Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Endodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom.
Department of Endodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom.
J Endod. 2022 Nov;48(11):1352-1360.e3. doi: 10.1016/j.joen.2022.08.008. Epub 2022 Sep 7.
Recent findings demonstrated that 1-year cone-beam computed tomography-based outcomes of molar root canal treatment were improved through an enhanced infection protocol (EnP), when compared with a current best-practice standard infection control protocol (StP). The EnP comprised measures to reduce iatrogenic contamination from direct and indirect contact surfaces, including the replacement of the rubber dams, gloves, files, all instruments, and surface barriers before root canal obturation. The aim of this study was to investigate the effect of such an EnP on resident microbiome present after chemomechanical instrumentation and the protocol ability in reducing iatrogenic contamination in molar teeth during root canal treatment.
Molar teeth were block-randomized to receive treatment under EnP or StP. To compare the differential effect of the protocol on the identity of bacteria present, 150 matched DNA extracts from 75 molar teeth samples (StP, n = 39; EnP, n = 36) were evaluated. Samples were taken before (S1) and after (S2) chemomechanical preparation and were subjected to next-generation sequencing of the V3-V4 region of the 16S rRNA gene before bioinformatical identification using the HOMD oral microbiome database and downstream taxonomic processing, providing measures of richness and diversity of bacteria and significant bacterial taxa during chemomechanical instrumentation and the effect of the 2 treatment groups.
Eighty-eight microbial taxa were significantly more abundant in StP S2 samples, including endodontically relevant contaminants taxa as Actinomyces, Cutibacterium, and Haemophilus. The S2 samples demonstrated fewer residual bacterial species in the EnP group, with 26.8 observed species compared with 38.3 in the StP. Reduced diversity and richness measures were noted in the EnP pre-obturation samples compared with the StP in OTU, Chao1, and ACE indices (P ≤ .05). Differential microbial identities between S1 and S2 samples and protocols demonstrated that the previously observed increased effectiveness of the EnP protocol was likely to prevent recontamination or de novo contamination of the root canal space during treatment.
The implemented EnP resulted in a specific reduction of microbial taxa often associated with recontamination or iatrogenic contamination, suggesting the basis for improved infection control measures during root canal treatment.
最近的研究结果表明，与当前最佳实践标准感染控制方案（StP）相比，通过增强感染方案（EnP），磨牙根管治疗 1 年后的基于锥束 CT 的治疗效果得到了改善。EnP 包括减少直接和间接接触表面医源性污染的措施，包括在根管填充前更换橡皮障、手套、锉、所有器械和表面屏障。本研究旨在调查这种 EnP 对化学机械预备后驻留微生物组的影响，以及该方案在磨牙根管治疗过程中减少医源性污染的能力。
磨牙随机分为接受 EnP 或 StP 治疗。为了比较方案对细菌存在的差异效果，从 75 颗磨牙样本（StP，n=39；EnP，n=36）中评估了 150 个匹配的 DNA 提取物。在化学机械预备前（S1）和后（S2）取样，并在使用 HOMD 口腔微生物组数据库进行生物信息学鉴定之前，对 16S rRNA 基因的 V3-V4 区进行下一代测序，并进行下游分类处理，提供化学机械预备期间细菌丰富度和多样性的测量值以及 2 个治疗组的显著细菌分类群。
在 S2 样本中，有 88 种微生物分类群明显更为丰富，包括与牙髓有关的污染物分类群，如放线菌、表皮葡萄球菌和嗜血杆菌。在 EnP 组中，S2 样本中残留的细菌种类较少，观察到 26.8 种，而 StP 中观察到 38.3 种。与 StP 相比，EnP 预填充样本中的多样性和丰富度测量值较低，在 OTU、Chao1 和 ACE 指数上（P≤.05）。S1 和 S2 样本和方案之间的差异微生物特征表明，先前观察到的 EnP 方案的有效性增加可能是防止治疗过程中根管空间的再污染或新污染。
实施的 EnP 导致与再污染或医源性污染相关的微生物分类群的特异性减少，这表明在根管治疗期间改善感染控制措施的基础。
