Antibiograma y antibioticoterapia en tratamiento de piezas necróticas con proceso apical
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2012-06
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Universidad de Guayaquil.Facultad Piloto de Odontología
Resumen
La mayoría de los microorganismos de la flora bucal son inofensivos pero
si la condición general del paciente está debilitada por alguna razón, las
bacterias con una virulencia normalmente baja, pueden ser peligrosas. La
microflora subgingival es mayoritariamente anaerobia y la mayoría de las
infecciones orales son causado por bacilos gram negativos.
Antes de la terapia endodóntica, la flora bacteriana en casos
asintomáticos está dominada por anaerobios. Es frecuente la aparición de
especies de Prevotella combinadas con bacilos anaerobios y facultativos
Gram positivos.
―Un tratamiento endodóntico sin los beneficios del control bacteriológico,
no se justifica económicamente ni tiene fundamento ético‖ Grossman
Porcentaje de casos con resultados satisfactorios (Grossman, 237)
La mayor parte del conocimiento actual de la microflora endodóntica está
basado en estudios con cultivos bacteriológicos.
La esterilidad de un conducto no puede determinarse por la vista o el
olfato. No todos los microorganismos producen olores desagradables (por
ejemplo, las pseudomonas tienen un olor agradable) y sólo unos pocos
son cromógenos. Si la finalidad del tratamiento de conductos es la
desinfección, resulta pueril examinar y oler la curación, para decidir si el
conducto está o no estéril.
Los métodos para detectar gérmenes en los conductos radiculares
son: Cultivo en medios apropiados Examen directo por frotis. Técnicas
inmunológicas (por ejemplo, usando anticuerpos fluorescentes).Métodos
con DNA (Biología molecular). Los últimos dos han tenido uso limitado en
la investigación y su valor en la endodoncia clínica no ha sido evaluado.
Algunos autores consideran que la técnica de cultivo está en vías de
desaparición entre los procedimientos endodónticos. Frank, sostiene que
el cultivo no es un factor que predisponga al éxito del tratamiento y su
omisión no supone su fracaso. En general, la práctica aceptada es
eliminar minuciosamente el contenido del conducto y obliterarlo con un
material inerte, no reabsorbible. El crecimiento bacteriano se produce si
existen los substratos en el conducto, pero si el conducto ha sido limpiado
de esos productos de degradación de las proteínas, las bacterias no
crecerán.
En la interpretación de cultivo tener en cuenta lo siguiente:
Los cultivos negativos se obtienen cuando:
El conducto radicular y los tejidos periapicales están ―estériles‖. Muestras
inadecuadas. La punta de papel debe idealmente penetrar la longitud total
del conducto y por lo menos llegar al tercio apical. Transferencia de una
concentración inhibidora de medicamento intraconducto. Un medio
inadecuado para mantener crecimiento de la cepa de microorganismos
presentes. Un error inherente a la técnica de cultivo.
Los cultivos positivos se obtienen cuando: Existe presencia de
microorganismos en el conducto radicular y/o en el tejido periapical
(franca infección).Existe contaminación debida a al técnica de cultivo
inadecuada
Most microorganisms of the oral flora are harmless but if the patient's general condition is weakened for some reason, bacteria with a normally low virulence, they can be dangerous. the subgingival microflora is mostly anaerobic and most Oral infections are caused by gram negative bacilli. Before endodontic therapy, the bacterial flora in cases asymptomatic is dominated by anaerobes. Often the emergence of combined with Prevotella species and facultative anaerobic bacilli Gram positive. -An endodontic treatment without bacteriological control benefits, is not economically justified nor does Grossman ético‖ foundation Percentage of cases with satisfactory results (Grossman, 237) Most of the current knowledge of the endodontic microflora is studies based on bacterial cultures. The sterility of a conduit can not be determined by sight or smell. Not all microorganisms produce unpleasant odors ( example, pseudomonas have a pleasant smell) and only a few They are chromogenic. If the purpose of root canal treatment is the disinfection, it is childish to examine and smell the cure, to decide whether the duct is sterile or not. Methods for detecting bacteria in root canals are: Crop appropriate means direct smear examination. techniques immunological (for example, using fluorescent antibody) .Métodos with DNA (molecular biology). The last two have had limited use in research and its value in clinical endodontics has not been evaluated. Some authors consider that the culture technique is currently being disappearance between endodontic procedures. Frank argues that Farming is not a predisposing factor to the success of treatment and omission does not mean failure. In general, the accepted practice is carefully remove the contents of a canal and obliterate inert, non-resorbable. Bacterial growth occurs if substrates exist in the duct, but if the tube has been cleaned degradation products of these proteins, bacteria do not will grow. In the interpretation of culture take into account: Negative cultures are obtained when: The root canal and periapical tissues are -estériles‖. samples inadequate. The paper point should ideally penetrate the entire length conduit and at least reach the apical third. Transferring a intracanal inhibitory drug concentration. a medium inadequate to maintain growth of the microorganism strain present. Inherent to the culture technique error. Positive cultures are obtained when: There presence of microorganisms in the root canal and / or the periapical tissue (overt infection) .There contamination by the culture technique inadequate
Most microorganisms of the oral flora are harmless but if the patient's general condition is weakened for some reason, bacteria with a normally low virulence, they can be dangerous. the subgingival microflora is mostly anaerobic and most Oral infections are caused by gram negative bacilli. Before endodontic therapy, the bacterial flora in cases asymptomatic is dominated by anaerobes. Often the emergence of combined with Prevotella species and facultative anaerobic bacilli Gram positive. -An endodontic treatment without bacteriological control benefits, is not economically justified nor does Grossman ético‖ foundation Percentage of cases with satisfactory results (Grossman, 237) Most of the current knowledge of the endodontic microflora is studies based on bacterial cultures. The sterility of a conduit can not be determined by sight or smell. Not all microorganisms produce unpleasant odors ( example, pseudomonas have a pleasant smell) and only a few They are chromogenic. If the purpose of root canal treatment is the disinfection, it is childish to examine and smell the cure, to decide whether the duct is sterile or not. Methods for detecting bacteria in root canals are: Crop appropriate means direct smear examination. techniques immunological (for example, using fluorescent antibody) .Métodos with DNA (molecular biology). The last two have had limited use in research and its value in clinical endodontics has not been evaluated. Some authors consider that the culture technique is currently being disappearance between endodontic procedures. Frank argues that Farming is not a predisposing factor to the success of treatment and omission does not mean failure. In general, the accepted practice is carefully remove the contents of a canal and obliterate inert, non-resorbable. Bacterial growth occurs if substrates exist in the duct, but if the tube has been cleaned degradation products of these proteins, bacteria do not will grow. In the interpretation of culture take into account: Negative cultures are obtained when: The root canal and periapical tissues are -estériles‖. samples inadequate. The paper point should ideally penetrate the entire length conduit and at least reach the apical third. Transferring a intracanal inhibitory drug concentration. a medium inadequate to maintain growth of the microorganism strain present. Inherent to the culture technique error. Positive cultures are obtained when: There presence of microorganisms in the root canal and / or the periapical tissue (overt infection) .There contamination by the culture technique inadequate
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Palabras clave
ENDODONCIA, ENFERMEDADES PERIAPICALES, ABSCESO PERIAPICAL
Citación
Cuesta Lavayen, Noemí Esther (2012) : Antibiograma y antibioticoterapia en tratamiento de piezas necróticas con proceso apical