Abstract
This study evaluated the ex vivoantimicrobial efficacy of the EndoVac system and the photodynamic therapy (PDT) associated with chemomechanical debridement (CMD) and intracanal medication on Candida albicans. Seventy-eight sterile premolars were contaminated withC. albicans (ATCC 21433) for 30 days. The teeth were randomly assigned into four groups: Control (CMD with conventional irrigation); Endovac (CMD with EndoVac system); PDT (CMD with conventional irrigation and PDT); and Endovac + PDT (CMD with EndoVac and PDT). After the therapies, intracanal dressing (calcium hydroxide) was applied to all teeth for seven days. Samples were obtained before (T1) and after the therapeutic procedures (T2), and after intracanal medication (T3), plated onto BHI agar and incubated (37°C, 48 h) to determine the colony-forming units (CFU)/mL. The overall mean level ofC. albicans at baseline was relatively high (1.85 x 106 ± 2.7 x 106 CFU mL-1). A significant reduction of C. albicans(p < 0.05) was observed over time (T1 to T2 and T1 to T3) in all groups. An additional significant reduction from T2 to T3 was observed only in the Endovac group (p < 0.05). No differences in mean reduction of C. albicans were observed among groups. However, the Endovac group presented the lowest mean counts of C. albicans at T3, whereas the PDT group had the highest counts of this microorganism (p < 0.05). The EndoVac system of irrigation/aspiration associated with CMD was the most effective therapeutic protocol for reducing intracanal levels of C. albicans. PDT showed a very limited efficacy against this species.
Highlights
The purpose of this study was to evaluate the ex vivo effectiveness of the EndoVac system and photodynamic therapy (PDT) as adjuncts to chemomechanical debridement (CMD) associated with intracanal calcium hydroxide [Ca(OH)2] medication in the reduction of C. albicans in the root canal system
Significant reductions (p < 0.05, Friedman test) in mean counts of C. albicans were detected within all groups (Figure 2), from pre-treatment (T1) to CMD (T2), and from pre-treatment (T1) to post-intracanal medication (T3) (p < 0.05, Wilcoxon test)
The mean levels of C. albicans at the final evaluation (T3) were significantly lower in the Endovac group compared to the PDT group (Figure 2; p > 0.05, Mann-Whitney test)
Summary
Persistent apical periodontitis is generally a result of incomplete elimination of microorganisms from the root canal system.[1,2,3] Several factors have been associated with unfavorable outcomes following root canal therapy, such as resistance of microorganisms to root canal treatment and intracanal medication, anatomical complexities of the root canal, deep invasion of microorganisms into dentinal tubules, and biofilm formation.[3,4,5,6] Candida albicans has been shown to be the major fungal species present in root-filled teeth with periradicular lesions, being usually isolated in association with facultative Gram-negative andBraz Oral Res [online]. 2015;29(1):[1,2,3,4,5,6,7]positive bacteria.[2,4,6] detection of C. albicans from root canal infection may have been overlooked due to technical limitations such as the low number of cells for recovery by cultural methods, the use of non-selective media, and the fact that these species are regarded as contaminants because of their colony morphology.[4]. Persistent apical periodontitis is generally a result of incomplete elimination of microorganisms from the root canal system.[1,2,3] Several factors have been associated with unfavorable outcomes following root canal therapy, such as resistance of microorganisms to root canal treatment and intracanal medication, anatomical complexities of the root canal, deep invasion of microorganisms into dentinal tubules, and biofilm formation.[3,4,5,6] Candida albicans has been shown to be the major fungal species present in root-filled teeth with periradicular lesions, being usually isolated in association with facultative Gram-negative and. The EndoVac irrigation/aspiration system (Discus Dental, Culver City, USA) and low-power laser used in photodynamic therapy (PDT) have been introduced into standard therapies to improve root canal disinfection
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