Patients included in the study have not made use of antibiotics within the previous 3 months. All teeth showed no periodontal pockets deeper than 4 mm. The study protocol was approved by the Ethics Committee of the Estácio de Sá University. All patients were asked to rinse the oral cavity for 1 min with 0.12% chlorhexidine before sampling procedures. Abscesses were sampled by aspiration of the purulent exudate from the swollen mucosa over each abscess. Pirfenidone research buy The overlying mucosa was disinfected with 2% chlorhexidine solution, and a sterile disposable syringe was used to aspirate the purulent exudate, which was immediately injected into cryotubes containing Tris–EDTA
(TE) buffer (10 mM Tris–HCl, 1 mM EDTA, pH 7.6) and frozen at −20 °C. In cases of asymptomatic apical periodontitis, samples were obtained from the root canals under strict aseptic Selleckchem CX-5461 conditions, which included rubber dam isolation and a two-step disinfection protocol of the operative field with 2.5% NaOCl, as previously described.22 Paper points used for sampling the root canals were transferred to cryotubes containing TE buffer and immediately frozen at −20 °C. Sterility control samples taken from the tooth crown were tested by using polymerase chain reaction (PCR) with universal primers for the bacterial 16S rRNA gene.
Accordingly, one case was excluded because of a positive result. Root canal samples from the teeth with asymptomatic apical periodontitis were also taken after chemomechanical procedures in order to evaluate the effects of treatment on endodontic
bacterial communities that were positive for antibiotic resistance genes. Root canals were instrumented with NiTi hand or rotary instruments at a working length (WL) established 1 mm short of the apical foramen with the aid of an electronic apex locator (Novapex, Forum Technologies, Rishon le-Zion, Israel) and confirmed by radiographs. Patency of the apical foramen was confirmed with a small file throughout the procedures and under control with the apex locator. The size of Dimethyl sulfoxide apical preparation ranged from #40 to #55. For irrigation, 2.5% NaOCl was used in all canals, 2 ml after each file size, and delivered by disposable syringes and NaviTip needles (Ultradent, South Jordan, UT) inserted up to 4 mm short of the WL. After preparation, smear layer was removed by rinsing the canal with 17% EDTA and 2.5% NaOCl. The canal was dried using sterile paper points and then flushed with 5 ml of 5% sodium thiosulfate to inactivate NaOCl. Next, a postpreparation (S2) sample was taken from the canals as for the initial sample. DNA was extracted from all samples using the QIAamp DNA Mini Kit (Qiagen, Valencia, CA) following the protocol recommended by the manufacturer. The presence of bacteria in clinical samples was determined by using PCR with universal primers for the bacterial 16S rRNA gene as described previously.