Omega-3 Fatty Acids Reduce Inflammation in Rat Apical Periodontitis

Introduction

The effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on pro- and anti-inflammatory mediators were evaluated in a rat model of pulp exposure–induced apical periodontitis (AP).

Diabetes increases interleukin-17 levels in periapical,hepatic, and renal tissues in rats

ObjectivesThis study aimed to evaluate the association between endodontic infection and diabetes on interleukin-17 levels in periapical, hepatic, and renal tissues of rats.DesignForty male rats were divided into groups: normoglycemic rats (N), normoglycemic rats with apical periodontitis (N-AP), rats with experimental diabetes (ED), and rats with experimental diabetes and apical periodontitis (ED-AP). Diabetes was induced by intravenous streptozotocin injection, and blood sugar levels were monitored to confirm disease development. Apical periodontitis (AP) was induced by pulp exposure to the oral environment during 30 days. After 30 days, hepatic and renal tissues were obtained, and IL-17 levels were quantified by ELISA. The right hemi-jaw was used to quantify IL-17 levels by immunohistochemistry. The values obtained in parametric tests were tabulated and analyzed statistically by analysis of variance (ANOVA) and Tukey tests, and the values obtained for scores were statistically analyzed by using the Kruskal-Wallis and Dun tests. The level of significance was set at 5%.ResultsED and ED-AP groups expressed significantly higher IL-17 levels in both hepatic and renal tissues (p < 0.05), compared to N and N-AP groups. Apical periodontitis (AP) in ED-AP group was significantly more severe than that in N-AP group (p < 0.05). Furthermore, there was a significantly larger increase in the IL-17 levels in ED-AP group compared to N group (p < 0.05).ConclusionOur results indicate that diabetes increases IL-17 levels in hepatic and renal tissues and also enhances IL-17 production in apical periodontitis area of rats.     

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.     

Influence of a High-fat Diet in the Progression of Apical Periodontitis

IntroductionThis study evaluated the effects of a high-fat diet (HFD) on the progression of apical periodontitis (AP) in rats.MethodsEight-week old Wistar rats (N = 24) were included in this study. Half of the animals received an HFD and the other half a control diet (CD). AP lesions were induced 8 weeks later by creating pulp exposure of the mandibular left first molars. The animal’s body mass was verified on a weekly basis. After 21 and 40 days, the animals were sacrificed. Blood was collected for biochemical tests, and the liver was removed for hepatic triglycerides analysis. The left hemimandibles were removed, radiographed, and then prepared for histologic evaluation. The right hemimandibles (region near molars) were removed for bone mineral density analysis by dual-energy X-ray absorptiometry.ResultsRadiographs showed that AP lesions were significantly larger in the HFD group compared with the CD group (P < .05). Histologic analysis confirmed that the AP lesions were larger and revealed a more severe inflammatory infiltrate in the HFD group. Bone mineral density was reduced in the HFD group compared with the CD groups (P < .05). The HFD resulted in a significant increase in body mass (P < .05), liver mass (P < .05), relative liver mass (P < .05), and hepatic triglycerides (P < .05). The levels of triglycerides and very–low-density lipoprotein were significantly higher in the 40-day HFD group compared with the 21-day HFD and 21- and 40-day CD groups (P < .05).ConclusionsFindings suggest that an HFD can influence the progression and severity of AP.     

Blood Profile and Histology in Oral Infections Associated with Diabetes

Introduction

We aimed to investigate the relationship between blood profile and histologic findings in both apical periodontitis (AP) and periodontal disease (PD) associated with diabetes.

Methods

Wistar rats (N = 80) were assigned to the following 8 groups: control, AP, PD, AP associated with PD, diabetes, diabetes with AP, diabetes with PD, and diabetes with AP and PD. Diabetes mellitus (DM) was induced with streptozotocin, AP was induced by exposure to the oral environment, and PD was induced using periodontal ligature. After 30 days, blood samples were collected, and the rats were euthanized. Subsequently, the maxillae were processed for light microscopy. Hematologic examinations were conducted to determine the total number of erythrocytes and leukocytes, erythrocyte constant, and blood glucose level. One-way analysis of variance and Kruskal-Wallis tests were used for statistical analysis, and the significance was set at P < .05.

