Can Apical Periodontitis Modify Systemic Levels of Inflammatory Markers? A Systematic Review and Meta-analysis

Introduction

This systematic review and meta-analysis investigated evidence to support whether apical periodontitis (AP) can modify the systemic levels of inflammatory markers (IM) in humans.

Methods

The MEDLINE, Embase, Cochrane, and PubMed databases were searched between 1948 and 2012, with no language restriction. Additionally, the bibliography of all relevant articles and textbooks were manually searched. Based on inclusion and exclusion criteria, 2 reviewers independently rated the quality of each study based on the Newcastle-Ottawa Scale. The primary outcome variable for meta-analysis was determined by the serum levels of IMs in AP subjects versus healthy controls or in AP subjects before versus after treatment intervention.

Results

Among the 531 initially identified articles, 20 comprised the final analysis. Thirty-one different IMs were analyzed, with immunoglobulin (Ig) A, IgM, IgG, and C-reactive protein (CRP) being the most commonly investigated. CRP, interleukin (IL)-1, IL-2, IL-6, asymmetrical dimethylarginine, IgA, IgG, and IgM were shown to be increased in patients with AP compared with controls in most studies. Meta-analyses showed that serum levels of IgA (P = .001), IgG (P = .04), and IgM (P < .00001) were increased in humans with AP compared with healthy controls and serum levels of CRP, IgA, IgE, IgG, and IgM were not significantly different between patients with AP before and after treatment (P > .05).

Conclusions

Available evidence is limited but consistent, suggesting that AP is associated with increased levels of CRP, IL-1, IL-2, IL-6, asymmetrical dimethylarginine, IgA, IgG, and IgM in humans. These findings suggest that AP may contribute to a systemic immune response not confined to the localized lesion, potentially leading to increased systemic inflammation.     

Healing of Apical Periodontitis in Patients with Inflammatory Bowel Diseases and under Anti–tumor Necrosis Factor Alpha Therapy

Introduction

We evaluated healing after nonsurgical primary/secondary endodontic treatment of apical periodontitis (AP) in patients with inflammatory bowel diseases (IBDs) treated with anti–tumor necrosis factor alpha biologic medications (BMs).

Immunocolocalization of Interferon Regulatory Factory 5 with Tumor Necrosis Factor Receptor–associated Factor 6 and AKT2 in Human Apical Periodontitis

IntroductionInterferon regulatory factor 5 (IRF5) is critical for the regulation of immune and inflammatory responses in health and diseases. However, the presence of IRF5 in human apical periodontitis remains unknown. This study aimed to explore the expression and colocalization of IRF5 with tumor necrosis factor receptor–associated factor 6 (TRAF6) and AKT2 in human apical periodontitis.MethodsA total of 39 human periapical tissues, including healthy gingival tissues (n = 12), periapical granulomas (PGs, n = 13), and radicular cysts (RCs, n = 14), were used in this study. The inflammatory infiltrates of lesions were evaluated by hematoxylin-eosin staining. The expression of IRF5 was detected by immunohistochemistry. Double immunofluorescence assessment was performed to colocalize IRF5 with CD68, TRAF6, and AKT2, respectively. Data were analyzed using the Kruskal-Wallis test.ResultsImmunohistochemistry revealed significantly higher expressions of IRF5 in PGs and RCs than the healthy control group. IRF5-CD68 double-positive cells were more predominant in RCs and PGs than the healthy control group. Significant differences of the IRF5-TRAF6 and IRF5-AKT2 double-positive cells were detected in periapical lesions compared with the healthy control tissues.ConclusionsIRF5 was highly expressed in macrophages of human periapical tissues and was colocalized with TRAF6 or AKT2 in human periapical tissues. These findings may provide new clues for understanding the pathogenesis of periapical diseases.     

Diagnostic Accuracy of 5 Dental Pulp Tests: A Systematic Review and Meta-analysis

Introduction

The aim of this systematic review was to investigate and compare the diagnostic accuracy including sensitivity, specificity, adjusted accuracy, adjusted positive predictive value (PPV), and adjusted negative predictive value (NPV) of cold pulp testing (CPT), heat pulp testing (HPT), electric pulp testing (EPT), laser Doppler flowmetry (LDF), and pulse oximetry (PO).

Nonsteroidal Anti-inflammatory Drugs for Managing Postoperative Endodontic Pain in Patients Who Present with Preoperative Pain: A Systematic Review and Meta-analysis

Introduction

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been commonly used to treat endodontic postoperative pain. The purpose of this study was to address the following Population, Intervention, Comparator, Outcome, Timing, Study design and setting question: in patients with preoperative pain who undergo initial orthograde endodontic treatment, what is the comparative efficacy of NSAIDS compared with non-narcotic analgesics or placebo in reducing postoperative pain and the incidence of adverse events.

In Vivo and In Vitro Comparison of Internal and Marginal Fit of Digital and Conventional Impressions for Full-Coverage Fixed Restorations: A Systematic Review and Meta-analysis

PurposeThis study aims to evaluate digital and conventional impressions for full-coverage restorations in terms of marginal and internal discrepancies.Study selectionThe analysis included in vivo and in vitro studies reporting the marginal or internal gap of full-coverage restorations that provide both the conventional and digital impression. The PubMed, Cochrane Trials, and Scopus databases were searched. The quality of clinical trials was rated using Cochrane Collaboration's tool, and the quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool. Heterogeneity among the studies was evaluated, and a meta-analysis with subgroup analysis was conducted whenever it was possible.ResultsThirty-three articles (8 prospective clinical trials and 26 in vitro studies) were selected to extract data after applying the predefined selection criteria. The standard mean difference (SMD) of the meta-analysis for marginal adaptation was ?0.76 (95% confidence interval: ?1.23 to ?0.29) and ?0.59 (95% confidence interval: ?0.93 to ?0.24) for in vitro and in vivo studies, respectively, indicating digital impressions provided significantly less marginal gap than conventional impressions in in vitro studies (P = .002). The impression technique did not significantly influence the internal adaptation.ConclusionsDifferences in marginal adaptation between the digital and conventional groups are not significant for in vivo studies, but for in vitro studies, the digital impression resulted in better marginal adaptation. Based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for marginal adaptation, clinical studies were classified as high confidence and in vitro studies were graded moderate because of the inconsistency. Furthermore, high-quality studies are needed to confirm our results (the International Prospective Register of Systematic Reviews; CRD42017077925).