Epidemiology of Odontogenic Sinusitis.

Odontogenic sinusitis (ODS) is more common than historically thought, representing 25% to 40% of all maxillary sinusitis. Due to a lack of widely accepted diagnostic criteria and a specific international diagnostic code, a true overall prevalence is unknown. ODS may be caused by either a multitude of infectious dental pathologies or complications after dental procedures. The most common dental etiologies causing ODS are apical periodontitis (endodontic) and oroantral communication or fistula after dental extraction. Less commonly, ODS can evolve after dental implant or maxillary sinus bone grafting surgeries, infection of odontogenic cysts, or advanced periodontitis.

Artificial intelligence vs. semi-automated segmentation for assessment of dental periapical lesion volume index score: A cone-beam CT study.

INTRODUCTION: Cone beam computed tomography periapical volume index (CBCTPAVI) is a categorisation tool to assess periapical lesion size in three-dimensions and predict treatment outcomes. This index was determined using a time-consuming semi-automatic segmentation technique. This study compared artificial intelligence (AI) with semi-automated segmentation to determine AI's ability to accurately determine CBCTPAVI score. METHODS: CBCTPAVI scores for 500 tooth roots were determined using both the semi-automatic segmentation technique in three-dimensional imaging analysis software (Mimics Research™) and AI (Diagnocat™). A confusion matrix was created to compare the CBCTPAVI score by the AI with the semi-automatic segmentation technique. Evaluation metrics, precision, recall, F1-score (2×precision×recallprecision+recall), and overall accuracy were determined. RESULTS: In 84.4 % (n = 422) of cases the AI classified CBCTPAVI score the same as the semi-automated technique. AI was unable to classify any lesion as index 1 or 2, due to its limitation in small volume measurement. When lesions classified as index 1 and 2 by the semi-automatic segmentation technique were excluded, the AI demonstrated levels of precision, recall and F1-score, all above 0.85, for indices 0, 3-6; and accuracy over 90 %. CONCLUSIONS: Diagnocat™ with its ability to determine CBCTPAVI score in approximately 2 min following upload of the CBCT could be an excellent and efficient tool to facilitate better monitoring and assessment of periapical lesions in everyday clinical practice and/or radiographic reporting. However, to assess three-dimensional healing of smaller lesions (with scores 1 and 2), further advancements in AI technologies are needed.

Effect of Foraminal Enlargement on Periapical Healing in Necrotic Teeth: A Systematic Review.

Introduction: Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion. Materials and Methods: Searches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. Ex vivo and in vivo studies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute's for ex vivo studies and Systematic Review Centre for Laboratory animal Experimentation's risk of bias tools for in vivo studies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided. Results: Of 950 studies, 2 in vivo studies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding ex vivo studies, 3 were eligible, using extracted human teeth. The inoculations in ex vivo models were performed with Enterococcus (E.) faecalis, and FE reduced E. faecalis in the ex vivo models. Conclusions: Foraminal enlargement seems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysis in animal studies. However, caution is necessary when translating these results to the clinical environment.

Multislice computed tomography demonstrating mental nerve paresthesia caused by periapical infection: A case report.

Components derived from an infected lesion within the bone can spread through various passages in the mandible, particularly via the mental foramen. Radiologically, the spread of infection is typically nonspecific and challenging to characterize; however, multislice computed tomography (MSCT) can effectively detect pathological changes in soft tissues and the bone marrow space. This report describes the case of a 55-year-old woman who experienced mental nerve paresthesia due to a periapical infection of the right mandibular second premolar. MSCT imaging revealed increased attenuation around the periapical lesion extending into the mandibular canal and loss of the juxtamental foraminal fat pad. Following endodontic treatment of the tooth suspected to be the source of the infection, the patient's symptoms resolved, and the previous MSCT imaging findings were no longer present. Increased bone marrow attenuation and obliteration of the fat plane in the buccal aspect of the mental foramen may serve as radiologic indicators of inflammation spreading from the bone marrow space.

Antibiotic Over-Prescription by Dentists in the Treatment of Apical Periodontitis: A Systematic Review and Meta-Analysis.

After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease. OBJECTIVES: The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. METHODS: PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle-Ottawa Scale. The certainty of evidence was assessed using GRADE. RESULTS: The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. CONCLUSIONS: Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.

