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1.
J Appl Oral Sci ; 29: e20201058, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886945

RESUMO

Apical periodontitis is an inflammatory disorder of periradicular tissues developed from endodontic infections. Understanding its pathophysiology and the underlying molecular mechanisms is key to the advancement of endodontics. MicroRNAs (miRNAs), a group of evolutionarily conserved small non-coding RNAs, may be phenotypically and functionally associated with the pathogenesis of apical periodontitis. Several studies have focused on the role of miRNAs in the pulp and periradicular biology, and they have demonstrated their essential functions, such as initiating odontogenic differentiation and promoting pro- or anti-inflammatory responses in pulpitis. Up to date, over 2,000 miRNAs have been discovered in humans; however, only few have been reported to associate with apical periodontitis. Therefore, identifying miRNAs involved in diseased apical tissues and conducting functional studies are important in expanding our current knowledge of pulp and periradicular biology and exploring novel therapeutic avenues. In this review, we revisit current models of apical periodontitis and miRNA biogenesis, analyze existing evidence of the involvement of miRNAs in diseased apical tissues, and discuss their diverse functions and potential values. Based on their sheer abundance, prolonged stability in biofluid, and relative ease of sampling, miRNAs may be a useful tool to be developed as diagnostic biomarkers for apical periodontitis. Furthermore, it can be used as therapeutic targets in conjunction with conventional endodontic therapies.


Assuntos
Endodontia , MicroRNAs , Periodontite Periapical , Pulpite , Polpa Dentária , Humanos , MicroRNAs/genética , Periodontite Periapical/genética
2.
Niger J Clin Pract ; 24(4): 621-628, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33851687

RESUMO

Background: Endodontic treatment failure is one of the most common problems encountered in dentistry. Aims: This study aimed to evaluate the causes of failure of endodontic treatment among patients in the Saudi Arabian city of Al-Kharj. Subjects and Methods: A total of 250 patients of both genders were involved in the study. Criteria confirming the failure of the endodontic treatment were pain, tenderness on pressure, periapical radiolucency, and sinus tract. Patients were selected by convenience sampling methods. A diagnostic chart was prepared to complete the investigation in three different hospitals, during a six-month period (October 2018 - March 2019). The results were analyzed statistically using Chi-square test and use of simple arithmetical methods to determine percentage and frequencies. Results: The main cause for endodontic failure was poor quality adjunctive treatment. 147 out of 179 male patients and 53 out of 71 female patients received poor quality treatment. There was a statistically significant difference between gender versus adjunctive treatment (P = 0.009) and between hospital versus adjunctive treatment (P = 0.005), and quality of adjunctive treatment between private hospital as compared to government hospital which was also statistically significant (P = 0.008). In quadrant wise distribution, first molars were the most commonly involved teeth. Inadequate filling of the root canal was (36.8%), missed canals (14.4), over-extension root canal fillings (12.8%), perforations (9.6%), instrumentation related (8.8%), and endodontic access preparation related (2.4%) in the decreasing order of frequency were seen as the most common causes of failure of endodontic treatment. Conclusion: First molars were the most commonly affected tooth in the failure of endodontic treatment. Poor adjunctive treatment and inadequate filling of the root canals were the most common causes of endodontic failure, more commonly seen in male than female patients and in private clinics/hospitals than government hospitals.


Assuntos
Cavidade Pulpar , Periodontite Periapical , Feminino , Humanos , Masculino , Dente Molar , Obturação do Canal Radicular , Tratamento do Canal Radicular/efeitos adversos , Arábia Saudita/epidemiologia
3.
J Appl Oral Sci ; 29: e20200799, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886941

