Clinical evaluation of intracanal medications on lipid mediators, inflammatory cytokines and effect on bacteria and products in endodontic infections of healthy patients or treated with head and neck radiotherapy

Abstract

This randomized study will evaluate in teeth with apical periodontitis the antimicrobial activity and the effect on bacterial products of treatment protocols using intracanal medications with calcium hydroxide [Ca(OH)2], N-acetyl cysteine (NAC) and chlorhexidine (CHX) and their associations. It will be subdivided into 2 subprojects. Subproject 1: It will evaluate the effect of intracanal medications (ICM): Ca(OH)2]+saline, Ca(OH)2+NAC, Ca(OH)2+CHX and CHX+NAC, on disinfection and reduction of endotoxins and LTA of the root canal in teeth with primary endodontic infection (PEI) and apical periodontitis (AP), as well as its effect on the inflammatory profile through the quantification of lipid mediators, inflammatory cytokines and metalloproteinase matrix and their action in the bone repair process through expression of bone markers. Patients will be submitted to a CT scan (CBCT) to assess the volume of periapical bone destruction using Nemotec® software and clinical signs and symptoms present before, during and after care will be evaluated. Single-rooted teeth with PEI and PA will be selected and their canals prepared using a single reciprocating file instrument and irrigation with 2.5% sodium hypochlorite, followed by ICMs. Samples of root canal content will be taken after coronary opening (S1), after root canal preparation (S2) and after 15 days of using ICMs for later analysis of the load (per culture - CFU/mL) and microbiological profile ( by Cherkerboard DNA-DNA hybridization), LPS levels (Limulus Amebocyte Lysate test - LAL) and LTA (by ELISA). Interstitial fluid will be collected after root canal preparation (SF1) and after 15 days of ICMs (SF2) for quantification of lipid (RvD2 and MaR1), inflammatory (IL-1b, IL-6, IL-10 and IL- 17, MMP-8 and MMP-13) and bone markers (RANKL, OPG and sclerotin) that will be performed through the enzyme immunoassay - ELISA and multiplex, respectively. Subproject 2: It Will evaluate the effect of ICMs Ca(OH)2+saline, Ca(OH)2+CHX and Ca(OH)2+NAC on disinfection and reduction of endotoxins and root canal LTA in teeth with PEI and AP, in a patient undergoing radiotherapy (RT) of the head and neck. Patients will be submitted to a CT scan (CBCT) to assess the volume of periapical bone destruction using Nemotec® software and clinical signs and symptoms present before, during and after care will be evaluated. Single-rooted teeth with PEI and PA will be selected and their root canals prepared using a single reciprocating file instrument and irrigation with 2.5% sodium hypochlorite, followed by ICMs. Samples of root canal content will be taken after coronary opening (S1), after root canal preparation (S2) and after 15 days of using ICMs for later analysis of the the load (per culture - CFU/mL) and microbiological profile ( by Cherkerboard DNA-DNA hybridization), LPS levels (Limulus Amebocyte Lysate test - LAL) and LTA (by ELISA). The data will be evaluated by descriptive and inferential statistical tests, according to the data obtained, according to their normality, with parametric or non-parametric tests. (AU)