A comparison of radiographically determined periapical healing and tooth survival outcomes of root canal (re)treatment performed in two care pathways within the United Kingdom Armed Forces.

AIMS: To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes. METHODOLOGY: This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4-8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi-square tests, univariate logistic regression and Cox proportional hazards models. RESULTS: A significantly (p < 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60-month cumulative tooth survival was lower (p = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55). CONCLUSIONS: For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity.

Association between pulp and periapical disease with type 2 diabetes: A bidirectional Mendelian randomization.

AIM: This current Mendelian randomization (MR) study aims to comprehensively explore the potential bidirectional link between pulp and periapical disease (PAP) with type 2 diabetes mellitus (T2DM). METHODOLOGY: Summary level data of European-based population genome-wide association studies (GWASs) were employed to undertake this MR study. With the selection of single nucleotide polymorphisms (SNPs) as the instrumental variable, the radial inverse-variance weighted (radial IVW) method with modified second-order weights was applied as the primary method. Additionally, a range of sensitivity analyses were conducted to investigate pleiotropy. Results from different sources of outcome were pooled by meta-analysis with the fixed model. RESULTS: The results of this MR analysis did not suggest a significant impact of pulp and periapical disease on type 2 diabetes (combined OR = 1.04, 95% CI: 1.00-1.07, p = .033) and vice versa (OR = 1.04, 95% CI: 0.96-1.14, p = .329). No significant pleiotropy was detected in the final model after the removal of outliers, demonstrating the reliability of the results in our primary analysis. CONCLUSIONS: With the limitations inherent in the present MR study, there is no significant evidence in either direction to suggest a causal association between pulp and periapical disease and type 2 diabetes mellitus.

Characteristics analysis of clinical trial registration for endodontic diseases based on the ClinicalTrials.gov and ChiCTR databases / 口腔疾病防治

Objective@#To summarize the clinical registration data of endodontic diseases registered in ClinicalTrials.gov in the United States and Chinese Clinical Trial Registry (ChiCTR), and analyze the registration characteristics at home and abroad@*Methods@#We searched the clinical studies related to endodontic disease registered in the two databases from January 1, 2000, to August 20, 2023. We extracted and analyzed the information from clinical studies related to endodontic diseases. The extracted content included information on the registration region, registration year, trial title, research direction, sample size, trial progress, study type, trial design, blinding method, clinical trial phase, and participating institutions.@*Results@#The two databases contained a total of 536 191 registered items, of which 634 were endodontic diseases. Clinical trials in the registry of endodontic diseases involved 43 countries, of which the top three were Egypt (188 items), China (130 items), and the America (46 items). In addition, the number of registrations of clinical trials on endodontic diseases has significantly increased since 2015. The research directions were mainly pulposis (434 items), caries (106 items), and periapical diseases (77 items), which mostly involved etiology, drug intervention, surgical intervention, new technology, and new materials. Moreover, there were 430 clinical trials (67.82%) with a sample size < 100 and 185 (29.18%) with a sample size of 100-999. The progress status at the time of registration showed the largest number of completed trials, accounting for 286 items (45.11%), followed by unknown (125 items), recruiting (110 items), and not yet recruiting (81 items). The main research types were intervention studies (546 items, 86.12%), and the main design model was randomized parallel controlled trials (473 items, 74.61%). Additionally, 423 items (66.72%) were marked using the blind method, mainly double-blind trials (195 items), followed by other/unmarked (123 items, 19.40%) and open study (88 items, 13.88%). Furthermore, the largest number of items in the study phase were marked other/unlabeled (388 items), followed by phaseⅡ study (69 items) and preliminary study (62 items). Additionally, 611 items (96.37%) were clinical trials with a number of participating institutions < 3, and 23 items (3.63%) had a number of participating institutions ≥ 3@*Conclusion@#The number of clinical trials registered for endodontic diseases is generally on the rise, but it is still relatively small. The quality of the study design needs to be enhanced, and the registration information in the study phase needs to be improved. Moreover, the number of multicenter trials is small. In the future, we should fully mobilize the talent advantages of well-known stomatology majors in China, take the lead in conducting high-quality, multi-center clinical research, and realize the transformation of results.

Post-treatment Apical Periodontitis in Primary Non-surgical Root Canal Treatment: A Multiple Correspondence Analysis.