RESUMO

OBJECTIVES: This study aimed to investigate patterns and risk factors related to the feasibility of achieving technical quality and periapical healing in root canal non-surgical retreatment, using regression and data mining methods. METHODOLOGY: This retrospective observational study included 321 consecutive patients presenting for root canal retreatment. Patients were treated by graduate students, following standard protocols. Data on medical history, diagnosis, treatment, and follow-up visits variables were collected from physical records and periapical radiographs and transferred to an electronic chart database. Basic statistics were tabulated, and univariate and multivariate analytical methods were used to identify risk factors for technical quality and periapical healing. Decision trees were generated to predict technical quality and periapical healing patterns using the J48 algorithm in the Weka software. RESULTS: Technical outcome was satisfactory in 65.20%, and we observed periapical healing in 80.50% of the cases. Several factors were related to technical quality, including severity of root curvature and altered root canal morphology (p<0.05). Follow-up periods had a mean of 4.05 years. Periapical lesion area, tooth type, and apical resorption proved to be significantly associated with retreatment failure (p<0.05). Data mining analysis suggested that apical root resorption might prevent satisfactory technical outcomes even in teeth with straight root canals. Also, large periapical lesions and poor root filling quality in primary endodontic treatment might be related to healing failure. CONCLUSION: Frequent patterns and factors affecting technical outcomes of endodontic retreatment included root canal morphological features and its alterations resulting from primary endodontic treatment. Healing outcomes were mainly associated with the extent of apical periodontitis pathological damages in dental and periapical tissues. To determine treatment predictability, we suggest patterns including clinical and radiographic features of apical periodontitis and technical quality of primary endodontic treatment.


Assuntos
Cavidade Pulpar , Periodontite Periapical , Mineração de Dados , Cavidade Pulpar/diagnóstico por imagem , Humanos , Retratamento , Estudos Retrospectivos , Tratamento do Canal Radicular
4.
BMC Oral Health ; 21(1): 124, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731077

RESUMO

BACKGROUND: The present study aimed at investigating the prevalence of Apical periodontitis in a Moroccan Adult subpopulation with a non-surgical root canal treatment and to assess associated risk factors including endodontic treatment quality, periodontal health status, coronal restoration cavity design and quality. METHODS: A total of 358 endodontically treated teeth were evaluated after more than 1-year period in a Moroccan subpopulation according to predetermined criteria. Studied parameters were assessed clinically and radiographically. The association between coronal restoration quality, cavity design, periodontal status, root canal filling quality, coronal restoration related features, presence or absence of the opposing dentition and the periapical status was determined. Data were analyzed using chi-square test, odds ratio and logistic regression. RESULTS: The present study revealed that gingival health, coronal restoration with CL II cavity design, and root canal filling quality influenced periapical status of endodontically treated teeth. Multivariate analysis showed that this association was statistically significant for gingival inflammation (95% CI 1.08-3.91, OR 2.05, p = 0.02), inadequate coronal restoration (95% CI 1.16-4.04, OR 2.16, p = 0.01), inadequate root canal filling length and homogeneity (95% CI 1.24-3.01, OR 1.93, P = 0.004), (95% CI 1.41-4.44, OR 2.50, p = 0.002) respectively. CONCLUSIONS: The present study revealed that inadequate coronal restorations especially with large proximal margins (CL II cavity design) and gingival inflammation increased the risk of apical periodontitis in endodontically treated teeth. Prevalence of Apical periodontitis in the present study was 72.1%.


Assuntos
Periodontite Periapical , Dente não Vital , Adulto , Estudos Transversais , Restauração Dentária Permanente , Humanos , Periodontite Periapical/epidemiologia , Prevalência , Fatores de Risco , Obturação do Canal Radicular , Tratamento do Canal Radicular/efeitos adversos , Dente não Vital/epidemiologia
5.
J Endod ; 47(5): 755-761, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33548327

