Hirurško liječenje periapeksnih lezija: antibakterijski efekat ozona i uticaj ekspresije gena na ishod liječenja/

Abstract

Uvod. Hirurška terapija apeksnih parodontitisa je indikovana u slučajevima neuspjeha endodontske terapije. Dezinfekcija površine korijena nakon uklanjanja periapeksne lezije i resekcije može imati pozitivan uticaj na ishod hirurške terapije periapeksnih lezija. Ozon se kao antiseptik primjenjuje u terapiji različitih oralnih oboljenja, ali p odaci o njegovom terapijskom efektu kod hirurškog liječenja periapeksnih lezija u literaturi nedostaju. U strukturnoj remodelaciji periapeksnih tkiva nakon hirurške intervencije , važnu kontrolu imaju i geni . U ograničenom broju istraživanja do sada je ispitivana i dokazana ekspresija gena u periap eksnim lezijama kao i njihov uticaj na procese izliječenja. Cilj. Cilj ove teze je bio da ispita efekat ozona na totalan broj bakterija i Streptococcus spp. na površini korijena kod hirurškog liječenja periapeksnih lezija i na ishod liječenja, kao i da se ispita povezanost ekspresije VEGF A, PDGF A, TNF, TGFb1, COL1A1, VTN, ITGA5, ANGPT1, CTGF i CXCL9 gena u p eriapeksnim lezijama sa ishodom hirurške terapije . Materijal i metode . U istraživanje su uključeni ispitanici kod kojih je indikovana hiruršk a terapij a periapeksnih lezija (resekcija vrha Mikrobiološki uzorci su uzeti od ispitanika tretiranih ozonom i to iz periapeksne lezije (S1), nakon uklanjanja lezije (S2) i nakon primjene gasnog ozona (S3) (n=24). Kontrolnu grupu za poređenje ishoda hirurške terapije činili su ispitanici kod kojih je s provedena hirurška terapija bez primjene ozona (n=23). Uzorci periapeksnih lezija i kontrolnih periodontalnih ligamenata zdravih impaktiranih zuba (n=20) su korišćeni za određivanje ekspresije gena. Za određivanje ukupnog broja bakterija bakterija Strepto coccus spp. i ekspresije gena u uzorcima korištena je „real time“ lančana reakcija polimeraze (qPCR). Procjena ishoda liječenja vršena je na osnovu kliničkih i radioloških pokazatelja . Rezultati. Uklanjanje periapeksne lezije p=0,014 )), kao i jednokratna primjena gasnog ozona p<0,001 dovela je do značajno g smanj enja totaln og broj a bakterija , ali ne i Streptococcus spp. kod hirurškog liječenja periapeksnih lezija. Uspjeh liječenja je bio veći kod ispitanika t retiran ih ozonom u poređenju sa kontrolnom grupom, ali razlika nije dostigla statističku značajnost . Različita ekspresija ispitivanih gena je nađena i u periapeksnim lezijama i kontrolnim uzorcima zdravog periodontalnog ligamenta , a komparativna analiza je pokazala značajnu razliku samo u ekspresiji COL1A1 gena p=0,025 ). A naliza podataka je pokazala tendenciju ka značajnoj povezanosti ekspresije COL1A1 i CTGF sa ishodom hirurškog liječenja . Zaključci. Jednokratna primjena ozona značajno smanjuje totalan broj bakterija kod hirurškog liječenja periapeksnih lezija i pozitivno utiče na ishod liječenja. Ekspresija COL1A1 gen a, zajedno sa ekspresijom CTGF gen a može imati važnu ulogu u procesima zarastanja periapeksnih lezija.

Introduction. Surgical treatment of periapical lesions is indicated in cases of failure of endodontic therapy. Disinfection of the root surface after removal of the periapical lesion and root resection can have a positive effect on the outcome of surgical treatment of periapical lesions. Ozone is used as an antiseptic in the treatment of various oral diseases, but data on its therapeutic effect in the surgical treatment of periapical lesions are missing in the literature. Genes also play an important role in the structural remodelling of periapical tissues after surgical intervention. In a limited number of studies so far, gene expression in periapical lesions as well as their influence on healing processes have been investigated and proven. Aim. The aim of this thesis was to examine the effect of ozone on the total number of bacteria and Streptococcus spp. on the root surface during the surgical treatment of periapical lesions and on the treatment outcome, as well as to examine the correlation of the expression of VEGF-A, PDGF-A, TNF, TGFb1, COL1A1, VTN, ITGA5, ANGPT1, CTGF and CXCL9 genes in the periapical lesions with the outcome of surgical treatment. Material and methods. The study included subjects for whom surgical treatment of periapical lesions (root-end resection) was indicated. Microbiological samples were taken from subjects treated with ozone, from the periapical lesion (S1), after removal of the lesion (S2) and after the application of gaseous ozone (S3) (n=24). The control group for comparing the outcome of surgical therapy consisted of subjects who underwent surgical therapy without the use of ozone (n=23). Samples of periapical lesions and control periodontal ligaments of healthy impacted teeth (n=20) were used to determine gene expression. To determine the total number of bacteria, Streptococcus spp. and gene expression in the samples, "real-time" polymerase chain reaction (qPCR) was used. The treatment outcome was evaluated based on clinical and radiological indicators. Results. Removal of the periapical lesion (p=0.014), as well as a single application of gaseous ozone (p<0.001), led to a significant decrease in the total number of bacteria, but not Streptococcus spp. in the surgical treatment of periapical lesions. Treatment success was higher in subjects treated with ozone compared to the control group, but the difference did not reach statistical significance. Different expression of the investigated genes was found in periapical lesions and control samples of healthy periodontal ligament, and comparative analysis showed a significant difference only in the expression of COL1A1 gene (p=0.025). Data analysis showed a tendency towards a significant correlation of expression COL1A1 and CTGF with the outcome of surgical treatment. Conclusions. A single application of ozone significantly reduces the total number of bacteria during the surgical treatment of periapical lesions and has a positive effect on the treatment outcome. The expression of the COL1A1 gene, together with the expression of the CTGF gene, may play an important role in the healing processes of periapical lesions.