Introduction: The presented study aimed to characterise periapical disease in teeth with primary non-surgical root canal treatment in persistent or emergent categories and their risk association. Methods: A retrospective observational study that evaluated permanent teeth with primary non-surgical root canal treatment, was conducted clinically and radiographically for over one year. The following variables were analysed: gender, age, type and location of tooth, previous diagnosis, treatment conditions, and type of coronal restoration. The supplementary variables included the perspectives of the treatment outcome, such as Remains normal, Improvement, and Failure. Statistical analysis was performed using a univariate analysis that estimated the average and proportion for each factor according to the result of the primary non-surgical root canal treatment. The multiple correspondence analysis identified the hierarchy between active variables and their association with the results. Results: A total of 232 teeth in 155 participants were analysed. A χ2 value, (P=0.023) showed that the emergent disease is associated with patients around the age of 50. The multiple correspondence analysis identified a tendency of grouping between the emergent disease and the short filling category, followed by symptomatic pulpitis as a previous diagnosis. The persistent disease was associated with errors and overfillings. An inadequate root filling and taper density adversely impacted the treatment outcome. Conclusions: The length of obturation influenced the presence of failure. Short fillings were associated with emerging periapical disease. Errors and overfillings contributed to the persistent disease in the populations studied.

Magnetic resonance imaging in the diagnosis of periodontal and periapical disease.

OBJECTIVES: Early pre-clinical inflammatory changes in periodontal and/or periapical lesions, which typically precede bone loss, are challenging to diagnose using ionizing-radiation-based imaging modalities. MRI provides relevant additional diagnostic information of inflammatory processes in soft and hard tissues. The aim of the present study is to undertake a systematic review of the literature on MRI in the diagnosis of periodontal and/or periapical disease. METHODS AND MATERIALS: The PubMed/MEDLINE and Scopus bibliographic databases were searched (2000-2021) using the search string: ("MRI" or "magnetic resonance imaging") and ("periodontitis" or "periodontal" or "apical pathology" or "endodontic pathology" or "periapical" or "furcation" or "intrabony"). The search was limited to studies published in English. The studies were assessed independently by three reviewers, focusing on the MRI sequences, imaging modalities (radiographs, cone beam CT (CBCT), and MRI), disease definition, assessed parameters, and outcome measurements. RESULTS: The search strategy yielded 34 studies, from which 13 were included. Overall, the findings of MRI were in agreement with CBCT. The studies showed that MRI provided diagnostic information of the hard and soft tissue components affected by periodontal and/or periapical disease with a fairly high sensitivity and specificity. However, the assessed parameters (e.g. MRI acquisition protocols, and disease definition) differed substantially. CONCLUSIONS: The included studies indicate that the use of MRI in the diagnosis of periodontal and/or periapical disease is feasible and promising. More studies are needed to define the accuracy of this non-ionizing-radiation-based diagnostic modality, in the assessment of periodontal and/or periapical lesions.

Pulp and periapical disease as a risk factor for osteonecrosis of the jaw: a national cohort-based study in Korea.

PURPOSE: This longitudinal cohort study aimed to evaluate the relationship between osteonecrosis of the jaw and pulp and periapical disease in patients who were administered bisphosphonates. METHODS: Using data from a nationwide cohort, we examined the association among dental caries, pulp and periapical disease, and osteonecrosis of the jaw in women aged >50 years who received bisphosphonates for more than 1 year between 2002 and 2015. Because of ambiguities in the diagnosis of osteonecrosis of the jaw in population-based data, we operationally defined and categorized the condition into established and potential osteonecrosis of the jaw. RESULTS: Pulp and periapical disease significantly increased the development of both established and potential osteonecrosis of the jaw (hazard ratio, 2.21; 95% confidence interval, 1.40-3.48; and hazard ratio, 2.22; 95% confidence interval, 1.65-2.98, respectively). Root canal treatment did not have any influence on the development of osteonecrosis of the jaw. CONCLUSIONS: Pulp and periapical disease may be a major risk factor for osteonecrosis of the jaw. The study findings suggest that patients should undergo regular dental examinations to detect pulp and periapical disease before or during the administration of bisphosphonates and that root canal treatment should be considered to decrease the risk of osteonecrosis of the jaw.

Application of advanced platelet-rich fibrin for through-and-through bony defect during endodontic surgery: Three case reports and review of the literature.