RESUMO

INTRODUCTION: The purpose of this study was to compare the immunoexpression of biomarkers interleukin (IL)-17, IL-6, and IL-1ß in primary chronic apical periodontitis in smokers and nonsmokers. METHODS: Teeth with primary chronic apical periodontitis indicated for extraction in 16 cigarette smokers and 16 nonsmokers were selected. Silanized sections of tissue were used for immunohistochemical analysis after being stained with hematoxylin-eosin for histopathologic categorization. Subsequently, the images were analyzed with an optical microscope, and each slide was subdivided into 5 high-magnification fields, with scores (0-2) being assigned according to the amount of staining for each antibody. RESULTS: The qualitative analysis of IL-17 cytokine expression showed no focal expression in 5.8%, weak to moderate expression in 17.6%, and strong expression in 76.4% of the smokers and no focal expression in 78.5% and weak to moderate expression in 21.4% of the nonsmokers. IL-6 expression was negative to focal in 13.3%, weak to moderate in 53.3%, and strong in 33.3% of the smokers and negative to focal in 33.3%, weak to moderate in 25%, and strong in 41.6% of the nonsmokers. IL-1ß expression was weak to moderate in 87.5% and negative to focal expression in 12.5% of the smokers and negative to focal expression in 100% of the nonsmokers. Quantitative evaluation of the data using the Mann-Whitney U test showed a significant difference in the immunoexpression of IL-17 (P < .0001) and IL-1ß (P < .0001) and no significant difference in the immunoexpression of IL-6 (P = .46) between the 2 groups (P < .05). CONCLUSIONS: The cytokines IL-17 and IL-1ß were more highly expressed in smokers than nonsmokers, whereas IL-6 expression was similar in the 2 groups.


Assuntos
Periodontite Crônica , Periodontite Periapical , Humanos , Interleucina-17 , Interleucina-8 , não Fumantes , Fumantes , Fumar/efeitos adversos
6.
J Endod ; 47(5): 711-720, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33548330

RESUMO

INTRODUCTION: Proresolving lipid mediators are specialized molecules (SPMs) involved in the active resolution of the inflammatory process by regulating tissue homeostasis. The aim of this study was to investigate the scientific literature to assess the potential of SPMs as an adjunct in the treatment of endodontic infection. METHODS: Three electronic databases (PubMed, Web of Science, and Scopus) were searched from their inception until February 2020 (PROSPERO CRD42020164743). Supplemental research was performed by screening the references of the relevant studies eligible for inclusion. A quality assessment of animal studies was performed using the Animal Research: Reporting of In Vivo Experiments guidelines, whereas the Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool was used to assess the risk of bias. RESULTS: A total of 3295 records were screened, and 8 articles meeting the criteria were included for this qualitative review. The eligible studies showed a high to moderate overall quality and a low to moderate risk of bias. SPMs positively affected the development of pulpitis and apical periodontitis in experimental animal models. The early treatment of pulpitis with the topical application of SPMs was beneficial to control inflammation within 24 hours from contamination. In addition, SPMs delivered within the root canals after disinfection were found effective in promoting periapical healing. CONCLUSIONS: Our findings suggest that SPMs may play a role in the inception and treatment of pulpal-periapical diseases, and they should be considered for future research for developing new therapeutics as an adjunct to endodontic treatment.


Assuntos
Endodontia , Periodontite Periapical , Pulpite , Animais , Assistência Odontológica , Humanos , Inflamação , Periodontite Periapical/terapia
7.
Int Endod J ; 54(5): 646-654, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33630330

RESUMO

The European Society of Endodontology (ESE) is in the process of developing S3Level Clinical Practice Guidelines for the treatment of pulpal and apical disease for the benefit of clinicians and patients. In order to ensure a homogenous review process in the development of the clinical practice guidelines, it is essential that the core outcomes for all endodontic treatments are standardized and recommendations are made regarding minimum follow-up time specific to each outcome measure. In the absence of a recognized core outcome set in Endodontics, the current project aimed to follow an established consensus process to define the most appropriate clinician and patient-reported outcomes. As part of the project, recommendations will also be agreed regarding an acceptable minimum follow-up period for studies by literature review and group discussion. The selected outcome measures and follow-up periods will be used in subsequent systematic analyses of the literature to investigate the effectiveness of endodontic treatment to alleviate pulpitis and apical periodontitis. In this paper, previous reviews, ESE Guidelines and Position Statements were searched in order to compile a list of potentially important outcome measures for the treatment of pulpitis (working group 1), the nonsurgical treatment of apical periodontitis (working group 2), the surgical treatment of apical periodontitis (working group 3) and the regenerative treatment of apical periodontitis (working group 4). Initially, the two S3 guideline leads selected two independent senior clinical academics with experience of evidence-based dentistry to lead each of the four working groups forming a 10-member steering group. The working group leads in turn selected 32 academics with experience of evidence-based dentistry to lead the individual systematic reviews contained within the respective working groups. These 42 individuals make up the Guideline Development Group (GDG). Prior to the selected systematic reviewers commencing writing and submitting the review protocol, the complete list of outcome variables identified in this document will be ranked by the 42 members of the GDG in their importance to the individual patient using a 9-point Likert scale. A summary of the survey scores will thereafter be shared with the members of the group and the final list of clinician and patient-reported outcome measures rated as critical for decision making (7-9 on Likert scale by majority of survey participants) to guide systematic reviews will be consented and confirmed during an online meeting of the steering group. In this online meeting, another aspect with regard to meaningfulness of clinical trial results to be addressed in systematic reviews will be consented: length of follow-up. In order to develop high quality guidelines, it is suggested that the follow-up period after treatment should be related to the specific outcome measure being addressed; however, a minimum of one year for assessing the effectiveness of treatments for pulpitis and apical periodontitis should be considered. It is accepted, that selected research questions that focus on pain, swelling, medication taken or investigating diagnostic accuracy are likely to have shorter follow-up periods. As a result of the GDG consensus process, the outcome measures and length of follow-up will, alongside the use of standard instruments to assess the methodological quality of clinical trials and other comparative studies, be applied to all the commissioned systematic reviews that will inform the subsequent process when developing the ESE S3 Level Clinical Practice Guidelines.


