Correlation between Volume of Apical Periodontitis Determined by Cone-beam Computed Tomography Analysis and Endotoxin Levels Found in Primary Root Canal Infection

Does supplemental photodynamic therapy optimize the disinfection of bacteria and endotoxins in one-visit and two-visit root canal therapy? A randomized clinical trial

“…Despite such a reduction, the present study has shown the limited ability of CMPs in eliminating endotoxins from primarily infected teeth as endotoxins were recovered from 100% of the root canals after instrumentation. Such finding is in agreement to previous investigations [8][9][10][11].…”

“…To the best of our knowledge, this is the first clinical study evaluating the ability of supplemental PDT to improve the removal of endotoxins from primarily infected root canals after CMP in one-visit and two-visit groups. Gram-negative bacterial endotoxins (LPSs), which exhibit a high biological toxicity and are related to the development of symptoms and severity of bone destruction, were detected in 100% of the primarily infected teeth in our study agreeing with previous investigations [8,10,11]. Our results have revealed that CMP by using single-file reciprocating instrumentation and irrigation with 2.5% NaOCl and 17% EDTA decreased significantly the levels of endotoxin in both one-visit (from 24.941 to 1.920 EU/mL) and two-visit (from 25.067 to 1.041 EU/mL) groups.…”

“…Lipopolysaccharide (LPS, also known as endotoxin) is the main virulence factor found in the outer membrane of the bacterial cell [9], exhibiting high biological activity [10]. Endotoxin has been detected in 100% of the primarily infected teeth [8,11], with higher levels of LPS being correlated with development of symptoms and severity of bone destruction [11][12][13][14][15].…”

“…Despite the advances in instrumentation techniques with the use of reciprocating single-instrument [5,8,16] or multiple NiTi files systems in continuous rotation motion [11,16], studies preconizing one-and two-visit treatment approach have failed in demonstrating an optimal disinfection of the root canal system [5,6,8,17,18].…”

Correlation Between Volume of Root Canal, Cultivable Bacteria, Bacterial Complexes and Endotoxins in Primary Infection

“…Such molecule is released during bacterial multiplication and cell death (11). Moreover, the levels of endotoxins in root canal infections are directly related to severity of periapical bone destruction (12)(13)(14).…”