Results

A significant correlation was found between the histologic findings and blood parameters.

Conclusions

In conclusion, diabetes accelerated the development and progression of AP and PD in the rats and caused an increase in the average erythrocyte volume as well as the leukocyte and neutrophil counts. Oral infections increase the total number of leukocytes, the number of neutrophils and lymphocytes, and blood glucose concentrations in DM rats.     

Apical periodontitis and periodontal disease increase serum IL-17 levels in normoglycemic and diabetic rats

Objectives

This study aimed to evaluate the influence of apical periodontitis (AP) and/or periodontal disease (PD) on serum interleukin-17 (IL-17) levels in a rat model of diabetes mellitus (DM).

Methods

Eighty male Wistar rats were divided into eight groups of ten animals each: normoglycemic, AP, PD, AP+PD, DM, DM+AP, DM+PD, and DM+AP+PD. DM was induced using streptozotocin, AP by dental pulp exposure to the oral environment, and PD by periodontal ligature. The animals were sacrificed after 30 days, and venous blood samples were collected via cardiac puncture to determine the serum IL-17 and neutrophil levels. The maxillae were dissected and processed for radiographic analysis. The periapical lesion areas were quantified in pixels. The total assessed values were tabulated according to each experimental group and were statistically analyzed using Spearman’s correlation and Kruskal-Wallis test (p?Results A significant difference in the serum IL-17 levels was observed between the groups without oral infections and the groups with AP+PD-associated lesions, regardless of the presence of DM (p?p?p?Conclusion The combination of AP and PD increased the serum IL-17 levels in DM and normoglycemic rats and increased the neutrophil levels in DM rats. Diabetes increased the neutrophil levels and bone resorption in rats.

Clinical significance

AP is capable of potentiating systemic inflammatory changes when associated with PD, and increases in blood glucose can accelerate the pathogenesis of oral infections.     

Maintaining Apical Patency Does Not Increase Postoperative Pain in Molars with Necrotic Pulp and Apical Periodontitis: A Randomized Controlled Trial

Introduction

This prospective, single-center, single-blind, randomized controlled trial aimed to evaluate whether maintaining apical patency (AP) during endodontic treatment increases postoperative pain in molar teeth with necrotic pulp and apical periodontitis.

Clinical Factors Associated with Apical Periodontitis Visible on Cone-beam Computed Tomography but Missed with Periapical Radiographs: A Retrospective Clinical Study

IntroductionCone-beam computed tomographic (CBCT) imaging is useful in detecting apical periodontitis, which is often missed in periapical (PA) radiographs. This study aimed to identify preoperative predictors correlated with the presence of apical periodontitis visible only in CBCT images and to investigate the important characteristics of such lesions.MethodsIn total, 332 consecutive patients with both PA radiographs and CBCT images were enrolled in this study. The patients’ clinical charts were reviewed retrospectively to collect information regarding their symptoms and diagnoses. Periapical lesions were assessed using a modified CBCT PA index by 2 endodontists. Patient-related factors (age, sex, and symptoms) and tooth-related factors (tooth type, location, pulp status, and pulpal diagnosis) were assessed to determine their relationships with the presence of apical periodontitis visible only in CBCT images.ResultsApical periodontitis was detected in 24.6% and 35.5% of untreated teeth by PA radiographs and CBCT images, respectively. In a multivariate logistic regression analysis, pulp necrosis was significantly correlated with the presence of apical periodontitis visible only in CBCT images (odds ratio = 5.401; 95% confidence interval, 1.911–15.265; P = .001); the involvement of molars showed borderline nonsignificant correlation (odds ratio = 2.843; 95% confidence interval, 0.990–8.164; P = .052). Lesion sizes smaller than 2 mm in diameter and the involvement of molars were significant factors of lesions visible only in CBCT images (P < .05).ConclusionsPulp necrosis was a preoperative predictor of apical periodontitis visible only in CBCT images. This research could provide a proper indication for CBCT imaging at diagnostic stages.     

