Impact of systemic health on treatment outcomes in endodontics Segura‐Egea, Juan J.; Cabanillas‐Balsera, Daniel; Martín‐González, Jenifer ...
International endodontic journal,
March 2023, 2023-Mar, 2023-03-00, 20230301, Letnik:
56, Številka:
S2
Journal Article
Recenzirano
Odprti dostop
Background
The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is ...resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth.
Objective
To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved.
Methods
The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models.
Results
Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT.
Discussion
Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region.
Conclusions
The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non‐retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.
Background
The prevalence of root filled teeth (RFT) worldwide will inform about the amount of clinical activity of dentists dedicated to treat endodontic disease.
Objectives
To carry out a ...systematic review with meta‐analysis answering the following question: What is the prevalence of RFT around the world? The percentage of people with at least one RFT was also investigated.
Methods
A systematic review including population‐based studies using the following databases: PubMed, EMBASE and Scielo. Studies related to prevalence of RFT were included. The outcome of interest of the study was the prevalence of RFT. The meta‐analyses were calculated with the Open Meta Analyst software to determine the global prevalence of RFT. Subgroups analyses were performed comparing geographical distribution, radiographic method and year of the study (classified in 20th or 21th century). The prevalence of people with at least one RFT was also analysed.
Results
Seventy‐four population‐based studies fulfilled the inclusion criteria. Twenty‐eight, forty‐four and two studies reported high, moderate and low risk of bias, respectively. No obvious publication bias was observed. Prevalence of RFT was estimated with 1 201 255 teeth and 32 162 patients. The calculated worldwide prevalence of RFT was 8.2% (95% CI = 7.3%–9.1%; p < .001). The global prevalence of people with at least one RFT was 55.7% (95% CI = 49.6%–61.8%; p < .001). In 20th century, the prevalence of RFT was 10.2% (95% CI = 7.9%–12.5%; p < .001), whereas in the 21st century the overall calculated prevalence of RFT was 7.5% (95% CI = 6.5%–8.6%; p < .001). Brazilian people (12%) and the European population (9.3%) showed the highest prevalence of RFT. In Europe, 59.6% (95% CI = 52.4%–66.8%) of people has at least one RFT.
Conclusions
This review showed that root canal treatment is a very common therapy throughout the world. More than half of the studied population have at least one RFT. A limitation of the present study is that most of the studies did not consider random sampling for population selection.
Registration
PROSPERO Systematic review registration number: (CRD42022329053).
Background
Several studies have suggested a relationship between AP, as well as the loss of root‐filled teeth (RFT), and hypertension (HTN).
Objectives
The aims of this systematic review and ...meta‐analysis were to investigate the prevalence of AP, and non‐retention of RFT, in hypertensive patients.
Methods
A search was performed in PubMed/MEDLINE, Web of Science, Scopus and EMBASE. The inclusion criteria established were studies published until February 2023, comparing hypertensive subjects with controls, assessing the prevalence of AP and/or providing data on the prevalence of non‐retained RFT. Meta‐analysis was performed using the RevMan (analyst) tool to determine the pooled prevalence of AP and loss of RFT. Risk of bias was assessed using the Cochrane Risk‐of‐Bias tool. The quality of evidence was assessed by GRADE.
Results
The search strategy identified 454 articles, and only eight met the inclusion criteria. Six studies had analysed the association between AP and HTN and two studies had analysed the association between non‐retention of RFT and HTN. Meta‐analysis showed and overall OR = 1.71 (95% CI = 0.92–3.16; p = .09) for the prevalence of AP among patients with HTN. The prevalence of non‐retention of RFT among patients with HTN has an overall OR = 1.78 (95% CI = 1.60–1.98; p = .000001). The risk of bias in the individual studies was low or moderate, and the quality of the overall evidence has shown a level of certainty very low.
Discussion
There is no association between the prevalence of AP and HTN. In addition, hypertensive patients have significantly increased odds of losing RFT. Given the high prevalence of hypertension, it is very common to perform root canal treatments on hypertensive patients. It is imperative to communicate this heightened risk to patients and recommend periodic monitoring of oral health and hypertension, paying special attention to this subset of patients.
Registration
PROSPERO CRD42022302385.
Aim
Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of ...bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing.
Methodology
Seventy‐nine patients were treated during the years 2013–2020 with large periapical lesions of endodontic origin (10–15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow‐up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi‐square test was used for categorical variables, the t‐test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables.
Results
Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p < .001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p > .05).
Conclusions
Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision‐making process.
