Dental radiographic changes in individuals with COVID-19: a controlled retrospective study.

OBJECTIVE: The aim of this study is to compare the pre-COVID-19 and post-COVID-19 dental radiological findings of individuals with positive rRT-PCR test results and with healthy controls using the apical periodontitis grade scale (APGS), radiographic-based periodontal bone loss (R-PBL), and radiographic DMFT indices, and to investigate the relatively long-term dental effects of COVID-19. METHODS: This study included people who had two panoramic radiographs taken between 2018 and 2022. There are 52 patients with positive rRT-PCR tests in the study group. The control group included 50 individuals. Study and control groups were compared using the apical periodontitis grade scale (APGS), radiographic-based periodontal bone loss (R-PBL), and radiographic DMFT indices. RESULTS: Although results showed a significant difference in percentage R-PBL value and R-PBL types in the study group, there was no significant difference in percentage R-PBL value and R-PBL types in the control group. Also, both groups showed a significant difference in the DMFT index. CONCLUSIONS: According to the results of this study, it can be said that COVID-19 increases the incidence of periodontitis, and it can be interpreted that the pandemic may adversely affect the general oral health of all people.

Prevalence of apical periodontitis in people living with HIV in Southern Brazil / Prevalência de periodontite apical em pessoas vivendo com HIV no Sul do Brasil

Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

Etiología, fisiopatología y tratamiento de la periodontitis apical. Revisión de la literatura / Etiology, pathophysiology and treatment of apical periodontitis. Literature review

La periodontitis apical (PA) es una inflamación y destrucción de los tejidos periapicales comúnmente causada por bacterias como resultado de caries o traumatismos dentales. Aunque los mecanismos de defensa del huésped están activados, la acción bacteriana provoca la destrucción apical. Se ha identificado la microbiota relacionada con esta patología en el interior del conducto radicular. Enterococcus faecalis es un coco grampositivo presente en casos clínicos persistentes de PA. Un tratamiento de conducto puede eliminar los agentes infecciosos. Sin embargo, si la PA persiste, se puede considerar un retratamiento del conducto radicular o una apicectomía. Aunque el diagnóstico definitivo de PA se logra mediante un examen histopatológico, los estudios de investigación confirman que es más probable que la tomografía computarizada de haz cónico detecte PA que la radiografía periapical (RP). El objetivo de esta revisión de la literatura es describir la etiología, índice periapical, clasificación de la periodontitis apical: aguda y crónica, así como pruebas diagnósticas adicionales y alternativas de tratamiento para su abordaje clínico. (AU)

Apical Periodontitis (AP) is an inflammation and destruction of the periapical tissues commonly caused by bacteria as a result of dental caries or trauma. Although the host's defense mechanisms are activated, the bacterial action causes apical destruction. The microbiota related to this pathology has been identified inside the root canal of teeth. Enterococcus faecalis is a gram-positive cocci present in persistent clinical cases of AP. A root canal treatment can eliminate the infectious agents. However, if AP persists, a root canal retreatment or an apicoectomy can be considered. Although the definitive diagnosis of AP is achieved by histopathological examination, research studies confirm that cone beam computed tomography is more likely to detect AP than periapical radiography (RP). The objective of this literature review is to describe the etiology, periapical index, apical periodontitis classification: acute and chronic, as well as additional diagnostic test and treatment alternatives for its clinical approach. (AU)

Root filled teeth in two parallel Danish cohorts: A repeated longitudinal cohort study.