Assuntos
Endodontia , Periodontite Periapical , Pulpite , Consenso , Humanos , Avaliação de Resultados em Cuidados de Saúde , Periodontite Periapical/terapia , Guias de Prática Clínica como Assunto , Pulpite/terapia , Revisões Sistemáticas como Assunto
8.
Aust Endod J ; 47(1): 105-112, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33523556

RESUMO

Cemento-osseous dysplasia (COD) is a lesion in which periapical bone is replaced by fibrous tissue, including osseous or cementum-like tissue. In the initial stage of COD, radiolucencies are noted at the root apex on periapical radiography, which can be confused with apical periodontitis. Understanding of correct pathological condition and careful assessment of COD is critical to avoid unnecessary endodontic interventions in healthy teeth. This report describes the ability and usefulness of cone-beam computed tomography (CBCT) and multi-slice computed tomography (MSCT) to detect COD. The findings in this case suggest that MSCT is more appropriate than CBCT, especially for patients with early- to middle-stage COD. However, the radiation dose is higher in MSCT than in CBCT; the application of MSCT should be limited to assessment of whether treatment or surgical management is necessary.


Assuntos
Periodontite Periapical , Tomografia Computadorizada de Feixe Cônico , Humanos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/terapia , Tomografia Computadorizada por Raios X
9.
Int J Mol Sci ; 22(3)2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33540711

RESUMO

The macroscopic and microscopic anatomy of the oral cavity is complex and unique in the human body. Soft-tissue structures are in close interaction with mineralized bone, but also dentine, cementum and enamel of our teeth. These are exposed to intense mechanical and chemical stress as well as to dense microbiologic colonization. Teeth are susceptible to damage, most commonly to caries, where microorganisms from the oral cavity degrade the mineralized tissues of enamel and dentine and invade the soft connective tissue at the core, the dental pulp. However, the pulp is well-equipped to sense and fend off bacteria and their products and mounts various and intricate defense mechanisms. The front rank is formed by a layer of odontoblasts, which line the pulp chamber towards the dentine. These highly specialized cells not only form mineralized tissue but exert important functions as barrier cells. They recognize pathogens early in the process, secrete antibacterial compounds and neutralize bacterial toxins, initiate the immune response and alert other key players of the host defense. As bacteria get closer to the pulp, additional cell types of the pulp, including fibroblasts, stem and immune cells, but also vascular and neuronal networks, contribute with a variety of distinct defense mechanisms, and inflammatory response mechanisms are critical for tissue homeostasis. Still, without therapeutic intervention, a deep carious lesion may lead to tissue necrosis, which allows bacteria to populate the root canal system and invade the periradicular bone via the apical foramen at the root tip. The periodontal tissues and alveolar bone react to the insult with an inflammatory response, most commonly by the formation of an apical granuloma. Healing can occur after pathogen removal, which is achieved by disinfection and obturation of the pulp space by root canal treatment. This review highlights the various mechanisms of pathogen recognition and defense of dental pulp cells and periradicular tissues, explains the different cell types involved in the immune response and discusses the mechanisms of healing and repair, pointing out the close links between inflammation and regeneration as well as between inflammation and potential malignant transformation.


