Department of Restorative Dentistry, Endodontic Division, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, Brazil.
Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, 650 West Baltimore Street, Baltimore, MD, 21201, USA.
Clin Oral Investig. 2022 Jan;26(1):643-650. doi: 10.1007/s00784-021-04042-z. Epub 2021 Jul 13.
This study investigated the influence of calcium hydroxide intracanal medications on the levels of metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in apical periodontitis (AP).
Twenty primarily infected root canals with AP were randomly divided into two groups: Ca(OH) + sterile saline solution (SSL) group and Ca(OH) + 2% chlorhexidine gel (CHX gel) group. We collected samples from the periradicular tissue fluid (PTF) before (s1) and after 14 days of intracanal medication (s2). MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2 were measured by ELISA assay.
MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2 were detected in all PTF samples at s1 and s2 (20/20). At s1, MMP-2 and MMP-9 were detected at higher levels than MMP-1 (p < .05). Higher levels of TIMP-1 than TIMP-2 were found in AP (p < .05). Additionally, we detected higher MMP-1, MMP-2, and MMP-9 over TIMP-1 and TIMP-2 levels in AP (p < .05). At s2, Ca(OH) + SSL was as effective as Ca(OH) + 2% CHX gel in lowering the levels of MMP-1, MMP-2, and MMP-9 after 14 days of intracanal medication, with no significant difference between them (p > .05). Both Ca(OH) intracanal medications had no significant impact on the levels of TIMP-1 and TIMP-2 (both p > .05). At s2, TIMP-1 levels were higher than TIMP-2 (p < .05). Moreover, there were positive correlations between the levels of MMP-1 and TIMP-1 and MMP-1 and TIMP-2 (p < .05).
Calcium hydroxide medications effectively lowered the levels of MMP-1, MMP-2, and MMP-9 in periapical tissues after 14 days of treatment, with no difference between them. Moreover, the calcium hydroxide intracanal medications tested here had no impact in TIMP-1 and TIMP-2 in periapical tissues.
MMPs and TIMPs play an essential role in the degradation of the extracellular matrix. The imbalance MMPs and TIMPs can cause periapical tissue destruction. Therefore, the reestablishment of the balance between activated MMPs and TIMPs with root canal therapy is essential to restore tissue homeostasis.
本研究旨在探讨氢氧化钙根管封药对根尖周炎（AP）患者根尖周组织液中金属基质蛋白酶（MMPs）及其组织抑制剂（TIMPs）水平的影响。
将 20 例初次感染的 AP 患牙随机分为两组：氢氧化钙+无菌生理盐水（SSL）组和氢氧化钙+2%洗必泰凝胶（CHX 凝胶）组。分别于根管封药前（s1）和封药后 14 天（s2）采集根尖周组织液（PTF）样本。采用 ELISA 法检测 MMP-1、MMP-2、MMP-9、TIMP-1 和 TIMP-2 的水平。
所有 PTF 样本在 s1 和 s2 时均检测到 MMP-1、MMP-2、MMP-9、TIMP-1 和 TIMP-2（20/20）。s1 时，MMP-2 和 MMP-9 的水平高于 MMP-1（p<0.05）。AP 中 TIMP-1 的水平高于 TIMP-2（p<0.05）。此外，AP 中 MMP-1、MMP-2 和 MMP-9 的水平高于 TIMP-1 和 TIMP-2（p<0.05）。s2 时，氢氧化钙+SSL 组与氢氧化钙+2%CHX 凝胶组在根管封药 14 天后均能有效降低 MMP-1、MMP-2 和 MMP-9 的水平，两组间无显著差异（p>0.05）。两种氢氧化钙根管封药对 TIMP-1 和 TIMP-2 的水平均无显著影响（均 p>0.05）。s2 时，TIMP-1 的水平高于 TIMP-2（p<0.05）。此外，MMP-1 与 TIMP-1 及 MMP-1 与 TIMP-2 之间呈正相关（p<0.05）。
氢氧化钙封药 14 天后可有效降低根尖周组织中 MMP-1、MMP-2 和 MMP-9 的水平，两组间无显著差异。此外，本研究中测试的氢氧化钙根管封药对根尖周组织中 TIMP-1 和 TIMP-2 无影响。
MMPs 和 TIMPs 在细胞外基质的降解中发挥重要作用。MMPs 和 TIMPs 失衡可导致根尖周组织破坏。因此，通过根管治疗恢复 MMPs 和 TIMPs 的平衡对于恢复组织内稳态至关重要。