AIM: The aim of the study was to compare the frequency of root filled teeth and quality of root fillings (RFs) in two parallel, Danish cohorts each examined over 10 years and to evaluate factors associated with apical periodontitis (AP) and extraction of root filled teeth. METHODOLOGY: Two randomly selected cohorts (C1, C2) from Aarhus (age: 20-64 years) were followed for approximately 10 years, with full-mouth radiographic surveys performed at 5-year intervals (C1: 1997-2003-2008; C2: 2009-2014-2019). Frequency of root filled teeth, quality of RFs and coronal restorations, periapical status and tooth extraction were registered. Logistic regression analyses compared C1 with C2 for baseline and follow-up periods and assessed variables associated with AP (PAI-based) and extraction of root filled teeth. RESULTS: C1 included 330 and C2, 170 individuals, mean age 42.9 and 47.3 years, respectively, who attended all three radiographic examinations. The relative frequency of root filled teeth was lower in C2 than C1 at baseline (C1: 4.7%, C2: 3.6%; p < .001) and after 10 years (C1: 5.7%, C2: 4.2%; p < .001). The relative frequency of new RFs was lower in C2 than in C1 (p = .02). C2 had fewer short/long RFs at baseline than C1; quality of new RFs or coronal restorations was similar in C1 and C2. The risk of tooth extraction (p = .93) and risk of AP (p = .37) at 10-year follow-up was similar between the two cohorts. For both C1 and C2, root filled teeth with AP at baseline had increased risk of having AP (p < .001) or having been extracted (p < .001) at follow-up. Risk of extraction was higher for root filled premolars (p = .01) and molars (p = .01) than anteriors. Risk of AP at follow-up was higher for root filled molars (p < .001). Furthermore, inadequate quality of RFs (p = .02) and coronal restorations (p = .04) increased the risk of AP at follow-up in C1 and C2. CONCLUSIONS: The frequency of root filled teeth and new RFs decreased and little to no change in new RFs' quality, AP, or tooth extraction was seen over time (1997-2019). Root filled molars and teeth with AP at baseline had increased risk of AP and extraction.

Endodontic variables in patients with SARS-CoV-2 infection (COVID-19) in relation to the severity of the disease.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. It has been hypothesized oral health may be related to the severity and complications of COVID-19. The aim of this study was to analyze the prevalence of apical periodontitis and the frequency of root canal treatment in a sample of patients with SARS-CoV-2 infection (COVID-19), correlating them with the severity of the disease. MATERIAL AND METHODS: This retrospective study was conducted following the Strengthening Reporting Observational Studies in Epidemiology (STROBE) guidelines. The study examined 280 patients with positive real time PCR COVID-19 test whose treatment was performed in our hospital. Fifty-two patients aged 52.3 ± 17.3 years, including 30 males and 22 females, who had an orthopantomography in their clinical record, performed in the last 2 years, were included. Patients with SARS-CoV-2 infection were grouped as mild or moderate (MM) and severe or critical (SC) illness groups, according to the NIH COVID-19 Treatment Guidelines (Wu & McGoogan 2020). Radiographic records were analyzed and apical periodontitis (AP) was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, χ2 test and multivariate logistic regression were used in the statistical analysis. RESULTS: The number of carious teeth was significantly higher in the SC group (3.4 ± 4.1), which showed more than twice as many teeth with carious lesions than the MM group (1.4 ± 1.8) (p = 0.02). Multivariate regression analysis showed association between the number of carious teeth and the severity of SARS-CoV-2 disease (OR = 1.5; 95% CI = 1.1-2.1; p = 0.017). Endodontic status (OR = 7.12; 95% CI = 1.2-40.9; p = 0.027) also correlated with the disease severity. CONCLUSIONS: The results suggest that the oral health status of COVID-19 patients correlated with the severity of the SARS-CoV-2 virus infection. Significant association has been found between the severity of COVID-19 disease and the presence of a greater number of teeth with caries lesions, as well as with endodontic status.

Frequency and Risk Factors of Maxillary Sinusitis of Endodontic Origin Evaluated by a Dynamic Navigation and a New Filter of Cone-Beam Computed Tomography.