Aim
Crohn's disease (CD) and ulcerative colitis (UC) are two chronic recurrent inflammatory processes of the gastrointestinal tract, grouped under the name inflammatory bowel disease (IBD), causing ...clinical episodes of intestinal inflammation. The aim of this study was to investigate the possible association between IBD and the prevalence of apical periodontitis (AP) and root canal treatment.
Methodology
A case–control study design matched to age and sex was used. The study group (SG) included 28 patients with IBD (13 with CD, 15 with UC). Another 28 healthy subjects, without IBD and age‐ and sex‐matched, were included in the control group (CG). Radiographic records were analysed and AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score. Student's t‐test, χ2 test and multivariate logistic regression were used in the statistical analysis.
Results
In the CG, only 17 subjects (61%) had at least one tooth with AP, whilst in the SG group they were 23 patients (82%; OR = 2.98; 95% CI = 0.87–10.87; p = .08). The number of subjects with one or more root filled teeth (RFT) in the CG was 14 (50%), whilst in the SG they were 22 (79%; OR = 3.67; 95% CI = 1.14–11.79; p = .026). At least one RFT with AP was evident in three subjects (10.7%) in the CG, whilst in the SG 15 patients (53.6%) showed RFT with AP (OR = 9.60; 95% CI = 2.35–39.35; p = .001). In the multivariate logistic regression analysis, only endodontic status was found to be associated with IBD (OR = 1.86; 95% CI = 1.24–2.80; p = .003).
Conclusion
IBD, UC and Crohn’s disease are associated with higher prevalence of RFT and higher percentage of RFT with periapical lesions. Dentists should consider these findings when caring for IBD patients by monitoring the evolution of periapical lesions of endodontically treated teeth.
Abstract Introduction The aim of this study was to investigate radiographically the prevalence of apical periodontitis (AP) and endodontic treatment in a sample of adult type II diabetic patients and ...control subjects. Methods In a cross-sectional study, the radiographic records of 50 adult patients reporting a history of well-controlled type 2 diabetes mellitus (DM) (study group) and 50 age- and sex-matched subjects who reported no history of DM (control group) were examined. Periapical status of all teeth was assessed using the periapical index score. Results The average number of teeth per patient in the diabetic and control groups was 21.9 and 24.6 teeth, respectively ( P = .012). AP in one or more teeth was found in 37 diabetic patients (74%) and in 21 control subjects (42%) (odds ratio = 3.9, P = .002). One or more root-filled teeth were found in 35 (70%) and 25 (50%) of diabetic and control subjects, respectively (odds ratio = 2.3, P = .043). Among diabetic patients with root-filled teeth, 16 (46%) had AP affecting at least one treated tooth. Among controls with root-filled teeth, 6 (24%) had AP affecting at least one treated tooth ( P > .05). Adjusting for teeth number, multivariate logistic regression analysis showed that periapical status (odds ratio = 3.3, P = .0071) and the number of root-filled teeth (odds ratio = 1.7; P = .0035) were significantly associated with diabetic status. Conclusions The results showed that in adult patients, type 2 DM is significantly associated with an increased prevalence of AP and endodontic treatment.
The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the ...medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol.
Abstract Introduction The aim of this study was to investigate radiographically the relationship of tobacco smoking and periapical status by using a retrospective case-control study design. Methods ...The records of 79 controls and 79 age- and sex-matched cases were examined. Case was defined as a patient who has at least 1 radiographically detectable periapical lesion in a tooth. Control was defined as a patient who has no radiographically detectable periapical lesion in any teeth. Periapical status was assessed by using panoramic radiographs and the periapical index score. The history of smoking and diabetes, the number of teeth and root-filled teeth, and the quality of root fillings were recorded. Statistical analyses were conducted by using the Cohen kappa test, χ2 test, Student's t test, and logistic regression analysis. Results Among the case subjects, 75% had antecedents of smoking, whereas in the control group only 13% had been smokers (odds ratio, 20.4; 95% confidence interval, 8.8–46.9; P = .0000). After multivariate logistic regression analysis adjusting for covariates (age, gender, number of teeth, root-filled teeth, root-filled teeth with a root filling technically unsatisfactory, and diabetes), a strong association was observed between the presence of at least 1 radiographically detectable periapical lesion and antecedents of smoking (odds ratio, 32.4; 95% confidence interval, 11.7–89.8; P = .0000). Conclusions After adjusting for age, gender, number of teeth, endodontic status, quality of root filling, and diabetic status, tobacco smoking is strongly associated with the presence of radiographically diagnosed periapical lesions.
Highlights • MTAP in revascularization procedures provides good histologic results. • PRP in revascularization procedures provides good histologic results. • MTAP and PRP improves the success rate of ...the revascularization procedure.
Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). ...Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279. Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth—4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07–1.26; p = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias. Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.
PDF
