Clinical influence of calcium hydroxide and N‐acetylcysteine on the levels of resolvins E1 and D2 in apical periodontitis

Abstract

Aim To investigate the presence of resolvins E1 (RvE1) and D2 (RvD2) in teeth with primary endodontic infections and apical periodontitis, and to assess the influence of calcium hydroxide medication [Ca(OH) 2 ], in association with 2% chlorhexidine gel (2% CHX gel), and N-acetylcysteine (NAC) on the levels of RvE1 and RvD2 in periapical tissues. Methodology Thirty-six single-rooted teeth with primary endodontic infections and apical periodontitis were selected and randomly divided into three groups according to the medication: [Ca(OH) 2 ] + saline solution (SSL) [Ca(OH) 2 + SSL group] (n = 12), Ca (OH) 2 + 2% chlorhexidine gel [Ca(OH) 2 + 2% CHX gel group] (n = 12) and NAC [NAC group] (n = 12). Samples were collected from the periapical interstitial fluid at two different sampling times: before (S1) and after 14 days of intracanal medications (S2). Resolvins were measured using the enzyme-linked immunosorbent assay. Data were analysed using paired t-test, Wilcoxon test and Kruskal-Wallis test, followed by Dunn's post hoc test; all statistical tests were performed at a significance level of 5%. Results RvE1 and RvD2 were detected in 100% of the samples (36/36) at S1 and S2. Ca(OH) 2 medication did not increase the levels of RvE1 or RvD2 (both P > 0.05); however, NAC significantly increased the levels of RvE1 and RvD2 after 14 days of treatment (P < 0.05). Conclusions RvE1 and RvD2 were detected in periapical tissues from teeth with root canal infections. Moreover, calcium hydroxide medication did not increase the levels of resolvins in apical periodontitis. In contrast, the use of NAC intracanal medication significantly increased the levels of RvE1 and RvD2 after 14 days of treatment.

Antibacterial and anti-inflammatory efficacy of N-acetyl cysteine in endodontic treatment: a scoping review

“…NAC showed an antibacterial efficacy comparable to that of CH. However, both NAC and CH were inferior to DS Karapinar et al 2016 [ 33 ] (Turkey) In vitro NAC (medicament) CH Cell lines LPS- induced Inflammatory mediators (TNF-α protein and mRNA, TGF-b1) ELISA and qRT-PCR 5, 10, 20, and 40 mM 24 h Equivalent anti-inflammatory efficacy of NAC and CH in reducing TNF-α Corazz et al 2021 [ 32 ] (Brazil) Randomized clinical trial NAC (medicament) G1: CH + saline G2: CH + 2% CHX 36 Teeth with endodontic infection (32 anterior & 4 premolars) Immunoresolvents, (Resolvins E1, D1) ELISA NA 14 days NAC significantly increased RvE1 and RvD2 in apical periodontitis after 14 days of treatment in comparison to CH Silveira 2013 [ 42 ] (Spain) In-vitro NAC 100 mg mL combination with alexidine (2%–0.007 8%) Alexidine alone Isolated from a failed endodontic treatment Microbail E. faecalis CFU NA 1–5 min All two groups showed similar result with not statistically significant Khosravi 2018 [ 43 ] (Iran) In-vitro G1: Ciprofioxacin and NAC G2: levofloxacin and NAC G1: normal saline G2: CH G3: ciprofloxacin G4: levofloxacin 120 Humans extracted teeth with single canals Microbial E. faecalis RCC SEM NA 1 Week All intracanal medicaments were significantly more effective than calcium hydroxide ( P < 0.05). The combination of levofloxacin and NAC caused significantly higher reduction in colony count in comparison with other tested medicaments ( P = 0.00...…”

“…As detailed in Table 1 , two studies [ 32 , 33 ] reported the anti-inflammatory efficacy of NAC. The first study by Corazz et al assessed the efficacy of NAC and calcium hydroxide on the levels of resolvins (immunosorbent, namely E1 and D2) in apical periodontitis.…”

“…The first study by Corazz et al assessed the efficacy of NAC and calcium hydroxide on the levels of resolvins (immunosorbent, namely E1 and D2) in apical periodontitis. The results revealed superior efficacy of NAC in increasing the immonosolvents as compared to calcium hydroxide [ 32 ]. The other study by Karapinar et al assessed the anti-inflammatory efficacy of NAC on lipopolysaccharide-stimulated human macrophage cell lines and showed strong efficacy of NAC in reducing TNF-α protein levels which was comparable to calcium hydroxide at the 4th hour.…”

“…The anti-inflammatory effect of calcium hydroxide is related to its high pH [ 34 , 40 ]. However, Corazza et al [ 32 ] reported that calcium hydroxide intracanal medication was unable to increase the levels of resolvins in apical periodontitis, while NAC intracanal medication significantly increased their levels after 14 days of treatment.…”

“…More specifically, 200 mg/ml solution of NAC was found to be more efficient than 5.25% NaOCl and 2% CHX in killing E. faecalis and S. mutant bacteria [ 31 ]. More recent studies reported that the application of NAC as intracanal medication considerably elevated resolving E1 and D2 levels which are potent endogenous anti-inflammatory mediators [ 32 ], and reduced TNF-α which is a potent inflammatory cytokine [ 33 ].…”