BACKGROUND: The use of advanced platelet-rich fibrin (A-PRF) membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases. CASE SUMMARY: Herein, three patients presented to the endodontic clinic suffering from apical periodontitis, associated with large bone resorption and related to previously endodontically treated teeth. Periapical surgery was indicated in these cases and the osteotomy site was covered by A-PRF membrane. Cone-beam computed tomography (CBCT) was used to assess the cases before and after the surgery. CONCLUSION: Four months post-surgery, the recall CBCT scan showed complete obliteration of the osteotomy with newly formed bone. A-PRF membrane showed promising results and was an advantageous addition to surgical endodontic treatment.

Treatment outcome of surgical and non-surgical endodontic retreatment of teeth with apical periodontitis.

AIMS: To evaluate and compare the treatment outcome of root filled teeth with apical periodontitis treated either non-surgically or by endodontic microsurgery, and to assess the influence of an intra-radicular post, clinical and demographic factors. METHODOLOGY: Clinical and radiological data from 1157 patients with apical periodontitis in previously root filled teeth treated by postgraduate students at the Department of Endodontics, University of Oslo, between September 2010 and January 2020 with recall data at least 11 months from completion were studied. Surgical cases were scored using the Rud/Molven criteria and grouped into success, uncertain or failure at control. Non-surgical cases were scored with the periapical index (PAI) and similarly grouped into success, uncertain or failure at control. Chi-square analyses were used for comparison of subgroups of teeth treated and logistic regression analyses for assessment of the influence of clinical variables. RESULTS: Non-surgical retreatment was performed on 351 teeth and 107 teeth were treated with endodontic microsurgery, with overall success rates of 65.5% and 77.6%, respectively. The difference was statistically significant. Teeth with an intra-radicular post treated non-surgically (n = 30) were successful in 73.3% of cases, whereas teeth with intra-radicular post treated with endodontic microsurgery (n = 30) had a lower, 66.7% success rate. The distribution of tooth groups (anterior, premolar and molar) differed significantly between surgical and non-surgical cases, with maxillary anterior and premolar teeth more often treated surgically. Non-surgical retreatment cases were significantly influenced by patients' age (older patients had poorer outcome) and pre-operative PAI score (negatively correlated with outcome). Surgical cases were not significantly influenced by the factors studied here. CONCLUSIONS: The tooth type differed significantly for teeth treated by surgical versus non-surgical methods. Microsurgical treatment with apicectomy and retrograde filling showed significantly better treatment results than non-surgical retreatment of teeth with apical periodontitis, whereas treatment outcome in teeth with posts after non-surgical treatment tended to be better than after surgical treatment. Outcome of non-surgical retreatment was negatively influenced by older age and higher pre-operative PAI score.

Hallazgos por imagen de patología dentaria en tomografía computarizada / CT findings for dental disease

La patología dentaria traumática y en especial la inflamatorio-infecciosa son muy prevalentes en nuestro medio. Esta última suele encontrarse de forma incidental en muchos de los estudios radiológicos que incluyen la región orofacial. Además, es una potencial causa de complicaciones graves, lo que hace que su diagnóstico y tratamiento precoz sean importantes. La tomografía computarizada multidetector ofrece un buen rendimiento diagnóstico en la patología dentaria, aunque sus manifestaciones radiológicas pueden ser sutiles y si no se conocen, pasar desapercibidas. Asimismo, son cada vez más frecuentes los procedimientos dentales invasivos, no exentos de complicaciones. Por otra parte, en la práctica diaria pueden encontrarse variedad de lesiones mandibulares radiolucentes o anomalías del desarrollo que pueden llevar a interpretaciones erróneas. Por todo ello, es recomendable que el radiólogo esté familiarizado con los posibles hallazgos en la patología dentaria.(AU)

Traumatic and especially inflammatory-infectious dental lesions are very prevalent in our context. Inflammatory-infectious disease is usually discovered incidentally on imaging studies that include the orofacial region. Moreover, these conditions can result in potentially severe complications, so early diagnosis and treatment are important. Multidetector computed tomography offers good diagnostic performance for dental lesions, although the radiological findings can be subtle and can go undetected if the radiologist is not familiar with them. Likewise, invasive dental procedures are becoming increasingly common, and these can also result in complications. On the other hand, in daily practice a variety of radiolucent mandibular lesions or developmental anomalies can lead to erroneous interpretations. For these reasons, radiologists should be familiar with possible findings related with dental conditions.(AU)

CT findings for dental disease.