INTRODUCTION: The aim of this study was to determine the frequency and risk factors of maxillary sinusitis of endodontic origin (MSEO) on posterior maxillary teeth evaluated using dynamic navigation and a novel filter of cone-beam computed tomographic (CBCT) imaging. METHODS: CBCT scans of 453 patients (814 teeth) were selected. Data were divided into 4 groups: (1) root canal treatment (RCT), (2) relation of the root apex to the maxillary sinus, (3) apical periodontitis (AP), and (4) maxillary sinus inflammation (no inflammation, periapical osteoperiostitis, periapical mucositis, partial obstruction, or total obstruction). Frequency distribution and cross-tabulation were used for data analysis. The association of maxillary sinus abnormalities with other variables was analyzed using the chi-square test. The significance level was set at 5%, and the association between dependent and independent variables was analyzed using robust Poisson regression models. RESULTS: MSEO was found in 65.6% of the cases, and the highest frequency rates were in the periapical mucositis (44%) and partial obstruction (15.8%) groups. The rates of risk factors were highest in the cases of RCT (54.9%), AP (34.3%), and the root apex in contact with the maxillary sinus (53.8%). The most frequent sex and age group were female (55.8%) and 41-50 years (30.5%). CONCLUSIONS: The frequency of MSEO was high and positively associated with RCT, AP, and the root apex's position in contact with the floor of the maxillary sinus. The maxillary sinus filter of the CBCT software provides a clear image of maxillary sinus abnormalities.

Biología del tejido óseo y cambios morfológicos en su regeneración / Biology of bone tissue and morphological changes in its regeneration

Introducción: La regeneración ósea permite la reintegración y conformación de tejidos posteriores a la extracción o corrección de un defecto óseo. Es considerada una técnica de estimulación para la formación de hueso nuevo, donde se favorece la construcción y la preservación del coágulo con el fin de evitar la infiltración en la zona de reparación, de componentes celulares (células epiteliales y conjuntivas). Objetivos: Describir los cambios a nivel morfológico durante el proceso de regeneración ósea y mencionar distintas técnicas de preservación ósea y los factores necesarios para su realización. Presentación de caso: Paciente femenina con periodontitis apical asintomática en órganos dentarios 34 y 37, que se sometió a preservación alveolar mediante la práctica de exodoncia atraumática y regeneración ósea con xenoinjerto, colocación de membrana colágeno e implante posextractivo inmediato. Principales comentarios: La colocación inmediata de implantes posexodoncia permite una buena preservación del alveolo, siempre y cuando las condiciones clínicas del paciente así lo permitan, por ejemplo, la ausencia de procesos infecciosos agudizados como en el presente caso. La regeneración ósea, en el defecto producido por el proceso inflamatorio periapical, implicó una correcta detoxificación de la zona a través del curetaje y la aplicación de antibióticos. La respuesta inmunológica exagerada ante injertos óseos no es frecuente; sin embargo, en este caso llevó a una pérdida parcial del sustituto óseo sin comprometer el pronóstico de los implantes(AU)

Introduction: Bone regeneration allows the reintegration and conformation of tissues after the extraction or correction of a bone defect. It is considered a stimulation technique for the formation of new bone, where the construction and preservation of the clot is favored in order to avoid infiltration in the repair area of cellular components (epithelial and conjunctiva cells). Objective: Describe the changes at the morphological level during the bone regeneration process and mention different bone preservation techniques and the necessary factors for their implementation. Case presentation: Female patient with asymptomatic apical periodontitis in dental organs 34 and 37, who underwent alveolar preservation through the practice of atraumatic exodontics and bone regeneration with xenograft, collagen membrane placement and immediate post-extraction implant. Main comments: The immediate placement of post-exodontic implants allows a good preservation of the alveolus, as long as the clinical conditions of the patient allow it, for example, the absence of exacerbated infectious processes as in the present case. Bone regeneration, in the defect produced by the periapical inflammatory process, involved a correct detoxification of the area through curettage and the application of antibiotics. Exaggerated immune response to bone grafts is not common; however, in this case it led to a partial loss of bone substitute without compromising the prognosis of the implants(AU)

Endodontic inflammatory disease: A risk indicator for a first myocardial infarction.

