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 »  Home  »  Endodontic Articles 1  »  Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions
Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions
Results



Results.
One tooth was excluded because the canal could not be dried at the end of the first visit. The radiographs taken after application of the calcium hydroxide all showed that the dressing was well condensed.

Table 2 shows the distribution of bacterial morphotypes at baseline (s1), at the end of preparation in the first visit (s2) and before (s3) and at the end of preparation in (s4) the second visit. There were no significant differences between group 1 and group 2 at the start of the experiment. The age distribution of patients did not differ between groups ( P 0.05). Sterility check samples taken before entering the pulp chamber were all negative. Microorganisms were found in all ( n 42) initial samples taken from the root canal at the first visit. The median CFU count of the first samples (s1, n 42) was 76 000 (range 80–3 10 7 ). An overview of the differences between s1, s2, s3 and s4 are given in Figs 1–3.
Figure 1 represents the mean number of cultivable bacteria in s1, s2, s3 and s4.
After instrumentation and irrigation, the CFU counts at s2 had dropped significantly ( P 0.05) to a median of 0 (range 0–7.8 10 4 ).

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Table 2. Proportions (%) and numbers of bacteria recovered from the root canal of teeth with apical periodontitis at the various sampling points.

This is a reduction to 0.18% of the baseline mean number of CFU at s1 (100%). Thirty-two specimens (77%) had no cultivable bacteria present in the root canal after initial instrumentation. The positive teeth at s2 had harboured significantly more species (5.5 1.7) at the start of the first visit (s1) than the teeth that were negative (4.3 1.4) at s2 ( P 0.05). Of the 10 root canals that harboured bacteria after completion of the first visit, seven belonged to group 1 and three belonged to group 2.

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Figure 1. Log CFU per sample. Different letters between samples represent statistically significant differences. Identical letters indicate no statistically significant differences between samples.

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Figure 2. Distribution of strict anaerobes and facultative anaerobes in samples s1, s2, s3 and s4. Different letters between samples (s1, s2, s3, s4) represent statistically significant differences. Identical letters indicate no statistically significant differences between the samples.

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Figure 3. Mean percentage of grampositive and gram-negative cocci and rods in samples s1, s2, s3 and s4 Different letters between samples (s1, s2, s3, s4) represent statistically significant differences. Identical letters indicate no statistically significant differences between the samples.

At the start of the second visit (s3), the CFU count of group 2 samples was significantly higher ( P 0.05) than the counts at the end of the first visit (s2), indicating regrowth of bacteria despite the presence of the calcium hydroxide dressing and a substantial coronal restoration. At s3, the mean number of CFU was 0.93% of the baseline s1. The median CFU count was 140 (range 0–1.4 10 5 ). Six (29%) of the 21 teeth in group 2 showed no growth after dressing with calcium hydroxide. The reinstrumentation and final irrigation at the second visit resulted, again, in a significant drop ( P 0.05) in median CFU count from s3 to s4. At s4 the number of CFU represented 0.014% of the baseline CFU (s1). Two teeth still harboured cultivable numbers of microorganisms in the root canal at the end of the second visit (s4). Comparisons of the median CFU counts between s2 and s4 showed no significant differences ( P 0.05) (Fig. 1).
Figure 2 shows the numbers of total species that were strict anaerobic or facultative anaerobic. Figure 3 shows percentages of gram-positive and gram-negative rods and cocci per sample.

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Table 3. Percentage (no.) of positive root canals harbouring a specific microorganism in samples s1, s2, s3 and s4.

The number of CFU ( P 0.05), the number of species ( P 0.05), the number of anaerobes ( P 0.05) and the percentage of gram-positive cocci ( P 0.05) had significantly dropped between s1 and s3. Table 3 shows that the most prevalent bacteria found at the start of treatment (s1) were P. intermedia (45%, 19/42 positive samples), P. micros (43%, 18/42) and A. odontolyticus (29%, 12/42). In the positive s2 samples the same microorganisms were still most prominent, A. odontolyticus 70% (7/10), P. intermedia 50% (5/10) and P. micros 50% (5/10). Although the number of root canals that were positive increased from three to 15 between s2 (group 2) and s3, the number of different species found per positive sample had not increased. At s4 seven different species were isolated from two positive root canals. Four of these species had been present in all four samples, P. intermedia , Capnocytophaga spp., A. odontolyticus and P. micros.