Traumatic and especially inflammatory-infectious dental lesions are very prevalent in our context. Inflammatory-infectious disease is usually discovered incidentally on imaging studies that include the orofacial region. Moreover, these conditions can result in potentially severe complications, so early diagnosis and treatment are important. Multidetector computed tomography offers good diagnostic performance for dental lesions, although the radiological findings can be subtle and can go undetected if the radiologist is not familiar with them. Likewise, invasive dental procedures are becoming increasingly common, and these can also result in complications. On the other hand, in daily practice a variety of radiolucent mandibular lesions or developmental anomalies can lead to erroneous interpretations. For these reasons, radiologists should be familiar with possible findings related with dental conditions.

Nonmalignant nonendodontic lesions mimicking periapical lesions of endodontic origin: A systematic review.

The objective of the study is to describe the clinical and radiographic features of nonmalignant nonendodontic periapical lesions (NMNPLs) mimicking lesions of endodontic cause. Five electronic databases, PubMed, Web of Science, Scopus, Embase, and ProQuest, were searched (till July 2021) for case reports, case series, and cross-sectional studies, in English language, reporting NMNPLs, which were clinically and/or radiographically simulating periapical pathosis of endodontic origin. Data extraction was done followed by quality assessment of the included articles using the Joanna Briggs Institute tool for case reports and case series. Seventy-three articles comprising 176 cases were included. Sixty-one articles were case reports, nine articles were case series, and three articles were retrospective studies. Male:female ratio was 1.5:1, with a higher prevalence of lesions occurring in the fourth and second decades of life. The majority of the lesions were located in the anterior maxilla. Radiographically, most of the lesions were well defined, radiolucent, and unilocular. Histologically, 29 different types of NMNPLs were reported, with the most common ones being odontogenic keratocyst (25.56%), dentigerous cyst (17.61%), ameloblastoma (11.36%), nasopalatine duct cyst (10.79%), and adenomatoid odontogenic tumor (5.68%). As all the included studies were observational, the quality of available evidence is considered low. Various features such as loss of tooth vitality, history of trauma, and presence of periapical radiolucency may lead to misdiagnosis of NMNPLs and must be considered during diagnosis of the lesion. Additional imaging modalities and histopathology can aid in right diagnosis.

Periapical status transitions in teeth with posts versus without posts: a retrospective longitudinal radiographic study.

OBJECTIVES: The aim of this study was to compare periapical status transitions in teeth after post placement compared with other post-endodontic treatments in root-filled teeth. MATERIAL AND METHODS: This retrospective longitudinal radiographic study included radiographs of 284 patients with root filled and restored teeth with composite fillings (Endo-fill group, n = 100), crown or fixed prosthesis (Endo-crown group, n = 82) or post and core restorations (Endo-post group, n = 102). All post and core restorations were made of gold alloy. The radiographs taken at the end of endodontic treatment, at the end of post-endodontic treatment and at least 8 months after post-endodontic treatment were evaluated. Post-operative periapical status was assessed according to the periapical index (PAI) and all teeth included in the study had no apical periodontitis preoperatively. Multi-state Markov analysis was used to assess periapical status transitions among the treatment groups. RESULTS: Of 284 root-filled teeth without apical periodontitis at baseline, 7.7% developed clear apical pathology within a minimum of 8 months observational period. In the Endo-post group 11 (10.78%) teeth transited from Healthy (PAI 1) to Disease (PAI 2-4) state compared with eight (9.75%) in the Endo-crown group and four (4%) in the Endo-fill group. The transition probabilities from Healthy (PAI 1) to Mild diseased (PAI 2) were 17.5% in the Endo-post group, 13.1% in the Endo-crown group and 5.3% in the Endo-fill group. Multivariate analysis showed that teeth in the Endo-fill group had 60% lower hazard to transit from Healthy (PAI 1) to Mild diseased (PAI 2) state [HR 0.40; 95% CI 0.12, 0.94]. A period exceeding 8 months between the end of the endodontic treatment and prosthetic treatment significantly increased the hazard of disease progression by three times compared with a period of ≤8 months [HR 3.16; 95% CI 1.06, 9.42]. CONCLUSIONS: Teeth without radiographic lesions at baseline and restored with posts had higher hazard to transit from healthy to diseased periapical status compared with teeth restored with composite restorations. Controlled clinical trials with longer follow-up periods are needed to validate these findings.

Pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study.

This study aimed to determine the incidence and contributing factors to pulpal and periapical disease in crowned vital teeth. Seventy-three pairs of healthy teeth were included and divided into two groups; 'crowned' and 'untreated' groups. The crowned group was prepared for full coverage crown and no treatment was carried out on the untreated group. Both groups were subjected to clinical and radiographic examination to detect endodontic signs and symptoms pre-operatively and one-week after crown cementation. Electric pulp test was also subjected to both groups, pre-operatively, after tooth preparation and before crown cementation. The incidence of pulpal and periapical disease was 6.8% and 1.4%, respectively, after tooth preparation. Factors associated with pulpal and periapical disease were exposed pulp during tooth preparation and pre-operative bone level <35%. Despite the low incidence, the occurrence of pulpal and periapical disease within a short period is noteworthy.

Influence of periapical lesion size on healing outcome following regenerative endodontic procedures: a clinical investigation.

OBJECTIVES: The current study aimed to investigate the influence of the periapical lesion size on healing outcome following Regenerative Endodontic Procedures (REPs) in mature teeth using cone-beam computed tomography (CBCT) and Mimics software. METHODS: The study included ten mature necrotic maxillary anterior teeth with periapical lesions ≥ 3 CBCT Periapical index score (CBCTPAI). REPs via blood clots were performed for all the teeth. CBCT scans were taken pre and postoperatively after 12 months follow-up periods and transferred to Mimics for volume measurements and comparison. Statistical analysis was performed using the Wilcoxon signed-rank test. RESULT: All teeth were symptom-free with a statistically significant decrease in the volume of the periapical lesion (P < 0.05) after 12 months except for one case. CONCLUSION: The study concluded that REPs could be a successful treatment modality for mature necrotic teeth with periapical lesions however the size of the preoperative periapical lesion could affect the outcome of the periapical healing. TRIAL REGISTRATION: The study was registered in ClinicalTrials.gov (ID: NCT04646538).

Avaliação da carga microbiana e fúngica de sistemas de canais radiculares infectados e a expressão apical de integrinas, citocinas e quimiocinas nos tecidos / Assessment of the microbial and fungal load of infected root canal systems and the apical expression of integrins, cytokines and chemokines in adjacent perirradicular tissues

Este estudo busca avaliar quantitativamente a expressão do RNA mensageiro (mRNA) das integrinas alfa1, alfa4, alfa 5, alfa L, citocinas e quimiocinas, a partir de células presentes no líquido intersticial periapical adjacente a dentes com infecção do canal radicular. Foram selecionados 22 indivíduos com necessidade de tratamento endodôntico e encaminhados à Faculdade de Odontologia da Universidade Federal de Minas Gerais (Belo Horizonte, MG, Brasil). As amostras foram coletadas em 11 dentes necróticos e portadores de infecções endodônticas e 11 dentes hígidos que necessitavam de tratamento endodôntico por motivos protéticos. Após a cirurgia de acesso e antes dos procedimentos de limpeza e modelagem do sistema de canais radiculares (T0), imediatamente após a limpeza e formatação do sistema de canais radiculares(T1), em 7 (T2) e 14 dias (T3), um cone de papel esterilizado endodôntico # 20 foi inserido no SCR, mantido por 2 min, e posteriormente armazenado a -70°C. Real-Time PCR analisou microbiologicamente essas amostras para ler a expressão gênica do rRNA microbiano 16S e fragmentos da região ITS do gDNA fúngico da espécie Candida. Após os procedimentos de limpeza e formatação do SCR, três cones de papel absorvente esterilizados foram inseridos. Passivamente, a ponta do papel ultrapassou o ápice radicular em 2 mm e permaneceu por 2 minutos. As amostras foram coletadas imediatamente após a limpeza e modelagem do RCS, 7 e 14 dias após a primeira sessão. As pontas de papel tiveram os 4 mm finais cortados, inseridos em Eppendorf e armazenados a - 70°C. Com este procedimento, o RNA foi extraído do líquido intersticial periapical para caracterizar as expressões dos genes ITGA1, ITGA4, ITGA5, ITGAL, IL-1ß, TNF-α, IL-17A, IL-10, IFN-γ, CCL2/MCP-1, CCL5, CXCR4, e 16S usando PCR em tempo real. O DNA genômico (gDNA) foi extraído para se avaliar a abundância de Candida utilizando-se sequências ITS, por PCR em tempo real. Os resultados demonstraram que os níveis de expressão de mRNA do 16S diminuíram após os procedimentos de limpeza e modelagem e que a abundância de Candida foi insipiente na amostra analisada. As citocinas pro- inflamatórias IL-1ß e IL-17 apresentaram níveis de expressão elevados frente a infecção, reduzindo significativamente após os procedimentos de limpeza e formatação. Os níveis de expressão gênica de TNF-α significantemente aumentaram, em ambos os grupos. Não se observou diferença significativa quanto a expressão gênica das citocinas IFN-γ, IL-10, CCL-2 e CCL-5 e das integrinas ITGAL e ITGA5 nos tempos avaliados. A expressão gênica de CXCR4 reduziu significativamente do tempo T1 para o T2, no grupo experimental. As expressões gênicas de ITGA1 e ITGA4, no grupo experimental, reduziram significativamente de maneira tempo dependente. Finalmente, não houve alteração significativa na expressão de marcadores de macrófagos (CD64), enquanto expressão de marcadores de fibroblastos (S100A4) aumentou significativamente no grupo controle. Concluiu-se que a carga microbiana e a abundância de leveduras correlacionam-se positivamente com a expressão de mediadores pró-inflamatórios e que a que terapia endodôntica negativamente impacta a expressão dos mediadores pró-inflamatórios e das integrinas nos tecidos perirradiculares.