AIM: To study the association between endodontic inflammatory disease and a first myocardial infarction (MI). METHODOLOGY: The study comprised 805 patients with recent experience of a first MI, each gender, age and geographically matched with a control. Panoramic radiographs were available for 797 patients and 796 controls. Endodontic inflammatory disease was assessed radiographically. The sum of decayed, missing and filled teeth (DMFT) was calculated, and the number of root filled teeth and teeth with periapical lesions were recorded. The associated risk of a first MI was expressed as odds ratios (OR) with 95% confidence intervals (CI), unadjusted and adjusted for confounders (family history of cardiovascular disease, smoking habits, marital status, education and diabetes). RESULTS: Patients who had suffered a first MI had higher DMFT (mean 22.5 vs. 21.9, p = .013) and more missing teeth (mean 7.5 vs. 6.3; p < .0001) than the healthy controls. The number of missing teeth was associated with an increased risk of a first MI (adjusted OR 1.04; CI 1.02-1.06). Conversely, decay-free, filled teeth were associated with decreased risk (adjusted OR 0.98; CI 0.96-1.00). Analysis based on age disclosed the following variables to be associated with an increased risk of a first MI: number of decayed teeth (adjusted OR 1.18; CI 1.02-1.37, in patients <60 years), any primary periapical lesion (adjusted OR 1.57; CI 1.08-2.29, in patients <65 years) and the proportion of root filled teeth (adjusted OR 1.18; CI 1.03-1.36, in patients ≥65 years). CONCLUSIONS: More missing teeth was independently associated with an increased risk of a first MI. In addition, endodontic inflammatory disease may contribute as an independent risk factor to cardiovascular disease since untreated caries, periapical lesions and root fillings, depending on age, were significantly associated with a first MI.

The Wnt/ß-catenin signaling pathway has a healing ability for periapical periodontitis.

Various disease-related genes have recently been identified using single nucleotide polymorphisms (SNPs). This study identified disease-related genes by analyzing SNP using genomic DNA isolated from Japanese patients with periapical periodontitis. Results showed that the SNP in LRP5 demonstrated a significant genotypic association with periapical lesions (Fisher's exact test, P < 0.05). We constructed an in vivo murine periapical periodontitis model to confirm the Wnt/ß-catenin signaling pathway's role in developing and healing periapical periodontitis. We observed that administration of the Wnt/ß-catenin signaling pathway inhibitor enlarged the periapical lesion. Moreover, applying lithium chloride (LiCl) to root canals accelerated periapical periodontitis healing. Histological analysis demonstrated that the expression levels of Col1a1 and Runx2 increased in the LiCl application group compared to that in the control group. Furthermore, many CD45R-positive cells appeared in the periapical lesions in the LiCl application group. These results indicated that LiCl promoted the healing of periapical periodontitis by inducing bone formation and immune responses. Our findings suggest that the Wnt/ß-catenin signaling pathway regulates the development of periapical periodontitis. We propose a bioactive next-generation root canal treatment agent for this dental lesion.

Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities.

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.

JAK2-STAT3 signaling pathway is involved in rat periapical lesions induced by Enterococcus faecalis.

OBJECTIVES: This study aimed to investigate the role of JAK2-STAT3 (Janus kinase 2/signal transducer and activator of transcription 3) in periapical disease caused by Enterococcus faecalis, as well as the correlation between lipoteichoic acid (LTA) in E. faecalis and the activity of the JAK2-STAT3 signaling pathway and osteoclast formation. MATERIALS AND METHODS: A rat model of periapical periodontitis induced by E. faecalis was established. Periapical bone resorption was confirmed by HE staining. The expression of JAK2, p-JAK2, STAT3, and p-STAT3 was assessed with immunohistochemical staining. Osteoclasts were observed through enzyme histochemical staining. LTA acted on mouse osteoclast precursor cells (RAW264.7 cells); a JAK2 inhibitor (AG490) was used to inhibit the JAK2-STAT3 pathway in RAW264.7 cells. The expression of proteins in the JAK2-STAT3 pathway and TRAP (tartrate resistant acid phosphatase) in RAW264.7 cells was also detected. RESULTS: Rat periapical periodontitis was successfully established and bone resorption peaked at day 21. The expression of critical components in the JAK2-STAT3 pathway increased with the progression of inflammation. LTA promoted the differentiation of RAW264.7 cells into osteoclasts. NFATc1 was highly expressed and was inhibited by AG490. CONCLUSIONS: JAK2-STAT3 signaling pathway plays an important role in the process of periapical bone resorption and osteoclastogenesis.

