High prevalence of apical periodontitis amongst type 2 diabetic patients

AIM: To study the prevalence of AP in patients with and without type 2 diabetes mellitus. METHODOLOGY: In a retrospective cohort study, the records of 38 subjects with diabetes and 32 control subjects were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periapical status was assessed using the periapical index score. Statistical analyses were conducted using the Cohen's kappa test, analysis of variance and logistic regression. RESULTS: Apical periodontitis in at least one tooth was found in 81.3% of diabetic patients and in 58% of control subjects (P = 0.040; OR = 3.2; 95% CI = 1.1-9.4). Amongst diabetic patients 7% of the teeth had AP, whereas in the control subjects 4% of teeth were affected (P = 0.007; OR = 1.8; 95% CI = 1.2-2.8). CONCLUSIONS: Type 2 diabetes mellitus is significantly associated with an increased prevalence of AP.     

Relationship between smoking and endodontic variables in hypertensive patients

Introduction

The aim of this study was to investigate the relationship between smoking and the prevalence of apical periodontitis and root canal treatment in hypertensive patients.

Methods

In a cross-sectional study, the records of 100 hypertensive patients, 50 smokers and 50 nonsmokers, were examined. Periapical status of all teeth was assessed by using the periapical index score.

Results

Apical periodontitis in 1 or more teeth was found in 92% of smoker patients and in 44% of nonsmoker subjects (P = .000; odds ratio [OR], 16.8; 95% confidence interval [CI], 4.6-61.3). One or more root-filled teeth were found in 58% and 20% of smoker and nonsmoker subjects, respectively (P < .01; OR, 5.5; 95% CI, 2.3-13.5). Among smoker hypertensive patients, 6% of the teeth had apical periodontitis, whereas in the nonsmoker subjects, 2% of teeth were affected (P < .01; OR, 3.3; 95% CI, 2.0-5.4). The percentage of root-filled teeth in the smoker and nonsmoker groups was 3.6% and 1.2%, respectively (P < .01; OR, 2.9; 95% CI, 1.6-5.5).

Conclusions

The prevalence of apical periodontitis and root canal treatment was significantly higher in smoker hypertensive patients compared with nonsmoker subjects.     

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目的了解辽宁省2型糖尿病患者的牙周状况。方法2007年7—12月在辽宁省糖尿病及代谢综合征的流行病学调查人群中按要求选取2型糖尿病伴牙周炎患者、单纯牙周炎患者、健康人为研究对象,进行问卷调查,检查6颗指数牙的牙周探诊深度(PD)、临床附着丧失(CAL)、龈沟出血指数(SBI)、简化口腔卫生指数(OHI-S)、牙齿松动度(TM),并对胆固醇(TC)、三酰甘油(TG)、空腹血糖(FPG)、葡萄糖耐量试验餐后2h血糖(OGTT 2h PG)进行检测。对上述指标进行统计分析。结果2型糖尿病患者牙周炎患病率为97.7%。排除性别、年龄、居住地、文化程度等因素的影响,2型糖尿病伴牙周炎患者的PD、CAL明显高于单纯牙周炎组。结论2型糖尿病患者牙周破坏严重,口腔卫生教育及防病、治病意识急待加强,同时应严格控制血糖、血脂等全身危险因素对牙周状况的影响。     

Periapical endodontic surgery: a 3-year follow-up study

AIM: To monitor the outcome of periradicular surgery in a group of teeth treated with microsurgical technology and ultrasonic root-end preparation. METHODOLOGY: One hundred and twenty-eight teeth with failed conventional root canal treatment were included. The surgical procedure was completed using ultrasonic retrotips and a zinc oxide-EBA (Super Seal, Ogna Pharmaceuticals. Milan, Italy)-reinforced material was used to seal the root end cavities. Lesions were examined radiologically at 1. 3. 6. 12, 24 and 36-month intervals. Radiographs were independently analysed according to a previously published classification. RESULTS: Eight teeth were extracted due to fracture or perforations undetected radiologically: these cases were excluded from the study. Of the 120 teeth examined. the overall success rate was 92.5%; 94 healed with complete bone filling of the surgical cavity, 17 were considered to have healed by apical scar formation, four demonstrated uncertain healing and five were considered failures. Eighty of 120 teeth examined had successfully healed from a radiological point of view within 12 months. No differences in outcome occurred between anterior, premolar and molar teeth. Although all failures occurred in teeth with posts, no statistically significant difference was noted (Mann-Whitney U-test, P = 0.37). CONCLUSION: Modern surgical endodontic procedures associated and ERA (Super Seal, Ogna Pharmaceuticals, Milan, Italy) root end fillings were successful over 3 years in 92.5% of cases.     

