Microbiome Changes during Regenerative Endodontic Treatment Using Different Methods of Disinfection

Area of Science:

• Endodontics
• Microbiology
• Regenerative Dentistry

Background:

• Necrotic pulp, open apexes, and apical periodontitis present complex endodontic challenges.
• The endodontic microbiome plays a crucial role in treatment outcomes.
• Understanding microbial changes under different antimicrobial protocols is essential.

Purpose of the Study:

• To qualitatively and quantitatively characterize endodontic microbiome changes.
• To evaluate the efficacy of three distinct antimicrobial protocols.
• To assess microbial shifts in teeth with specific endodontic conditions.

Main Methods:

• A multicenter clinical trial involving 97 teeth with necrotic pulp, open apexes, and apical periodontitis.
• Randomized division into apexification (APEX), regeneration (REGEN), and revascularization (REVASC) groups.
• Microbiological sampling at three time points (S0, S1, S2) using 16S rRNA gene analysis.

Main Results:

• All protocols significantly reduced bacterial load, with APEX and REVASC showing less residual DNA than REGEN.
• Relative abundance of certain bacterial phyla (Bacteroidetes, Fusobacteria, Spirochaetes, Synergistetes) decreased.
• REVASC demonstrated the greatest reduction in bacterial taxa, followed by APEX, then REGEN.

Conclusions:

• Enhanced antimicrobial protocols improve the reduction of quantitative and qualitative endodontic microflora parameters.
• The choice of antimicrobial protocol significantly impacts bacterial load reduction.
• Revascularization and apexification protocols show promising results in managing endodontic infections.