Evaluation of the Relationship between Type II Diabetes Mellitus and the Prevalence of Apical Periodontitis in Root-Filled Teeth Using Cone Beam Computed Tomography: An Observational Cross-Sectional Study.

OBJECTIVE: This study aimed to investigate the prevalence of apical periodontitis (AP) in patients with type II diabetes mellitus (DM) with either optimal glycemic control (OGC) or poor glycemic control (PGC) compared with nondiabetics using cone beam computed tomography (CBCT). SUBJECTS AND METHODS: The periapical status of 75 teeth with adequate root canal treatment performed at least 1 year ago that could be visualized in the field of view of CBCT images of 43 DM patients (29 females, 14 males) was compared with a control group consisting of 162 teeth of 86 nondiabetics (56 females, 30 males). In addition, the DM group was divided into subgroups according to the patients' mean glycated hemoglobin level as either having OGC or PGC. The periapical status of the teeth was evaluated using the CBCT periapical index (CBCTPAI), and AP was diagnosed as a CBCTPAI ≥1. χ2, Fisher's exact test, and independent-samples t tests were used for the statistical analysis, and p < 0.05 was considered significant. RESULTS: Significant differences between the DM group and the control group were observed (p< 0.05) in terms of AP (the frequencies of both CBCTPAI ≥1 and CBCTPAI ≥3) and the frequency of cardiovascular disease, while there were no significant differences between the DM subgroups (p > 0.05). CONCLUSION: The prevalence of AP and severe bone destruction in periapical tissues was significantly higher in the DM patients compared with the nondiabetic patients.

Associação entre a periodontite apical e o diabetes mellitus: uma revisão da literatura / Association between apical periodontitis and diabetes mellitus: a literature review

Objetivo: realizar uma revisão de literatura para verificar a relação entre o diabetes mellitus e a periodontite apical (PA). Revisão da literatura: a PA caracteriza-se por uma perda óssea na região do ápice dental, que decorre principalmente da contaminação do sistema de canais radiculares. Embora a PA seja um processo inflamatório local, na região do periápice radicular, sua progressão pode ser influenciada por patologias sistêmicas, como o diabetes. O diabetes melittus é uma patologia crônica na qual há alteração na produção de insulina ou resistência à ação desta, esse hormônio auxilia a manter a concentração normal de glicose sanguínea. O quadro de hiperglicemia crônica presente no paciente diabético descompensado ocasiona alterações fisiológicas, que permitem suspeitar de uma relação entre o diabetes e a progressão de lesões periapicais. Considerações finais: a literatura estudada sugere uma associação positiva entre a presença do diabetes e a progressão de lesões periapicais. Porém, apesar de os estudos apontarem que existe uma maior prevalência de periodontite apical em diabéticos, ainda são poucas as evidências científicas sobre o assunto. (AU)

Objective: the present study aims to review the lit-erature to verify the relationship between diabetes mellitus and apical periodontitis (AP). Literature Review: the AP is characterized by bone loss in the tooth apex region, mainly resulting from the contamination of the root canal system. Although AP is a local inflammatory process in the root peri-apex region, its development may be affected by systemic pathologies such as diabetes. Diabetes mellitus is a chronic condition that causes chang-es in insulin production or the resistance to its action, considering this hormone helps maintain-ing the normal concentration of blood glucose. The chronic hyperglycemia condition in decom-pensated diabetic patients causes physiological changes that allow establishing a relationship be-tween diabetes and the development of the peri-apical lesions. Final considerations: the literature studied suggests a positive association between the presence of diabetes and the development of periapical lesions. However, although studies in-dicate a higher prevalence of apical periodontitis in diabetics, there is still little scientific evidence on the subject. (AU)

Management and Histobacteriological Findings of Mucosal Fenestration: A Report of 2 Cases.

