Clinical influence of different intracanal medications on Th1-type and Th2-type cytokine responses in apical periodontitis.

Abstract

INTRODUCTION:

This clinical study assessed the influence of different intracanal medications on Th1-type and Th2-type cytokine responses in apical periodontitis and monitored the levels of bacteria from primarily infection during endodontic procedures.

METHODS:

Thirty primarily infected teeth were randomly divided into 3 groups according to the medication selected: chlorhexidine (CHX), 2% CHX gel; Ca(OH)2/SSL, Ca(OH)2 + SSL; and Ca(OH)2/CHX, Ca(OH)2 + 2% CHX gel (all, n = 10). Bacterial sample was collected from root canals, and the interstitial fluid was sampled from lesions. Culture techniques were used to determine bacterial counts (colony-forming units/mL). Th1 (tumor necrosis factor-α, interferon-γ, and interleukin [IL]-2) and Th2 cytokines (IL-4, IL-5, and IL-13) were measured by enzyme-linked immunosorbent assay.

RESULTS:

All intracanal medication protocols were effective in reducing the bacterial load from root canals (all P < .05) and lowering the levels of Th1-type cytokines in apical lesions (all P < .05), with no differences between them (P > .05). Both Ca(OH)2 treatment protocols significantly increased the levels of Th2-type cytokines (P < .05), with no differences between them (P > .05). Thus, chlorhexidine medication showed the lowest effectiveness in increasing the levels of Th2-type cytokine. After treatment, regardless of the type of medication, the linear regression analysis indicated the down-regulation of Th2-type cytokines by Th1-type cytokines.

CONCLUSIONS:

All intracanal medication protocols were effective in reducing bacterial load and lowering the levels of Th1-type cytokines. Thus, the use of Ca(OH)2 medications contributed to the increase in the Th2-type cytokine response in apical periodontitis.

• Authors: Frederico C Martinho, Gustavo G Nascimento, Fabio R M Leite, Ana P M Gomes, Lilian F Freitas, Izabel C G Camões
• Journal: Journal of endodontics (J Endod) Vol. 41 Issue 2 Pg. 169-75 (Feb 2015) ISSN: 1878-3554 [Electronic] United States
• PMID: 25453567 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Chemical References

• IL4 protein, human
• Interleukin-2
• Root Canal Irrigants
• Tumor Necrosis Factor-alpha
• Interleukin-4
• Interferon-gamma
• Chlorhexidine

Topics

• Bacterial Load (drug effects)
• Chlorhexidine (administration & dosage)
• Humans
• Interferon-gamma (metabolism)
• Interleukin-2 (metabolism)
• Interleukin-4 (metabolism)
• Periapical Periodontitis (drug therapy, microbiology, pathology)
• Root Canal Irrigants (administration & dosage)
• Root Canal Preparation (methods)
• Root Canal Therapy (methods)
• Th1-Th2 Balance (drug effects)
• Tumor Necrosis Factor-alpha (metabolism)