Qualitative and quantitative assessment of parodontopathogenes in endodontium of teeth affected by Parodontitis with 50% or more bone loss

The role of these microorganisms as a source of toxins and for development of Parodontitis

Purpose

The purpose of this prospective study was to examine the canal pulp tissue of teeth which are affected by parodontitis both second or third stage of pathological mobility and 50% or more bone loss. The PET test was carried out by MIP Pharma – Germany. This is genetic test for anaerobic microorganisms.

Patient selection. Materials and Methods

In this survey a total of 41 teeth were tested using PET test. The patients suffering from Parodontitis localisata or Parodontitis generalisata were treated in Laser Dental Centre “Dr. Rositsa Koleva” as a part of the complex parodontal treatment. The classical endodontal procedure was performed. Before endodontal treatment patients medical histories were evaluate to exclude those with diseases known to affect bone metabolism, such as uncontrolled diabetes mellitus, hyperthyroidism and hypothyroidism, hyperparathyroidism and hypoparathyroidism, rheumatoid arthritis, Paget’s disease, osteogenesis imperfect, multiple myeloma, biphosphonate-related osteonecrosis of the jaw and others. Digital orthopantomography was taken to assess the bone resorption stage of Processus alveolaris before the treatment 30 number of the patients were tested with PET test from gingival sulcus. The patients were informed of the therapeutic protocol and gave their consent for the treatment.

Therapeutical protocol

Patients were given the following therapeutical scheme: 10 days of Fluorochinolon, 7 days of Metronidazole. The endodontal procedure was performed 3 days after the beginning of antibiotic treatment. The endodontic treatment was performed after local anaesthesia application without adrenalin and began with isolation and disinfection of the operating area. It was followed by trepanation of the pulp camera. The probe was inserted in the canal for 10 seconds and then the classical procedure of canal treatment was performed. In each canal 5 microprobes were inserted. Microprobes were sent to MIP Pharma, Germany for quantitative and qualitative analysis.
Results: 30 patients, 14 women and 16 men were examined. All teeth were treated in one session. There was no evidence of pain or complication after the procedure.

Discussion

Teeth affected by Parodontitis have more than normal mobility which is considered so far to be a result of bone loss. In Parodontology one of the biggest question is if is better for the patients to devitalize these teeth or not. Microbiological results from all teeth in this survey came with recommendation for mechanical cleaning of the canal. In all the cases after endodontal treatment the pathological mobility of the teeth was one to two stages lower than before the procedure one month later.

Conclusion

The results showed presence of parodontopathogenes in quantities which cause bionecrosis of the lymph, blood, vessel and the nerve in the pulp camera. In two cases were isolated Porphyromonas gingivalis and Treponema denticola and the bone resorption was concentrated around the apex causing Periodontitis chronica granulomatosa.
In the condition of bionecrosis the nerve extirpation is an algetic procedure, that’s why it was necessary for anaesthetic to be used. Parodontopathogenes in endodontium are a focus which releases toxins toward periodontium through lateral dentine tubule contributing to progressive bone loss for a long period of time. After the endodontal treatment all the teeth had one to two stages less pathological mobility. The presence of this bacteria in the canal system demand different treatment attitude during endodontal treatment because of contamination in the lateral canal system too.

Laser Dental Centre
Doctor Rositsa Koleva