This article describes 2 unusual cases of mucosal fenestration associated with necrotic infected teeth, resulting in exposure of the root apex to the oral cavity. Both cases consisted of maxillary incisors with pulp necrosis and radiographic/tomographic evidence of apical periodontitis. Clinically, the root apex was exposed to the oral cavity through a fenestration in both bone and mucosa and covered with bacterial plaque and calculus. These teeth were treated by a combination of nonsurgical and surgical endodontic treatment. During surgery, the root apices were resected to within the alveolus and the fenestrated area covered by the flap. Specimens consisting of the root apex and surrounding soft tissues were subjected to histopathological and histobacteriological analyses. Histobacteriological analysis revealed extensive resorptive defects on the root apices filled with thick bacterial biofilm, irregular detachment of the cementum layers with consequent infection of the underlying spaces, and heavy infection in the apical foramina. The soft tissue specimens exhibited no or minimal inflammation. The 2 cases showed satisfactory postsurgical healing of the hard and soft tissues. Both cases of mucosal fenestration showed root apices covered with dense bacterial biofilms and associated with a bone crypt with no significant inflammatory tissue therein. The 2 cases were successfully treated by conservative approaches involving a combination of nonsurgical and surgical endodontic treatment with root-end resection.

Healing of Apical Periodontitis after Nonsurgical Root Canal Treatment: The Role of Statin Intake.

INTRODUCTION: Numerous previously undocumented factors may influence the healing of apical periodontitis (AP). The aim of this cohort study was to analyze the association between statin medication intake during the follow-up period and healing of AP. METHODS: Patients who self-reported being on statins during nonsurgical root canal treatment or retreatment and patients who reported never taking statins were included. All patients who received treatment on a tooth with periapical radiolucency in the postgraduate endodontics clinic at the University of Maryland School of Dentistry (2011-2014) were invited for follow-up 2 to 5 years after treatment. Healing was determined using the periapical index (PAI). Two calibrated endodontists assessed outcomes blinded to the statin intake. The association of statin intake and healing of endodontic treatment (ie, healed [PAI 1-2]/not healed [PAI 3-5]) was analyzed using the Fisher exact test. Logistic regression analysis was used to explore the association between statin intake and treatment outcome, controlling for the following confounding variables: diabetes mellitus, cardiovascular disease, and smoking, with confidence intervals set at 95%. RESULTS: A total of 60 cases were included in the final analysis, including 30 patients taking statins and 30 patients not taking statins as the control. The Fisher exact test showed significantly higher healing at the 2-year or greater follow-up in patients taking statins compared with controls (93.0% vs 70%; Fisher exact test, P = .02). CONCLUSIONS: The results of this study show a significant association between long-term statin intake and healing of AP after nonsurgical root canal treatment.

Crown therapy in young individuals with amelogenesis imperfecta: Long term follow-up of a randomized controlled trial.

OBJECTIVES: Amelogenesis imperfecta (AI) is a rare, genetically determined defect in enamel mineralization. Several problems are associated with AI: hypersensitivity, wear, restorations requiring replacement, gingivitis, aesthetic problems, and social avoidance. We conducted a randomized controlled trial of crown therapy in young individuals with AI showing excellent results. This study reports results from a long-term-follow-up with focus on quality, longevity and adverse events. METHODS: The RCT included 27 patients (aged 11-22 years) with severe AI in need of crown therapy and used a split-mouth technique. After placing 119 Procera® crowns and 108 IPS e.max Press crowns following randomization, we assessed longevity, quality, adverse events, and tooth sensitivity and calculated survival rates and success rates. RESULTS: We followed the original 227 crowns for 4.3-7.4 years (mean 5.5 ±â€¯0.8). In all, 79% (193) crowns were followed for at least 5 years. The survival rate was 99.6% and the success rate, 94.7%; 95% of the crowns had excellent or acceptable quality. Due to suboptimal marginal integrity, 4% of the crowns required adjustment. Sensitivity problems decreased after crown therapy (p < 0.001). All adverse events occurred in patients aged 19-23 years and involved apical periodontitis (3% of teeth); all but two events were related to dental trauma in the actual tooth. CONCLUSIONS: Ceramic crown therapy in adolescents and young adults with severe forms of AI show excellent survival and success rates and longevity with few adverse events. CLINICAL SIGNIFICANCE: Ceramic crown therapy can be recommended for adolescents and young adults with severe forms of amelogenesis imperfecta.

