every three months.@*Results @# In the experimental group, 27 cases cured, 17 cases improved, the success rate was 91.67% (44/48). In the control group, 19 cases cured, 12 cases improved, the success rate was 72.09% (31/43). The success rate in experimental group was significantly higher than the control group (χ2 = 5.997, P = 0.014). @*Conclusion@# Effect of microscopic periapical surgerycombined with MTA apical filling in treatment of chronic periapical periodontitis is satifactory.

Application value of calcium hydroxide agent in root canal disinfection of patients with chronic periapical periodontitis / 中国生化药物杂志

Objective To explore the application value of calcium hydroxide agent in root canal disinfection of patients with chronic periapical periodontitis in stomatology department.Methods 108 cases patients with chronic periapical periodontitis from June 2013 to June 2014 in Cixi Guanhaiwei Zhen Health Centers were randomly divided into study group (n =54) and control group (n=54).The control group received camphor phenol cotton for root canal disinfection, and study group received calcium hydroxide agent.The clinical curative effect between two groups was compared.Results After 7 days’ treatment, the total effective rate was 98.15%in study group, which was significantly higher than 79.63%in control group (χ2 =9.375,P<0.05).After follow up 6 months, the total effective rate was 94.44%in study group, which was significantly higher than 77.78%in control group (χ2 =6.271,P<0.05).The incidence of endodontic interappointment pain (EIP) in study group was 11.11%, which was significantly lower than 25.93%of control group (χ2 =3.93,P<0.05).Conclusion Calcium hydroxide agent has a significant efficacy on in root canal disinfection of patients with chronic periapical periodontitis in stomatology department, could reduce the incidence of EIP and promote healing of chronic periapical periodontitis, which is the first disinfectant in the stomatology department of primary hospital.

Envolvimento de sinais coestimulatórios na periodontite apical crônica em humanos / Co-stimulatory signals in chronic periapical periodontitis

As lesões periapicais são induzidas por uma infecção crônica da polpa dental. Antígenos microbianos estimulam a resposta imune específica e inespecífica nos tecidos apicais. Como consequência desse processo, diante da incapacidade das defesas do hospedeiro para erradicar a infecção, uma lesão periapical é formada, com o objetivo de restringir a invasão microbiana. O desenvolvimento da periodontite apical crônica depende de uma fina regulação da ativação dos linfócitos. A ativação das células T requer dois sinais, um mediado pelo complexo TCR, após o reconhecimento do antígeno, e o outro mediado pela interação dos receptores coestimulatórios. CD28 é um receptor coestimulatório, enquanto CTLA-4 e PD-1 induzem um sinal inibitório para a ativação de células T. Para compreender o envolvimento de células T na periodontite apical crônica, avaliamos a presença destas células na lesão periapical e os fatores coestimulatórios, citocinas e espécies reativas do oxigênio que estas células estariam produzindo. As amostras analisadas foram de tecido gengival para o grupo controle (n = 20) e lesões periapicais para o grupo com periodontite apical crônica (n = 20). Quanto ao perfil celular das lesões periapicais, os resultados mostraram que linfócitos T (59,3 ± 3,7%) foram as células predominantes, sendo a subpopulação CD4+ (72,7 ± 3,4%) a mais encontrada. A seguir, verificou-se a expressão de moléculas de superfície em células T. Observou-se que a expressão de CD28 (0,5 ± 0,5%) foi significativamente mais baixa em amostras de lesões periapicais que no grupo controle principalmente para linfócito T CD8+. Já CTLA-4 foi identificado em altos níveis para pacientes com periodontite apical tanto para CD3+CD4+ (86,1 ± 2,6%) quanto para CD3+CD8+ (59,8 ± 8,6%). PD-1 (73,5 ± 5,6%) e PD-L1 (59,8 ± 8,6%) apresentaram alta positividade para CD3+CD4+. Esses resultados indicaram um possível envolvimento da via de sinalização de PD-1 e PD-L1 na modulação da resposta de células T de...

Periapical lesions are induced by the chronic infection of dental pulp. Microbial antigens stimulate both non-specific and specific immune response in periapical tissue. As a consequence of these processes and the inability of host defense mechanisms to eradicate infection, chronic periapical lesion are formed, with the aim of restricting microbial invasion. Negative co-stimulatory signals mediated via cell surface molecules such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed death-1 (PD-1) play a critical role in down- modulation immune responses and maintaining peripheral tolerance. Both CTLA-4 and PD-1 are induced on actived T cell, and these are involved in the immunophatogenesis of periapical lesions. Inhibitory signals mediated via molecules such as programmed-death-1 (PD-1) play a critical role in down-modulating immune responses and maintaining peripheral tolerance. We investigated the involvement of cytokines and PD-1 engagement in mediating the T cell activation in chronic periapical diseases. Gingival samples from healthy individuals (n= 20) and patients with chronic periapical periodontitis (n= 20) were collected and used for the subsequent assays. The leukocytes in the lesion site were evaluated using flow cytometry. The production of cytokines interferon-gamma (IFN-), interleukin (IL)-10, tumor necrosis factor-alpha (TNF-) and transforming growth factor-beta (TGF-) was evaluated by ELISA. We observed a significant increase in the total number of leukocytes from periapical lesions as compared with healthy group. Our results for the composition of infiltrating cell in periapical lesion showed that the predominant cells were lymphocytes T (59,3 ± 3,7%) and contained a higher proportion of CD4+ cells (72,7 ± 3,4%). T cells from patients with periapical lesions expressed significantly higher levels of PD-1 (73,5 ± 5,6%) and PD-L1 (59,8 ± 8,6%). The levels of CTLA-4 were higher in CD3+CD4+ (86,1± 2,6%) and CD3+...

The Clinical Effect of Vitapex in the Treatment of Chronic Periapical Periodontitis / 医学研究杂志

Objective To evaluate the clinical effect of Vitapex paste in the treatment of chronic periapical periodontitis.Methods Seventy patients who suffer from chronic periapical periodontitis were selected randomly.Their root canals were filled with Vitapex paste for almost one year.Results 68 teeth of the 70 patients received succesful results,and the success rate reached 97%.Conclusion The application of Vitapex paste in the treatment of chronic periapical periodontitis not only helps the healing of the inflammation,but also leads to a good closure of apical foramen.

Detection of porphyromonas endodontalis in chronic periapical periodontitis by PCR / 实用口腔医学杂志

Objective:To evaluate the prevalence of Pe in clinical samples of chronic periapical periodontitis.Methods:A total of 100 clinical samples of chronic periapical periodontitis were collected and Pe 16S rDNA was detected by using 16S rDNA gene-directed PCR.The detection rate of Pe were calculated.Results:The detection rate of Pe was 50% in the 100 clinical samples.Conclusion:The results indicate that Pe is closely associated with endodontic infections.

Evaluation of Vitapex paste in root canal therapy for infected permanent teeth / 实用口腔医学杂志

Objective:To evaluate the effect of Vitapex in root canal therapy (RCT) for infected permanent teeth.Methods:159 permanent teeth with chronic periapical periodontitis were treated by RCT, and the canals were filled with Vitapex (in 54 teeth),ZOE (in 52 teeth) and ZOE plus iodoform (in 53 teeth) respectively.The effects were evaluated by clinical and radiological observation.Results:The ratio (%) of apical tissue reaction in 3 days following RCT in the group of Vitapex,ZOE and ZOE plus iodoform was 14.8,59.6 and 50.9 (P0.05) respectively.Conclusion:Vitapex is effective in the treatment of infected root canals.