Clinical evaluation of periapical inflammatory process before and after the use of different root canal medications by the levels of inflammatory biomarkers - metalloproteinases, myd88, tlr-2 and strem-1

Abstract

The objectives of this clinical study are: 1) To study the inflammatory process involved in apical periodontitis from primarily infected teeth by the levels of MMP1, MMP2, MMP8 e MMP9 in apical peridontitis tissues from primarily infected teeth; correlating their levels with the presence of clinical symptomatology and size of radiolucent area; 2) To investigate the levels of MyD88, TLR-2 e sTREM-1 in periapical tissues from primarily endodontic infected teeth with apical periodontitis; 3) To investigate the efficacy of diferent root canal medications on the levels of metalloproteinases (MMP1, MMP2, MMP8 e MMP9) and inflammatory biomarkers (MyD88, TLR-2 e sTREM-1) sampled from intersticial fluid from apical periodontitis. Twenty-four infected teeth with the presence of apical periodontitis will be selected. Samples will be collect from root canals and interstitial periapical fluid by using apyrogenic/sterile paper points at two different sampling times, before (Initial sample) and after the use of root canal medicaments (final sampling) [G1, Ca(OH)2 + SSL (n=12) and G2, Ca(OH)2 + 2% CHX-gel (n=12)] used for 14 days. After the initial sampling and root canal instrumentation, apical patency will be performed for the final sampling specimen from the intersticial fluid which will be performed 2mm beyond apical constricition. Samples will be immediatly stored in plastic tubes containing Tamponated solution + Tween 20 + proteases inhibitors; the levels of MMP1, MMP2, MMP8, MMP9, MyD88, TLR-2 e sTREM-1 sampled from peirapical tissues will be determined by ELISA assay (Enzyme-Linked Immunosorbent Assay). The data obtained in the present study will be typed on a spreadsheet and statistical analyzed by SPSS for Windows and package Statistica 9.0.