Ovariectomy Exacerbates Apical Periodontitis in Rats with an Increase in Expression of Proinflammatory Cytokines and Matrix Metalloproteinases.

INTRODUCTION: The aim of this study was to evaluate the gene expression of proinflammatory cytokines, matrix metalloproteinases (MMPs), and cathepsin K in apical periodontitis (AP) and the volume of lesions in ovariectomized and sham-operated rats. METHODS: Twenty 12-week-old female Wistar rats were subjected to ovariectomy (OVX) or sham surgery. After 9 weeks, access cavities were prepared in the maxillary and mandibular first molars, pulp tissue was removed, and canals were exposed to the oral environment during 21 days for the induction of AP. The groups were as follows: sham, OVX, sham+AP, and OVX+AP. Animals were euthanized, and blocks containing the maxillary first molar and the surrounding bone were removed for quantification of proinflammatory cytokines cathepsin K and MMP genes by real-time polymerase chain reaction. The hemimandibles containing the mandibular first molars were used for analysis of the AP lesion volume by micro-computed tomographic imaging. RESULTS: AP in OVX rats showed an increased expression of interleukin 1 beta, tumor necrosis factor alpha, interleukin 6, MMP-8, and MMP-13 (P < .05). OVX alone, without AP induction, did not affect the expression of the evaluated genes. Additionally, AP induced an increase in cathepsin K expression, without significant differences between AP in the sham and OVX groups (P > .05). Micro-computed tomographic imaging showed a significantly greater AP lesion mean volume in OVX compared with sham animals (P < .05). CONCLUSIONS: AP lesions in ovariectomized rats are larger and have an increased expression of proinflammatory cytokines and MMPs, indicating that the infection combined with ovariectomy has an important role in the regulation of these signaling molecules and enzymes during the development of AP. Based on that, it may be assumed that the hypoestrogenic condition aggravates inflammation and degradation of extracellular matrix components in AP, which may provide insight into understanding the development of AP in female postmenopausal patients.

Complicated untreated apical periodontitis causing paraesthesia: A case report.

The purpose of this article was to report a case of untreated apical periodontitis resulting in severe late complications. A patient with an asymptomatic crowned root canal-treated mandibular molar revealing a radiographic substandard endodontic treatment and a slight periapical radiolucency was made aware of the treatment options and opted for no treatment. The lesion slightly increased in size after 6 years, but the tooth remained asymptomatic and endodontic retreatment was again refused. After 4 more years, the patient presented with an abscess and severe pain, complicated by paraesthesia of the left chin and lip. Radiographic examination revealed that the lesion had increased considerably to involve the mandibular canal. The treatment protocol included long-term intracanal medication with calcium hydroxide and follow-ups revealed complete resolution of the periapical radiolucency and the paraesthesia had completely subsided.

A Case of External Dental Fistula Related to a Fixed Cantilever Bridge.

An external dental fistula is a skin manifestation caused by an underlying dental problem. We report a rare case of external dental fistula associated with a fixed cantilever denture. A 77-year-old Japanese woman presented with an enlarging reddish granulomatous lesion on her right cheek that was diagnosed as an external dental fistula. A fixed cantilever denture had initially been attached to her upper jaw with her seven bona fide teeth. However, six teeth were completely lost and the denture was attached to only one tooth, which showed apical periodontitis. Subsequently, the external dental fistula developed. We should keep in mind that a patient with a fixed cantilever denture can suffer from apical periodontitis and a subsequent external dental fistula due to a failure to maintain appropriate oral hygiene.