Prevalence and Size of Periapical Radiolucencies Using Cone-beam Computed Tomography in Teeth without Apparent Intraoral Radiographic Lesions: A New Periapical Index with a Clinical Recommendation

Introduction

The purpose of this study was to determine the prevalence and size of periapical radiolucencies using cone-beam computed tomographic (CBCT) imaging in teeth without apparent signs of intraoral radiographic lesions.

Periapical and endodontic status of permanent teeth in patients with hypophosphatemic rickets

Summary Hypophosphatemic rickets (HR) is a rare hereditary disease in which dental problems in terms of spontaneous periapical infections are frequently reported. Most previous reports have been based on a small number of HR patients and have been published before the disease could be confirmed genetically. The aim of the present study was to describe the periapical and endodontic status of permanent teeth in patients with genetically and/or biochemically confirmed HR. The patients were recruited from a medical study on HR patients. The patients underwent a dental examination including a digital panoramic radiograph, which was scored for endodontically affected teeth (i.e. teeth with periapical radiolucencies and/or endodontically treated teeth). A total of 52 patients (age range: 5·7–74·5 years; 17 males and 35 females) were included. HR patients were characterised by a high number of endodontically affected teeth (mean: 4·2; s.d.: 5·0). The number of affected teeth rose significantly with age (P < 0·01), and no statistically significant gender difference was found. The relative distribution of endodontically affected teeth in the three tooth groups (incisors and canines, premolars, and molars) varied according to age. In the youngest age group, only incisors and canines were affected, while the relative proportion of affected premolars and molars increased with age. Endodontically affected teeth are common in HR patients, and the number of affected teeth increased significantly with age. Hence, the need for endodontic treatment among HR patients is comprehensive.     

Accuracy of Cone-beam Computed Tomography and Periapical Radiography in Apical Periodontitis Diagnosis

Introduction

This study aimed to investigate the correlation and the agreement between periapical radiography (PR) and cone-beam computed tomography (CBCT) correlating to histologic findings in the diagnosis of apical periodontitis (AP).

Methods

One hundred thirty-four premolar root canals from 10 dogs were treated after AP induction. Four months later, the animals were killed, and standard digital PRs were obtained. The area of AP was measured by using ImageJ software. CBCT (i-CAT) images from each arch were obtained, and AP area and volume were measured by using Osiri-X software. The apical inflammatory infiltrate was evaluated under light microscopy. The correlation between imaging methods was evaluated by using the Pearson coefficient. The Bland-Altman method was used to assess the agreement between PR and CBCT data. The Spearman coefficient was used to correlate the imaging data and histologic findings.

Results

Despite a strong correlation between PR and CBCT areas, the agreement limits were very broad (95% limits of agreement, 0.19–1.08). PR only measured, on average, 63% of CBCT values. Although there was a strong correlation between PR area and CBCT volume, the Bland-Altman method suggests that the larger the CBCT volume, the more underestimated the PR value. When APs had a volume smaller than 6 mm³, the PR estimation of CBCT data was unpredictable. A positive correlation was found for PR area, CBCT area, CBCT volume, and histology data.

Conclusions

The diagnosis of AP based on PR data is clinically limited, and it should not be used for scientific investigations.     

A 20-year follow-up study of endodontic variables and apical status in a Swedish population

AIM: To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings. METHODOLOGY: One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered. RESULTS: The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings. CONCLUSIONS: There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up.     

Th1/Th2/Th17/Treg Balance in Apical Periodontitis of Normoglycemic and Diabetic Rats

IntroductionThe aim of this study was to evaluate the inflammatory profile of T helper (Th) cells in normoglycemic (N) and diabetic rats with apical periodontitis (AP).MethodsTwenty male Wistar rats were divided in 2 groups: N rats and rats with diabetes mellitus (DM). DM was induced using streptozotocin, and AP was induced by dental pulp exposure of the first mandibular molar to the oral environment. After 30 days, the mandibles were removed and processed for histologic analysis, bacterial analysis, and immunochemical assays for interleukin (IL)-6, tumor necrosis factor alpha, IL-17, IL-23, interferon gamma, and IL-10. The Mann-Whitney U test and Student t test were used for statistical analysis (P < .05).ResultsThe DM group showed more intense inflammatory infiltrate with larger sizes of bone reabsorption and a greater presence of bacteria than the N group (P < .05). Proinflammatory cytokine levels in the DM group were also greater than those in the N group (P < .05). However, interferon gamma was more intense in the N group than in the DM group (P < .05).ConclusionsThe inflammatory profile of AP in DM is different from that in the N group, suggesting that Th1 is a secondary strain and the Th17 strain is predominant in DM.     

Healing of Apical Periodontitis after Nonsurgical Treatment in Patients with Type 2 Diabetes

Introduction

The purpose of this prospective study was to compare the success of primary root canal treatment between type 2 diabetic and nondiabetic patients and to investigate the effect of periapical healing on glycated hemoglobin (HbA1c) in type 2 diabetic patients with apical periodontitis.

Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis

OBJECTIVES: The purpose of this study was to compare the local efficacy of nonsurgical periodontal therapy between type 2 diabetic and non-diabetic patients and the effect of periodontal therapy on glycaemic control. BACKGROUND: A complex two-way relationship exists between diabetes mellitus and periodontitis. Material AND METHODS: After selection, 20 subjects (10 diabetic and 10 non-diabetic) underwent baseline examination, periodontal clinical study and biochemical analysis of gingival crevicular fluid (GCF). After the pre-treatment phase, subgingival scaling and root planing were performed. Subsequently, all subjects continued the maintenance programme and were re-examined at 3 and 6 months. RESULTS: Diabetic and non-diabetic subjects responded well after therapy, showing a very similar progression during the follow-up period. Both groups showed clinically and immunologically significant improvements. Significant reductions were also found in the total volume of GCF and levels of interleukin-1beta and tumour necrosis factor-alpha. Diabetic subjects showed an improvement in their metabolic control. The change in glycosylated haemoglobin (HbA(1C)) was statistically significant at 3 and 6 months. CONCLUSIONS: The clinical and immunological improvements obtained were accompanied by a significant reduction in HbA(1C) values in type 2 diabetic subjects. Larger studies are needed to confirm this finding and establish whether periodontal therapy has a significant effect on glycaemic control.     

Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population

Abstract The objective of this study was to determine the periapical status and the quality of root canal fillings and to estimate the endodontic treatment needs in a German population. Clinical and radiographic data and the operative procedures performed were evaluated on 323 patients coming to a dental surgery in Stuttgart, Germany, in 1993. In 182 individuals at least one tooth exhibited a root canal filling, a necrotic pulp or an irreversible pulpitis. Out of the 7897 teeth examined, 215 (2.7%) had a root canal treatment (category A), 122 being nonendodontically treated (1.5%) did not respond to the sensitivity test (category B) and 53 (0.7%) were diagnosed as having irreversible inflamed pulp tissue (category C). The prevalence of teeth associated with radiographic signs of periapical pathosis was 61 % in the group of root canal filled teeth and 88% in the group of pulpless and non-endodontically treated teeth. Using the level and the density of the root canal filling as criteria for evaluating the technical standard, only 14% of the endodontic treatments of non-apicectomized teeth were qualified as adequate. The minimal endodontic treatment need is 2.3% related to all examined teeth when the root canal filled teeth with clinical symptoms of periapical periodontitis (category A) and those of categories B and C are included. The real endodontic treatment need is suggested to be larger when considering that the technical quality of the obturation is poor in most symptomless endodontically treated teeth associated with a periapical lesion. In the case of retreatment of these teeth, the endodontic treatment need would then be calculated at 3.7%.     

高频次牙周洁治对2型糖尿病伴慢性牙周炎患者的临床疗效

目的:评价高频次的牙周洁治对2型糖尿病伴慢性牙周炎患者的临床疗效.方法:将40名2型糖尿病伴慢性牙周炎患者按照性别、年龄匹配的原则分配到A组(高频次牙周洁治组,20例)和B组(单次牙周洁治组,20例),并于基线检查和治疗完成后6个月进行复查,A组在此过程中每月复诊一次并进行牙周龈上洁治,B组基线时洁治后无处理,比较两组牙周检查指标及血糖检查指标的变化.结果:A组各项牙周指标及血糖指标均较基线显著降低,且对两组间差异进行协方差分析(糖化血红蛋白水平为协变量)处理,两组差异有统计学意义.结论:高频次的牙周洁治能显著改善2型糖尿病伴慢性牙周炎患者的牙周炎症状及血糖水平.     

Association between C-reactive protein,neutrophil to lymphocyte ratio and the burden of apical periodontitis: a case-control study

Objective: Endodontic originated chronic apical periodontitis (AP) is an inflammatory disease of periapical tissue. High-sensitivity C-reactive protein (hsCRP) as an inflammatory marker and hemogram indexes provide valuable information to clinicians for diagnosis, screening and follow-up of various diseases. The aim of this study was to investigate AP in terms of its association with hemogram indices and hsCRP levels.

Material and methods: Study includes 104 patients with AP and 40 participants as the control group. 160 teeth were diagnosed as AP through digital radiographic images and scored with respect to Periapical Index (PAI) scoring. Afterwards, patients were categorized into 3 grades in accordance with both the number and the severity of AP. AP grade 0 was considered for the control group with regard to a new scoring system. Patients with only one tooth involved with AP with a PAI score of 3 or 4 were categorized as an AP Grade 1, when a patient had more than one tooth with a PAI score of 3 or 4 he was classified as an AP Grade 2 and a patient with at least one tooth scored as a PAI 5 was rated as an AP Grade 3. Hemograms and hsCRP levels were measured for each individual to establish a correlation with inflammatory markers.