Association of endodontic infection with detection of an initial lesion to the cardiovascular system

Introduction

Dental infections might predispose toward the onset of cardiovascular disease (CVD). To date, only a few studies, yielding inconclusive findings, have investigated the potential correlation between apical periodontitis (AP) and CVD. The aim of this study (as the first part of a prospective study) was to evaluate, in the absence of CV risk factors, whether subjects with AP were more exposed to the pathogenetic indices of an atherosclerotic lesion.

Methods

Forty men between the ages of 20 and 40 years who were free from periodontal disease, CVD, and traditional CV risk factors were enrolled in the study; 20 subjects had AP, and 20 acted as controls. All subjects underwent dental examination and complete cardiac assessment: physical examination, electrocardiogram, conventional and tissue Doppler echocardiography, and measurement of endothelial flow reserve (EFR). The following laboratory parameters were tested: interleukins -1, -2, and -6 (IL-1, IL-2, IL-6), tumor necrosis factor alpha, and asymmetrical dimethylarginine (ADMA). Data were analyzed by using the 2-tailed Student's t test, Pearson t test (or Spearman t test for nonparametric variables), and multivariate linear regression analysis.

Results

Echocardiography revealed no abnormalities in any of the subjects studied. ADMA levels were inversely correlated with EFR (P < .05) and directly correlated with IL-2 (P < .001). Patients with AP presented with significantly greater blood concentrations of IL-1 (P < .05), IL-2 (P < .01), IL-6 (P < .05), and ADMA (P < .05) and a significant reduction of EFR (P < .05).

Conclusions

Increased ADMA levels and their relationship with poor EFR and increased IL-2 might suggest the existence of an early endothelial dysfunction in young adults with AP.     

Regenerative Endodontics: A Potential Solution for External Root Resorption (Case Series)

IntroductionRegenerative endodontic procedures (REPs) are aimed to treat apical periodontitis and promote root maturation of immature necrotic teeth. However, REPs are not intended to be a primary indication for treating or arresting external root resorption (ERR). The purpose of this study was to describe REP treatment in the cessation of ERR.MethodsFour cases (5 teeth) of posttraumatic immature teeth diagnosed with necrotic pulp and apical periodontitis or chronic apical abscess were treated with REPs using plasma-rich fibrin as a scaffold. All the teeth showed ERR and have been followed up to 3 years.ResultsThis case series shows how REPs arrested ERR. In 3 of the cases, replacement resorption was arrested, thus avoiding complications of ankylosis and the need for decoronation.ConclusionsIn addition to the known advantages of REPs, we show that REPs are a promising treatment modality for arresting ERR, warranting further clinical trials.     

Combination of Nonsurgical Endodontic and Vital Pulp Therapy for Management of Mature Permanent Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis and Apical Periodontitis

IntroductionThis prospective study evaluated the outcome of a combination of nonsurgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP).MethodsInstitutional ethical clearance was obtained. Mandibular molar teeth (N = 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of ≥3 in either 1 of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n = 30), single-visit NSET was performed using a standardized operating protocol. In the NSET-VPT group (n = 30), subsequent to full pulpotomy, at the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed upon application of a 2.5% sodium hypochlorite pressure pack), a mineral trioxide aggregate radicular barrier was placed, and it was covered with light-cured resin-modified glass ionomer cement. NSET was performed in the root exhibiting a PAI score ≥3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48, and 72 hours. Teeth were followed up clinically and radiographically at 12 months. The presence/absence of symptoms and the change in PAI scores were noted. The data were statistically analyzed.ResultsThe success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was no significant difference (P > .05).ConclusionsThe combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multirooted mandibular teeth with SIP and AP.     

