Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial.

Esteban Isai Flores Orozco,Flávia Goulart da Rosa Cardoso,Daiana Cavalli,Cassia Cestari Toia,Eduardo Bresciani,Rayana Duarte Khoury,Marcia Carneiro Valera

doi:10.1590/1678-7757-2019-0100

Esteban Isai Flores Orozco, Flávia Goulart da Rosa Cardoso + Show 5 more

Open Access

https://doi.org/10.1590/1678-7757-2019-0100

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Abstract

Objective:This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization.Methodology:Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis.Results:A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%).Conclusion:Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Highlights

The successful treatment of apical periodontitis depends on the maximum decrease in microorganisms and their by-products in root canals
Bacteria were found in all initial samples (20/20), with median values of 2.4×105 colony-forming units (CFUs)/mL (20 – 1.8×106 CFU/mL)
A statistically significant difference was found in the median percentage values for the reduction in cultivable bacteria (p

Summary

Introduction

The successful treatment of apical periodontitis depends on the maximum decrease in microorganisms and their by-products in root canals. Root canal preparation is associated with an irrigating solution to obtain maximal reduction in microbial load inside the root canal to prevent or eliminate apical periodontitis.. The root canal system has some anatomical complexities such as apical ramifications, isthmus, and dentinal tubules, which may impede full disinfection. Studies have shown the presence of microorganisms in necrotic teeth in the main canal, and throughout the root canal system, even after chemomechanical preparation.. The remaining bacteria may influence the treatment result and can be associated with persistent apical periodontitis.. All efforts have been made to obtain maximum bacterial elimination from the root canals before filling. Studies have shown the presence of microorganisms in necrotic teeth in the main canal, and throughout the root canal system, even after chemomechanical preparation. The remaining bacteria may influence the treatment result and can be associated with persistent apical periodontitis. all efforts have been made to obtain maximum bacterial elimination from the root canals before filling.

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