Results: The neutrophil/lymphocyte ratio (NLR) levels of patients with AP Grade 3 were significantly higher than all other AP grades (p?<?.05). hsCRP levels in patients with an AP Grade 2 and 3 were higher than both AP Grade 0 and 1 (p?<?.05).

Conclusions: hsCRP levels of patients were reliable predictive indicators for AP severity in correlation with the new proposed scoring system for AP.     

Partial- and full-mouth scaling and root planing in type 2 diabetic subjects: a 12-mo follow-up of clinical parameters and levels of cytokines and osteoclastogenesis-related factors

Santos VR, Ribeiro FV, Lima JA, Miranda TS, Feres M, Bastos MF, Duarte PM. Partial‐ and full‐mouth scaling and root planing in type 2 diabetic subjects: a 12‐mo follow‐up of clinical parameters and levels of cytokines and osteoclastogenesis‐related factors. J Periodont Res 2012; 47: 45–54. © 2011 John Wiley & Sons A/S Background and Objective: The aim of this study was to evaluate the effects of full‐mouth scaling and root planing (FMSRP) and partial‐mouth scaling and root planing (PMSRP), up to 12 mo after treatment, on clinical parameters, and levels of cytokines and osteoclastogenesis‐related factors in type 2 diabetic subjects with chronic periodontitis. Material and Methods: Thirty‐four subjects received FMSRP (n = 17) or PMSRP (n = 17) within 24 h or in multiple sessions, respectively. Clinical parameters and local levels of tumor necrosis factor‐α (TNF‐α), interferon‐γ (IFN‐γ), interleukin (IL)‐17, IL‐23, IL‐4, receptor activator of NF‐β ligand and osteoprotegerin were assessed at baseline, and 3, 6 and 12 mo after therapies. Results: Clinical parameters improved after both therapies (p < 0.05), and no between‐group differences were observed at any time‐point (p > 0.05). Overall, there were no considerable differences in the local levels of the biomarkers studied between groups (p > 0.05). The IL‐23 concentration and total amount of IFN‐γ increased in the FMSRP group and decreased in the PMSRP group from baseline to 3 mo and from baseline to 6 mo, respectively (p < 0.05). Conclusion: Both PMSRP and FMSRP promoted benefits in clinical parameters and showed a similar modulation of cytokines and osteoclastogenesis‐related factors at 12 mo in type 2 diabetic subjects.     

Effects of non-surgical periodontal treatment on clinical response, serum inflammatory parameters, and metabolic control in patients with type 2 diabetes: a randomized study

Background: Scientific evidence on the effects of chronic periodontitis on diabetes mellitus remains inadequate and inconclusive. This intervention study is designed to evaluate the effects of periodontal treatment on clinical response, systemic inflammatory parameters, and metabolic control in patients with Type 2 diabetes. Methods: A total of 134 patients were randomly allocated into two treatment groups and one control group. Treatment group 1 underwent non‐surgical periodontal treatment at baseline and additional subgingival debridement at the 3‐month follow‐up. Patients in treatment group 2 received non‐surgical periodontal treatment and supragingival prophylaxis at the 3‐month follow‐up, and those in the control group received no intervention throughout the study. All participants were reexamined at 1.5, 3, and 6 months after initial treatment. At each visit, clinical periodontal examinations were conducted and blood samples were taken to evaluate high‐sensitivity C‐reactive protein (hsCRP), tumor necrosis factor‐α (TNF‐α), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and lipid profiles. Results: Both treatment groups had a significantly lower hsCRP level after periodontal therapy (P <0.05). Although HbA1c declined significantly in treatment group 2 (P <0.05), the intergroup difference for HbA1c, FPG, TNF‐α, and lipid profiles was not statistically significant after therapy (P >0.05). Conclusions: Non‐surgical periodontal treatment can effectively improve periodontal and circulating inflammatory status. Despite a lack of strong evidence, trends in some results support improved glycemic control after periodontal treatment in patients with diabetes.     

2型糖尿病患者牙周指标与糖化血红蛋白关系的研究

目的 :研究 2型糖尿病患者牙周指标与糖化血红蛋白间的相关关系。方法 :随机选择 3 0例 2型糖尿病伴牙周炎患者于牙周基础治疗前检测其体重 ,菌斑指数 ,牙龈指数 ,探诊出血指数 ,探诊深度 ,附着丧失 ,糖化血红蛋白值。结果 :糖化血红蛋白与附着丧失、年龄的密切相关。结论 :糖化血红蛋白是影响牙周破坏的重要指标。