This study seeks to quantitatively evaluate the expression of messenger RNA (mRNA) of integrins alpha1, alfa4, alpha 5, alpha L, cytokines, and chemokines, from cells present in the periapical interstitial fluid adjacent to teeth with root canal infection. Twenty-two individuals needing endodontic treatment and referred to the School of Dentistry of the Federal University of Minas Gerais (Belo Horizonte, MG, Brazil) were selected. The samples were collected in 11 necrotic teeth and carriers of endodontic infections and 11 healthy teeth needing endodontic treatment for prosthetic reasons. After access surgery and before root canal system (RCS) cleaning and shaping procedures (T0), immediately after cleaning and shaping the root canal system (T1), in 7 (T2) and 14 days (T3) an endodontic sterilized paper point #20 was inserted into the RCS, maintained for 2 min, and subsequently stored at -70°C. Real-Time PCR microbiologically analyzed these samples to read the gene expression of microbial rRNA 16S and fragments of the ITS region of the Fungus Candida species gDNA. After RCS cleaning and shaping procedures, three sterilized absorbent paper cones were inserted. Passively, the paper point exceeded the root apex by 2 mm and remained for 2 minutes. Samples were collected immediately after RCS cleaning and shaping, 7 and 14 days after the first session. The paper points have the 4 mm of their tip cut, inserted in Eppendorf, and stored at - 70°C. This procedure extracted RNA from the periapical interstitial fluid to characterize the expressions of the genes ITGA1, ITGA4, ITGA5, ITGAL, IL-1ß, TNF- α, IL-17A, IL-10, IFN-γ, CCL2/MCP-1, CCL5, CXCR4, ITS using Real-Time PCR. The results showed that 16S mRNA expression levels decreased after cleaning and modeling procedures and that Candida abundance was incipient in the analyzed sample. Pro-inflammatory cytokines IL-1ß and IL-17 showed high expression levels against infection, significantly reduced after cleaning and formatting procedures. TNF-α gene expression levels significantly increased in both experimental and control groups. No significant difference was observed regarding the gene expression of the cytokines IFN-γ, IL-10, CCL-2, and CCL-5 and the integrins ITGAL and ITGA5. The gene expressions of ITGA1 and ITGA4 in the experimental group were significantly reduced time-dependent. Finally, there was no significant change in their macrophage markers (CD64) expression, while fibroblast markers (S100A4) expression significantly increased in the control group. It was concluded that microbial load and yeast abundance are positively correlated with the expression of pro-inflammatory mediators and that endodontic therapy negatively impacts the expression of pro-inflammatory mediators and integrins in periradicular tissues.