Microbiological assessment of success and failure in pulp revitalization: a randomized clinical trial using calcium hydroxide and chlorhexidine gluconate in traumatized immature necrotic teeth

ABSTRACT

Aim

To compare differences in the disinfection efficacy of calcium hydroxide (CH) and chlorhexidine gluconate (CHD) dressings in pulp revitalization (PR) of traumatized immature necrotic teeth; to investigate the microflora in successful/failed PR and whether bacterial persistence influences the outcomes of PR.

Methods

Microbiological assessment of the average bacterial load (CFU/sample) and bacterial diversity (taxa/sample) was performed on 41 teeth at three timepoints (S2-before, S3-after debridement and S5- after root canal dressing).

Results

The primary microflora was more diverse in successful cases than in failed. Decreases in CFU/sample and taxa/sample occurred S2 - S3, though new increases occurred at S5 in the CHD subgroup (successful and failed) and CFU/sample in the CH subgroup (failed). At S5, the successful cases showed more bacterial decreases. No specific species was associated with the outcomes with no statistical differences between the disinfection efficacy.

Conclusions

There were no statistical differences in CH and CHD efficacy. At S5, microflora persisted in both successful and failed outcomes, but the abundance and diversity increased significantly only in the failed cases. The successful outcomes presented higher diversity and higher decreases of the primary microflora at S5 than the failed outcomes. The abundance and diversity increased significantly at S5 only in failed cases.

KEYWORDS:

• endodontic pulp revitalization
• microbiological assessment
• chlorhexidine gluconate
• calcium hydroxide
• immature traumatized necrotic teeth
• dental trauma

Authors contribution

AW: Conceptualization; data curation; investigation; project administration; software; writing the original draft preparation and reviewing (Co-first authorship with equal contribution).

NRV: Formal analysis; validation; methodology; writing the original draft preparation and reviewing and editing (Co-first authorship with equal contribution).

OR: Laboratory analyses, statistical analyses and interpretation of the results; methodology; writing; reviewing, and editing.

GT: Conceptualization; formal analysis; supervision; funding acquisition; validation; writing, reviewing, and editing.

MB: Conceptualization; methodology; formal analysis; funding acquisition; supervision; validation; writing, reviewing, and editing.

DLG: Statistical analyses and interpretation of the results, reviewing, and editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20002297.2024.2343518

Additional information

Funding

The work was supported by the Steering Group for Dental Research Region Stockholm and Karolinska Institute [FoUI-966223]; Knut and Alice Wallenberg Foundation under Grant 396168403; the Region of Västerbotten (Sweden) via TUA under Grant numbers 396168402 and 7002665; and by the Steering Group for Dental Research Region Stockholm and Karolinska Institute under Grant FoUI-966 [396168402]; Knut and Alice Wallenberg Foundation under Grant 396168403; the Region of Västerbotten (Sweden) via TUA under Grant numbers 396168402 and 7002665; and by the Steering Group for Dental Research Region Stockholm and Karolinska Institute under Grant FoUI-966 [7002665].