Regenerative Endodontic Procedures for the Treatment of Necrotic Mature Teeth with Apical Periodontitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

IntroductionRegenerative endodontic procedures (REPs) are intended to repair and regenerate part of the pulp-dentin complex. The aim of this study was to systematically appraise the existing evidence on the effectiveness of REPs on mature teeth with pulp necrosis and apical periodontitis.MethodsElectronic database and hand searches were performed on 8 databases of published and unpublished literature from inception to January 3, 2021, for the identification of randomized controlled trials (RCTs) or prospective clinical trials. The related key words included “regenerative,” “pulp revascularization,” “revitalization procedure,” and “necrotic mature teeth.” A random effects meta-analysis was conducted assessing success as the main outcome treatment. Risk of bias was assessed through the Cochrane Risk of Bias 2.0 tool, and the quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsOf the 337 initial hits, 4 RCTs were eligible for inclusion, whereas 3 were included in the quantitative synthesis. Overall, there was no difference in the relative risk for a successful/unsuccessful treatment outcome between REPs or conventional treatment (3 studies, relative risk = 1.03; 95% confidence interval, 0.92–1.15; P = .61; heterogeneity I² = 0.0%, P = .53; prediction interval = 0.51–2.09). Risk of bias ranged from low to raising some concerns, whereas the quality of the evidence was graded as moderate.ConclusionsBased on moderate-quality evidence, REPs appear as a viable treatment alternative for mature necrotic teeth with periapical lesions at present. Furthermore, well-designed RCTs might also provide confirmatory evidence in this respect while also framing a backbone for standardization of the therapeutic protocol of REPs.     

Association between Increased Inducible Costimulator/Inducible Costimulator Ligand Expression with Bone Destruction in Apical Periodontitis

IntroductionThe aim was to assess the association of inducible costimulator (ICOS) and ICOS ligand with bone destruction in apical periodontitis (AP).MethodsSpecimens from patients presenting with AP were obtained during apicoectomy and subjected to histopathologic analysis and molecular assessment of ICOS/ICOS ligand. In addition, the experimental AP was induced by exposing the pulp of first mandibular molars of rats. Histologic and radiographic examinations were performed to validate the periapical lesions. The immunolocalization and messenger RNA expression of ICOS/ICOS ligand were evaluated by immunofluorescence staining and quantitative real-time polymerase chain reaction. The osteoclastic activities in periapical lesions, including the lesion size and the expression of tartrate-resistant acid phosphatase and the receptor activator of nuclear factor kappa B ligand, were recorded and followed by correlation analysis with ICOS/ICOS ligand expression.ResultsIn excisional specimens from AP patients, a significantly increased expression of ICOS/ICOS ligand was found compared with the healthy control. In the experimental AP samples, the expression of ICOS/ICOS ligand, tartrate-resistant acid phosphatase, and receptor activator of nuclear factor kappa B ligand was significantly elevated in inflamed periapical tissues (AP group) when compared with the healthy control. The number of ICOS⁺/ICOS ligand⁺ cells was highly correlated with the periapical lesion size (r = 0.892, P < .01 and r = 0.930, P < .01, respectively).ConclusionsThe increased expression of ICOS/ICOS ligand in periapical lesions was associated with the inflammatory infiltration and alveolar bone destruction of AP.     

