Evaluation of oxidative stress in patients with chronic apical periodontitis treated with single session root canal treatment using different root canal filling paste: In vivo study

Objective: The aim of this study was to compare oxidative stress markers in patients who underwent single-session root canal treatment using epoxyamine resin-based and bioceramic-based root canal sealants. The baseline PAI levels of the participants were also compared with the oxidative stress markers obtained from the samples taken at baseline. Materials and Methods: Twenty-six patients with chronic apical periodontitis were divided into two equal groups (n=13) according to the root canal sealer to be used (Bioceramic Group and Epoxyamine Group). The root canal paste to be used in the patients was selected by another clinician from closed envelopes. PAI scores of the patients were recorded before treatment. A saliva sample was taken from the patients before starting root canal treatment. During root canal treatment, tooth and pulp tissue samples were taken from the root canal. After the root canal treatment was completed with the selected sealer, an appointment was made for the 30th day and a second saliva sample was taken on the 30th day. Saliva and root canal samples were analysed for Total Antioxidant Status(TAS), Total Oxidant Status (TOS), Oxidative stress index (OSI), 8-Epi, Malondialdehyde (MDA) and Myeloperoxidase (MPO) markers. ELISA test kit was used for 8-Epi and colorimetric analysis methods were used for other markers. In statistical analyses, Independent Sample T test was used to compare two independent groups when the assumption of normality was met, Dependent Sample T test was used when the assumption was dependent, and Mann Whitney U and Wilcoxon Sign Rank test were used when the assumption was not met. Pearson's correlation was used to analyse the relationships between continuous measurements suitable for normal distribution, and Spearman's correlations were applied in the absence of normal distribution. (p<0.05) was considered significant. Results: In the Bioceramic Group, a statistically significant decrease in the 8-Epi marker was observed at day 30 compared to day 1. No statistically significant difference was observed when TAS, TOS, OSI, MDA, MPO values were analysed according to time in the Bioceramic Group. In the Epoxyamine Group, no significant difference was observed between the 1st and 30th days. There was no significant correlation between the biochemical results obtained from the samples taken from the root canal and the results obtained from the saliva taken before treatment. When the change in oxidative stress markers over time was compared between the groups, no significant difference was found between the Epoxyamine Group and the Bioceramic Group. When the PAI scores were correlated with the markers obtained from saliva samples taken before treatment, a positive and very high level significant correlation was found between PAI and 8-Epi. No statistically significant correlation was found between PAI scores and samples taken from the root canal. Conclusions: In this study using bioceramic and epoxyamine resin-based root canal sealants, the findings were similar between the groups. The observed decrease in 8-Epi when bioceramic root canal sealants were used may provide insight into the possible benefits of using bioceramic-based root canal sealants in patients with systemic diseases with high levels of oxidative stress, or in patients with high PAI scores. The relationship between 8-Epi and PAI analysed from saliva also confirms that increased bone loss increases systemic oxidative stress. Since the study of oxidative stress markers in endodontics is a relatively new topic, further studies are needed in this field.