O uso da clorexidina intracanal em molares decíduos com necrose pulpar : estudo clínico e microbiológico

Abstract

The success of endodontic treatment depends on many factors, and the reduction or elimination of bacterial infection is the most important one. Therefore, the use of substances that act against these microorganisms and their products becomes an important stage in treatment. The aim of this in vivo split-mouth study was to compare the efficacy of a 1% chlorhexidine gel, calcium hydroxide/camphorated paramonochlorophenol (Callen PMCC®) as intracanal medications, and a Control group (1-visit endodontic treatment) against mutans streptococci (EGM) and anaerobic bacteria found in primary molars with necrotic pulps. A total of 21 children (37 teeth) participated in this study. Initial (pre-treatment) and final (14 days post-treatment) intra-canal samples were collected for microbiological analysis and were incubated in Mitis Salivarius Bacitracin plates under microaerophilic conditions for EGM counting; as well as in Brucella-agar plates, anaerobically, to allow growth of anaerobic bacteria. The success rate of the pulpectomies after a 12 months follow-up were also evaluated based on clinical and radiographic parameters. Chlorhexidine gel significantly reduced EGM levels (p=0,010, Wilcoxon test), whereas Callen PMCC® significantly reduced anaerobic bacteria levels (p=0,002). Significant difference was observed when comparing EGM reduction levels between the Chlorhexidine and Control groups (p=0,032, Mann-Whitney test). The success rate was 81,71% in the Callen PMCC® group, 78.57% in the Chlorhexidine group and 77.77% in the control group. We concluded that 1% chlorhexidine gel, as well as calcium hydroxide/camphorated paramonochlorophenol, has limited efficacy in the reduction of bacteria from deciduous infected root canals. The present results suggest that a possible association between these two medications in future studies may eliminate more efficiently these bacteria.