Clinical research
Detection and Eradication of Microorganisms in Root-filled Teeth Associated With Periradicular Lesions: An In Vivo Study

https://doi.org/10.1016/j.joen.2007.01.012Get rights and content

Abstract

This study determined the presence of microorganisms by culture and polymerase chain reaction in asymptomatic root-filled teeth with periradicular lesions. Furthermore, a disinfecting regimen using sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), chlorhexidine digluconate (CHX) irrigation, and calcium hydroxide (Ca(OH)2) dressing was assessed. After removal of the root-filling material, specimens of 20 cases undergoing retreatment were sampled. Moreover, the canals were sampled after each step of the disinfecting regimen. Prevalence of microorganisms was 60% by culture and 65% by polymerase chain reaction. In four of those samples (31%), DNA of Enterococcus faecalis was found. After further root canal preparation and irrigation using NaOCl and EDTA, microorganisms could be detected in none of the teeth. Thus, CHX and Ca(OH)2 could not show further disinfection. In contrast, microorganisms were found in two teeth after the interappointment dressing. It may be concluded that proper root canal preparation and irrigation using NaOCl and EDTA are sufficient for decontamination of the root canal system during endodontic retreatment.

Section snippets

Clinical Material

Twenty patients (10 women and 10 men; age, 25 to 75 years; mean age, 47 years) who were referred for endodontic treatment to the University Clinic and Dental Hospital, Freiburg, Germany, were selected for this study. The patients were not enrolled into the study if any of the following criteria were present: (1) severe systemic diseases, (2) pregnancy or lactation, (3) use of any antibiotics within the past 30 days, (4) participation in another clinical study during the previous 3 months, (5)

Microbial Cultures

With regard to the cultures obtained after removal of the root canal filling material (S0), 12 teeth (60%) contained cultivable microorganisms. Of these 12 teeth, the quantity of microorganisms recovered ranged from 0 to 7.8 × 107 CFU/mL (with a median of 3.5 × 103 CFU/mL) and from 3.0 × 103 to 1.0 × 109 CFU/mL (with a median of 1.5 × 105 CFU/mL) with regard to aerobic and anaerobic cultivation, respectively. After irrigation with EDTA and NaOCl (S1) and after irrigation with CHX (S2), none of

Discussion

Culture samples showed that 60% of the root-filled teeth associated with periradicular disease yielded microorganisms. Using PCR, in 65% (13/20) of the teeth bacterial DNA was detected. In four of those samples (31%), DNA of E faecalis was found. After further root canal preparation and irrigation using NaOCl and EDTA, microorganisms could be detected in none of the teeth. Thus, CHX and the intracanal dressing with Ca(OH)2 could not show further disinfection. In contrast, microorganisms were

Acknowledgments

The authors express their sincere appreciation to Dr. K. Pelz for his helpful criticism and suggestions.

References (37)

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