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Influence of the apical enlargement size on the endotoxin level reduction of dental root canals. 2012

Ariane Cassia Salustiano Marinho, and Frederico Canato Martinho, and Alexandre Augusto Zaia, and Caio Cezar Randi Ferraz, and Brenda Paula Figueiredo de Almeida Gomes
Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil.

Gram-negative bacteria play an essential role in endodontic infections because they have virulence factors such as endotoxin. Due to its potential cytotoxic activity, special attention has been given to the removal/neutralization of this endotoxin in the root canal system. OBJECTIVE The aim of this study was to evaluate the influence of the apical enlargement size (AES) by using rotary instruments on the endotoxin level reduction of dental root canals. METHODS Forty root canals of the mandibular premolar teeth were used. Escherichia coli endotoxin (055: B55) was inoculated into thirty root canals. Ten teeth served as the negative control group. After the incubation period, the first endotoxin samples were collected from the root canals with a sterile/apyrogenic paper point for the analysis of the endotoxin units (EU/mL) present before instrumentation (S1). Specimen instrumentation was performed with the Mtwo rotary system in the sequence 10/.04, 15/.05, 20/.06, 25/.06, 30/.05, 35/.04 and 40/.04. To monitor the effectiveness of increasing apical enlargement on endotoxin removal, the second endotoxin samples were collected from all the root canals after instrumentation with the following instruments: #25/.06--(S2); #30/.05--(S3); # 35/.04--(S4); and #40/.04--(S5). Limulus amebocyte lysate (LAL) was used to quantify the levels of endotoxin. The results were statistically compared by using repeated measures of ANOVA with post hoc Tukey testing. RESULTS Increasing levels of endotoxin removal was achieved by large sized apical enlargement: S2 (AES #25/.06)--89.2%, S3 (AES #30/.05)--95.9%, S4 (AES #35/.04)--97.8% and S5 (AES #40/.04)--98.2%. Substantial reduction of endotoxin content was obtained in S4 and S5 compared to S2 (p<0.05), however, the root canal preparation was not able to eliminate the endotoxin. CONCLUSIONS Under the conditions of this study, it was concluded that the reduction of endotoxin levels of the dental root canals could be predicted by increasing the apical enlargement size.

UI MeSH Term Description Entries
D009532 Nickel A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme UREASE.
D009811 Odontometry Measurement of tooth characteristics.
D011897 Random Allocation A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. Randomization,Allocation, Random
D003762 Dental Instruments Hand-held tools or implements especially used by dental professionals for the performance of clinical tasks. Instrument, Dental,Dental Instrument,Instruments, Dental
D004731 Endotoxins Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. Endotoxin
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000704 Analysis of Variance A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable. ANOVA,Analysis, Variance,Variance Analysis,Analyses, Variance,Variance Analyses
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D014025 Titanium A dark-gray, metallic element of widespread distribution but occurring in small amounts with atomic number, 22, atomic weight, 47.867 and symbol, Ti; specific gravity, 4.5; used for fixation of fractures.
D018709 Statistics, Nonparametric A class of statistical methods applicable to a large set of probability distributions used to test for correlation, location, independence, etc. In most nonparametric statistical tests, the original scores or observations are replaced by another variable containing less information. An important class of nonparametric tests employs the ordinal properties of the data. Another class of tests uses information about whether an observation is above or below some fixed value such as the median, and a third class is based on the frequency of the occurrence of runs in the data. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed, p1284; Corsini, Concise Encyclopedia of Psychology, 1987, p764-5) Kolmogorov-Smirnov Test,Kruskal-Wallis H Statistic,Mann-Whitney U Test,Rank-Sum Tests,Spearman Rank Correlation Coefficient,Wilcox Test,Wilcoxon Rank Test,Non-Parametric Statistics,Nonparametric Statistics,Statistics, Non-Parametric,Kolmogorov Smirnov Test,Mann Whitney U Test,Non Parametric Statistics,Rank Sum Tests,Rank Test, Wilcoxon,Rank-Sum Test,Statistics, Non Parametric,Test, Kolmogorov-Smirnov,Test, Mann-Whitney U,Test, Rank-Sum,Test, Wilcox,Test, Wilcoxon Rank,Tests, Rank-Sum,U Test, Mann-Whitney

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