Root Canal Preparation and Enlargement Using Thermally Treated Nickel-Titanium Rotary Systems in Curved Canals

IntroductionThe purpose of this study was to evaluate root canal preparation and apical enlargement of curved canals using rotary heat-treated and heat/surface-treated systems by micro–computed tomographic imaging.MethodsCurved mesial root canals (n = 48) of mandibular molars (20°–40°) were prepared using ProDesign Logic (PDL; Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil) 25/.01 and 25/.06 or HyFlex EDM (HFEDM) 10/.05, HyFlex CM 20/.04, and HFEDM 25/.08. Apical enlargement was performed using PDL 40/.05 or HFEDM 40/.04. Scanning (9 μm) was performed before and after preparation and after apical enlargement using micro–computed tomographic imaging. Volume, percentage of volume increase, debris, untouched root canal surface, and centering ability were analyzed. Statistical analysis was performed using Mann-Whitney, Wilcoxon, and unpaired t tests (α = .05).ResultsHFEDM promoted a higher volume increase of the root canals than PDL after preparation and after apical enlargement (P < .05). The apical enlargement promoted a significant decrease in debris and untouched surface in both groups (P < .05). The percentage of debris and untouched surface were similar between HFEDM and PDL after preparation and after apical enlargement (P > .05). Both systems promoted centered canals (P > .05).ConclusionsHFEDM instruments promoted greater volume of the root canal than PDL. However, the cleaning ability of the instruments was similar. The apical increase up to size 40 with both instruments provided less debris and untouched surfaces and allowed centralization of the curved root canals.     

Immunolocalization of bone-resorptive cytokines in rat pulp and periapical lesions following surgical pulp exposure

The bone-resorptive cytokines interleukin 1 (IL-1) and tumor necrosis factor (TNF) have been implicated in the pathogenesis of many chronic inflammatory diseases, including pulpitis and apical periodontitis. To further elucidate their role in these disorders, we have identified cells that express IL-1α and TNFα in infected pulps and in developing rat periapical lesions after surgical pulp exposure. As detected by immunohistochemistry, IL-1α- and TNFα-positive cells were present as early as 2 days after pulp exposure in both the pulp and periapical region. The numbers of cytokine-expressing cells increased up to day 4 in the pulp and up to day 30 in the periapex. In contrast, cells expressing IL-1β and TNFβ the homologous forms of these mediators, were not found in pulp or periapical lesions during this period. Cells expressing IL-1α and TNFα were identified primarily as macrophages and fibroblasts, with occasional staining of polymorphonuclear leukocytes. Osteoblasts and osteoclasts were also positive, whereas lymphocytes were negative. In general, cytokine-expressing cells were located proximal to abscesses and the root apex. These findings demonstrate that cells that express bone-resorptive cytokines IL-1α and TNFα are present immediately after pulp exposure in this model, which supports the hypothesis that these mediators play a key role in pulpal and periapical pathogenesis, including the concomitant bone destruction. They also indicate that both resident connective tissue cells as well as infiltrating cells express bone-resorptive cytokines in response to infection in these lesions.     

Effect of the Progression of Fusobacterium nucleatum–induced Apical Periodontitis on the Gut Microbiota

IntroductionFusobacterium nucleatum, which is involved in the development of periodontal disease and apical lesions, can be transmitted to the colon and metastasize to colorectal cancer, suggesting a link between oral and systemic diseases. We analyzed the effects of F. nucleatum on bacterial flora in the gut and surrounding organs in a rat model of apical periodontitis and analyzed the infection route to the gut and distant organs.MethodsWe induced apical periodontitis in rat molars by infecting the dental pulp with F. nucleatum and then took X-ray images and performed histopathologic analyses. Next, we removed the maxilla, gut, heart, liver, and kidney from the rats at 0, 2, 4, and 8 weeks postsurgery and then extracted DNA samples and performed polymerase chain reaction and microbiome analyses using the Illumina MiSeq (Illumina Co, Tokyo, Japan).ResultsThe presence of inflammatory cell infiltration confirmed apical periodontitis from 2–8 weeks. Polymerase chain reaction and microbiome analyses revealed F. nucleatum in the rat gut from 2 weeks and in the kidney from 8 weeks. The rat gut, heart, liver, and kidney exhibited altered bacterial flora, including a marked decrease in Verrucomicrobia and an increase in Proteobacteria after 2 weeks and increases in Bacteroidetes and Firmicutes after 4 weeks.ConclusionsThe onset of F. nucleatum–induced apical periodontitis changed the bacterial flora in the rat gut, heart, liver, and kidney, with a confirmed progressing infection in the large intestines.     

