Clinical influence of calcium hydroxide intracanal medications on matrix metalloproteinases and tissue inhibitors of metalloproteinases in apical periodontitis

Flavia F C Teixeira; Flavia G R Cardoso; Nadia S Ferreira; Ana P M Gomes; Bruna J M Corazza; Marcia C Valera; Frederico C Martinho

doi:10.1007/s00784-021-04042-z

Clinical influence of calcium hydroxide intracanal medications on matrix metalloproteinases and tissue inhibitors of metalloproteinases in apical periodontitis

Clin Oral Investig. 2022 Jan;26(1):643-650. doi: 10.1007/s00784-021-04042-z. Epub 2021 Jul 13.

Authors

Flavia F C Teixeira¹, Flavia G R Cardoso¹, Nadia S Ferreira¹, Ana P M Gomes¹, Bruna J M Corazza¹, Marcia C Valera¹, Frederico C Martinho²

Affiliations

¹ Department of Restorative Dentistry, Endodontic Division, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, Brazil.
² Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, 650 West Baltimore Street, Baltimore, MD, 21201, USA. fmartinho@umaryland.edu.

PMID: 34255199
DOI: 10.1007/s00784-021-04042-z

Abstract

Objectives: This study investigated the influence of calcium hydroxide intracanal medications on the levels of metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in apical periodontitis (AP).

Materials and methods: Twenty primarily infected root canals with AP were randomly divided into two groups: Ca(OH)₂ + sterile saline solution (SSL) group and Ca(OH)₂ + 2% chlorhexidine gel (CHX gel) group. We collected samples from the periradicular tissue fluid (PTF) before (s1) and after 14 days of intracanal medication (s2). MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2 were measured by ELISA assay.

Results: MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2 were detected in all PTF samples at s1 and s2 (20/20). At s1, MMP-2 and MMP-9 were detected at higher levels than MMP-1 (p < .05). Higher levels of TIMP-1 than TIMP-2 were found in AP (p < .05). Additionally, we detected higher MMP-1, MMP-2, and MMP-9 over TIMP-1 and TIMP-2 levels in AP (p < .05). At s2, Ca(OH)₂ + SSL was as effective as Ca(OH)₂ + 2% CHX gel in lowering the levels of MMP-1, MMP-2, and MMP-9 after 14 days of intracanal medication, with no significant difference between them (p > .05). Both Ca(OH) ₂ intracanal medications had no significant impact on the levels of TIMP-1 and TIMP-2 (both p > .05). At s2, TIMP-1 levels were higher than TIMP-2 (p < .05). Moreover, there were positive correlations between the levels of MMP-1 and TIMP-1 and MMP-1 and TIMP-2 (p < .05).

Conclusions: Calcium hydroxide medications effectively lowered the levels of MMP-1, MMP-2, and MMP-9 in periapical tissues after 14 days of treatment, with no difference between them. Moreover, the calcium hydroxide intracanal medications tested here had no impact in TIMP-1 and TIMP-2 in periapical tissues.

Clinical relevance: MMPs and TIMPs play an essential role in the degradation of the extracellular matrix. The imbalance MMPs and TIMPs can cause periapical tissue destruction. Therefore, the reestablishment of the balance between activated MMPs and TIMPs with root canal therapy is essential to restore tissue homeostasis.

Keywords: Calcium hydroxide; Intracanal medication; Matrix metalloproteinase; Root canal.

MeSH terms

Calcium Hydroxide*
Humans
Matrix Metalloproteinases
Periapical Periodontitis* / drug therapy
Root Canal Irrigants
Root Canal Therapy
Tissue Inhibitor of Metalloproteinase-1

Substances

Root Canal Irrigants
Tissue Inhibitor of Metalloproteinase-1
Matrix Metalloproteinases
Calcium Hydroxide