MODULACIÓN DE LA RESPUESTA INMUNE EN PERIODONTITIS APICAL, EL PAPEL DE LA MEDICACIÓN INTRACONDUCTO EN LOS MEDIADORES INFLAMATORIOS: ARTÍCULO DE REVISIÓN

Abstract

Introducction: Apical periodontitis (AP) is an inflammatory disease of the periapical tissues that triggers a complex response of the immune system. For this reason, the primary objective of the endodontic treatment is the disinfection of the Root Canal System (RCS) and the development of different alternatives during the treatment to achieve the repair of the bone tissues. An important part of the endodontic treatment is the intracanal medication, which has evolved to the active modulation of the immune response of the host. Aim: To assess the available evidence regarding the role of the intranal medication in the modulation of the immune response during AP, emphasizing the influence of inflammatory mediators. Methods: This investigation is a structured scoping review, searching literature to analyze the molecular and cellular mechanisms involved in the pathogenesis of the AP, and 19 articles for analyzing the effect of the intracanal medication in the biological mediators. The included articles were evaluated with the RoB2, Syrcle and JBI tools. Conclusion: The evidence included was of high quality, except the animal studies. Calcium hydroxide has been shown to modulate the response of lymphocytes TH1/TH2, but it does not destroy all the resistant bacteria and lowers the pro-resolving resolvins. These limitations allow the development of new agents (metformin, selenium, nanoparticles, N-acetilcisteína, lithium carbonate and prothymosinalpha) that have demonstrated the elimination of resistant bacteria, macrophages polarization and activation of bone repair pathways.