Treatment of a Large Cystlike Inflammatory Periapical Lesion Associated with Mature Necrotic Teeth Using Regenerative Endodontic Therapy

Introduction

Regenerative endodontic therapy is currently used to treat immature permanent teeth with necrotic pulp and/or apical periodontitis. However, mature teeth with necrotic pulp and apical periodontitis have also been treated using regenerative endodontic therapy. The treatment resulted in resolution of apical periodontitis, regression of clinical signs and symptoms but no apparent thickening of the canal walls, and/or continued root development. A recent study in an animal model showed that the tissues formed in the canals of mature teeth with apical periodontitis after regenerative endodontic therapy were cementumlike, bonelike, and periodontal ligament–like tissue with numerous blood vessels. These tissues are similar to the tissues observed in immature permanent teeth with apical periodontitis after regenerative endodontic therapy.

Methods

A 23-year-old woman had a history of traumatic injury to her upper anterior teeth when she was 8 years old. Subsequently, #8 developed pulp necrosis and an acute apical abscess and #7 symptomatic apical periodontitis. The apex of #8 was slightly open, and the apex of #7 was completely formed. Instead of nonsurgical root canal therapy, regenerative endodontic therapy was attempted, including complete chemomechanical debridement on #8 and #7. This was based on the premise that filling of disinfected root canals with the host's biological vital tissue might be better than filling with foreign materials.

Results

After regenerative endodontic therapy of #8 and #7, there was radiographic evidence of periapical osseous healing and regression of clinical signs and symptoms. The pulp cavity of #8 decreased in size, and the apex closed. The pulp cavity of #7 appeared to be obliterated by mineralized tissue. These indicated ingrowth of new vital tissue into the chemomechanically debrided canals.

Conclusions

Regenerative endodontic therapy of mature teeth with apical periodontitis and apical abscess can result in the regression of clinical signs and/or symptoms and healing of apical periodontitis but no apparent thickening of the canal walls or continued root development. Filling of the disinfected canals with the host's vital tissue may be better than with foreign materials because vital tissue has innate and adaptive immune defense mechanisms.     

Plasma polyunsaturated fatty acids and periodontal recovery in Taiwanese with periodontitis: A significant relationship

BackgroundPlasma levels of polyunsaturated fatty acids (PUFAs) are different before and after periodontal treatment. Asians and Westerners have significantly different baseline levels of plasma PUFAs. However, no Asian study has reported the effects of nonsurgical treatment on the correlation between periodontal condition and plasma levels of PUFAs. We analyzed whether recovery from periodontitis was correlated with the elevation of plasma fatty acids 3 months after the nonsurgical intervention and with no recommended supplements.DesignThirty-five Taiwanese patients with periodontitis were recruited. Probing pocket depths (PPDs) and clinical attachment levels (CALs) were measured at baseline and 3 months after the nonsurgical treatment. Plasma levels of fatty acids were determined using gas chromatography. Differences and correlations between plasma fatty acid composition and periodontitis severity at baseline and 3 months after treatment were determined.ResultsTwenty-six patients completed the study. At the baseline, PPDs were negatively correlated with plasma n-3 PUFAs (r = −0.52, p < 0.01), but at 3 months post intervention, periodontitis severity had declined and the weight percentages of n-3 PUFAs, DPA, and DHA were significantly (p = 0.019, 0.005, and 0.037, respectively) higher. The recovery percentages of CALs were positively and significantly correlated with plasma ΔPUFAs and the percentage of Δn-3 PUFAs in ΔPUFAs (r = 0.42 and 0.45, respectively; p < 0.05 for both).ConclusionsWe conclude that a higher weight percentage of n-3 PUFAs in total PUFAs was related to the recovery of CALs 3 months after the nonsurgical periodontal treatment. However, no such relationship was found for PPDs.