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Clinical efficacy of endodontic protocols on reducing cultivable bacteria and endotoxin in infected root canal in patients submitted to head and neck radiotherapy: a randomised clinical trial

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Abstract

Objectives

Assess the efficacy of biomechanical preparation using a reciprocating system followed by final irrigation protocols, then intracanal medication, on reducing endotoxins and cultivable bacteria of infected teeth in irradiated patients.

Materials and methods

Twenty-two infected single-rooted canals in patients submitted to head and neck radiotherapy were prepared by reciprocating motion and 2.5% NaOCl. Patients were randomly divided into two groups of 11 patients before the final irrigation protocol: apical positive pressure (APP) or passive ultrasonic activation (PUA). Both groups were treated in two sessions, using Ca(OH)2 as intracanal medication for 14 days. Root canal content sampling was performed after canal access (S1), after biomechanical preparation plus the irrigation protocol (S2), and after intracanal medication (S3). Chromogenic limulus amoebocyte lysate assay measured endotoxin levels (EU/mL), and bacterial load was determined by culture techniques (CFU/mL).

Results

Treatment protocols reduced bacterial counts after S2 in both groups (p = 0.01). S3 differed from S1 (p = 0.01), but not from S2 (p = 0.4). Endotoxin levels were reduced in both groups after S2 (P = 0.03) and were lower in S3 than in S2, with significant differences in the APP group (p = 0.03).

Conclusions

Biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth, followed by the irrigation protocol (APP or PUA), demonstrated efficacy in reducing endodontic contaminants. Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals.

Clinical relevance

This clinical study demonstrated that endodontic treatment in irradiated patients is efficacious at reducing bacterial load and endotoxin levels.

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Data availability

The data is available in the UNESP Institutional Repository: https://repositorio.unesp.br.

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Funding

The work was supported by the Programa Nacional de Cooperação Acadêmica da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES/Brasil and the Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP (grant n° 2018/01703-9).

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Authors and Affiliations

  1. Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University – UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil

    Diego Guilherme Dias de Rabello, Marcia Carneiro Valera, Bruna Jordão Motta Corazza & Claudio Antônio Talge Carvalho

  2. Department of Diagnosis and Surgery, Maxillofacial Surgery Division, Institute of Science and Technology, São Paulo State University – UNESP, São José dos Campos, São Paulo, 12245-000, Brazil

    Lúcio Murilo dos Santos

Authors
  1. Diego Guilherme Dias de Rabello
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  2. Marcia Carneiro Valera
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  3. Bruna Jordão Motta Corazza
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  4. Lúcio Murilo dos Santos
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  5. Claudio Antônio Talge Carvalho
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Corresponding author

Correspondence to Marcia Carneiro Valera.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the local Institute Review Board (São Paulo State University (UNESP), Institute of Science and Technology, São José dos Campos, Brazil) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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de Rabello, D.G.D., Valera, M.C., Corazza, B.J.M. et al. Clinical efficacy of endodontic protocols on reducing cultivable bacteria and endotoxin in infected root canal in patients submitted to head and neck radiotherapy: a randomised clinical trial. Clin Oral Invest 27, 7199–7207 (2023). https://doi.org/10.1007/s00784-023-05283-w

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