Assuntos
Polpa Dentária/patologia , Periodontite Periapical/patologia , Tecido Periapical/patologia , Pulpite/patologia , Animais , Antígenos de Neoplasias/imunologia , Carcinogênese/imunologia , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/fisiopatologia , Quimiocinas/metabolismo , Proteínas do Sistema Complemento/metabolismo , Cárie Dentária/fisiopatologia , Polpa Dentária/microbiologia , Dentina/irrigação sanguínea , Dentina/inervação , Dentina/metabolismo , Fibroblastos/imunologia , Fibroblastos/metabolismo , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/fisiologia , Células-Tronco Mesenquimais/fisiologia , Neoplasias Bucais/etiologia , Neoplasias Bucais/imunologia , Neoplasias Bucais/fisiopatologia , Rede Nervosa/fisiologia , Neuropeptídeos/metabolismo , Óxido Nítrico/fisiologia , Odontoblastos/fisiologia , Granuloma Periapical/etiologia , Granuloma Periapical/patologia , Tecido Periapical/microbiologia , Cisto Radicular/etiologia , Cisto Radicular/fisiopatologia
10.
Medicine (Baltimore) ; 100(4): e23755, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530175

RESUMO

BACKGROUND: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis is the most common cause of dental pain and arise from an inflamed or necrotic dental pulp. There is growing evidence to support the effectiveness of probiotics in combination with antibiotics on periodontitis. We therefor will conduct this study to evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis. METHODS: We will systematically search the following databases: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM), and WanFang database. A grey literature search will be conducted using ZETOC Conference Proceedings and Open Grey. Only randomized controlled trials (RCTs) related to research on probiotics in combination with antibiotics to treatment patients with periodontitis will be included. All sources have to be searched from their inception to October 2020. Two authors will independently select studies, extract study data, and evaluate the quality of the included studies. We will use Review Manager Software (RevMan 5.3) to analyze data. RESULTS: This study will systematically evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis. CONCLUSIONS: This study will generate evidence for a better clinical decision of patients with periodontitis. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/QZ6SB (https://osf.io/qz6sb/).


Assuntos
Antibacterianos/uso terapêutico , Metanálise como Assunto , Periodontite Periapical/tratamento farmacológico , Probióticos/uso terapêutico , Revisões Sistemáticas como Assunto , Tomada de Decisão Clínica , Protocolos Clínicos , Quimioterapia Combinada , Humanos , Dor/prevenção & controle , Periodontite Periapical/complicações , Projetos de Pesquisa
11.
J Appl Oral Sci ; 29: e20210483, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503222

RESUMO

OBJECTIVE: The aim of this study was to evaluate whether probiotics multi-strain formula affects the development of apical periodontitis (AP) induced in rats. METHODOLOGY: 16 Wistar rats were divided in two groups (n=8): rats with AP fed with regular diet (Control-C (CG)); rats with AP, fed with regular diet and supplemented with multi-strain formula (one billion colony-forming units (CFU)): GNC Probiotic Complex (PCG) ( Lactobacillus acidophilus, Lactobacillus salivaris, Lactobacillus plantarum, Lactobacillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium animalis subs. lactis and Streptococcus thermofilus ). AP was induced in the upper and lower first molars by dental pulp exposure to the oral environment. PCG was administered orally through gavage for 30 days during the AP development. After this period the animals were euthanized and the mandibles were removed and processed for histologic analysis, and immunochemical assays for interleukin (IL)-6, IL-10, IL-1ß, RANKL, OPG, and TRAP. The Mann-Whitney U test and Student's t test were performed (P<.05). RESULTS: The CG showed more intense inflammatory infiltrate than the PCG group (P<.05). IL-1ß, IL 6 and RANKL decreased in the PCG group compared with CG (P<.05). The IL-10 level increased in the PCG group (P<.05). The OPG level was similar in both groups (P>.05). The number of mature osteoclasts (TRAP-positive multinucleated cells) was lower in PCG group when compared to the CG (P<.05). CONCLUSION: Probiotic Complex modulates inflammation and bone resorption in apical periodontitis.


