Correlation between Volume of Apical Periodontitis Determined by Cone-beam Computed Tomography Analysis and Endotoxin Levels Found in Primary Root Canal Infection.
BACKGROUND
This clinical study was conducted to correlate the levels of endotoxins and bacterial counts found in primary endodontic infection with the volume of periapical bone destruction determined by cone-beam computed tomography (CBCT) analysis. Moreover, the levels of bacteria and endotoxins were correlated with the development of clinical features.


METHODS
Twenty-four root canals with primary endodontic disease and apical periodontitis were selected. Clinical features such as pain on palpation, pain on percussion, and previous episode of pain were recorded. The volume (cubic millimeters) of periapical bone destruction was determined by CBCT analysis. Endotoxins and bacterial samplings were collected by using sterile/apyrogenic paper points. Endotoxins were quantified by using limulus amebocyte lysate assay (KQCL test), and bacterial count (colony-forming units [CFU]/mL) was determined by using anaerobic culture techniques. Data were analyzed by Pearson correlation and multiple logistic regression (P < .05).


RESULTS
Endotoxins and bacteria were detected in 100% of the root canal samples (24 of 24), with median values of 10.92 endotoxin units (EU)/mL (1.75-128 EU/mL) and 7.5 × 10(5) CFU/mL (3.20 × 10(5)-8.16 × 10(6) CFU/mL), respectively. The median volume of bone destruction determined by CBCT analysis was 100 mm(3) (10-450 mm(3)). The multiple regression analysis revealed a positive correlation between higher levels of endotoxins present in root canal infection and larger volume of bone destruction (P < .05). Moreover, higher levels of endotoxins were also correlated with the presence of previous pain (P < .05).


CONCLUSIONS
Our findings revealed that the levels of endotoxins found in root canal infection are related to the volume of periapical bone destruction determined by CBCT analysis. Moreover, the levels of endotoxin are related to the presence of previous pain.
Department of Restorative Dentistry, Endodontic Division, São José dos Campos Institute of Science Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil.
Flávia G R
FG
Cardoso
Department of Restorative Dentistry, Endodontic Division, São José dos Campos Institute of Science Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil.
Nádia S
NS
Ferreira
Department of Restorative Dentistry, Endodontic Division, São José dos Campos Institute of Science Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil.
Frederico C
FC
Martinho
Department of Semiology, Federal University of Pelotas, School of Dentistry, Pelotas, Rio Grande do Sul, Brazil.
Gustavo G
GG
Nascimento
Department of Radiology, São José dos Campos Institute of Science Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil.
Luiz R C
LR
Manhães
Department of Radiology, São José dos Campos Institute of Science Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil.
Marco A
MA
Rocco
Department of Restorative Dentistry, Endodontic Division, São José dos Campos Institute of Science Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil.
Cláudio A T
CA
Carvalho
Department of Restorative Dentistry, Endodontic Division, São José dos Campos Institute of Science Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil. Electronic address: marcia@fosjc.unesp.br.
Marcia C
MC
Valera
D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging; D001424:Bacterial Infections / Q000175:diagnosis*; D058491:Bacterial Load; D054893:Cone-Beam Computed Tomography; D003788:Dental Pulp Diseases / Q000382:microbiology*; D004731:Endotoxins / Q000032:analysis*; D006801:Humans; D008875:Middle Aged; D010485:Periapical Periodontitis / Q000000981:diagnostic imaging* / Q000382:microbiology* / Q000628:therapy; D012390:Root Canal Therapy / Q000009:adverse effects*; D055815:Young Adult
D004731:Endotoxins
Bacteria; CBCT; endotoxins; infection