Assuntos
Lactobacillus rhamnosus , Periodontite Periapical , Probióticos , Animais , Suplementos Nutricionais , Periodontite Periapical/terapia , Ratos , Ratos Wistar
12.
Int Endod J ; 54(6): 926-940, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33411973

RESUMO

AIM: To verify the effects of melatonin supplementation on insulin sensitivity, plasma concentrations of inflammatory cytokines, insulin signalling and inflammatory pathways in the soleus (SM) and extensor digitorum longus (EDL) muscles of rats with apical periodontitis (AP). METHODOLOGY: Seventy-two Wistar rats were distributed into 4 groups: (a) control (C), (b) control supplemented with melatonin (M), (c) AP (AP), and (d) AP supplemented with melatonin (AP + M). AP was induced by pulp exposure of the maxillary and mandibular right first and second molars to the oral environment. After AP induction, oral supplementation with 5 mg kg-1 melatonin (diluted in drinking water) for 60 days was initiated. At the end of the treatment, the following were analysed: (1) plasma concentrations of insulin and inflammatory cytokines (TNF-α, IL-6, IL-1ß and IL-10) using ELISA kits; (2) glycaemia using enzymatic assay; (3) insulin resistance using homoeostasis model assessment of insulin resistance (HOMA-IR) index; and (4) phosphorylation status of pp185 tyrosine, Akt serine, IKKα/ß, and JNK in SM and EDL using Western blot. Analysis of variance of two or three factors was performed, followed by the Bonferroni test. P values < 0.05 were considered statistically significant. RESULTS: AP promoted insulin resistance, significantly increased (P < 0.05) plasma concentrations of pro-inflammatory cytokines (TNF-α, IL-6, and IL-1ß), significantly decreased (P < 0.05) the concentration of anti-inflammatory cytokine IL-10, impaired insulin signalling in SM, and increased IKKα/ß phosphorylation status in SM and EDL. Melatonin supplementation in rats with AP improved insulin sensitivity, significantly decreased (P < 0.05) TNF-α and IL-1ß, significantly increased (P < 0.05) IL-10 plasma concentrations, and changed the insulin signalling in soleus muscle and IKKα/ß phosphorylation status in SM and EDL muscles. CONCLUSIONS: Melatonin is a potent adjuvant treatment for improving apical periodontitis-associated changes in insulin sensitivity, insulin signalling and inflammatory pathways. In addition, the negative impact of AP on general health was also demonstrated.


Assuntos
Resistência à Insulina , Melatonina , Periodontite Periapical , Animais , Insulina , Melatonina/farmacologia , Periodontite Periapical/tratamento farmacológico , Ratos , Ratos Wistar
13.
Int Endod J ; 54(6): 834-847, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33480079

RESUMO

AIM: To quantitatively and qualitatively compare the host proteomic profile in samples of symptomatic and asymptomatic apical periodontitis (AP) using nano-liquid chromatography-electron spray tandem mass spectrometry. METHODOLOGY: Samples were obtained from 18 patients with radiographically evident AP, divided into symptomatic and asymptomatic groups (nine per group) according to clinical characteristics. After sample collection, protein extraction, purification and quantification of the samples were performed, which were analysed by reverse-phase liquid chromatography coupled to mass spectrometry. Label-free quantitative proteomic analysis was performed by Protein Lynx Global Service software. Differences in expression of proteins between the groups were calculated using the Monte Carlo algorithm, considering P < 0.05 for down-regulated proteins and 1 - P > 0.95 for up-regulated proteins. Proteins were identified with the embedded ion accounting algorithm in the software and a search of the Homo sapiens UniProt database. RESULTS: A total of 853 individual human proteins were identified. In the quantitative analysis, common proteins to both groups accounted for 143 proteins. Differences in expression between groups resulted in 51 up-regulated proteins (1 - P > 0.95) in the symptomatic group, including alpha-1-antitrypsin, protein S100-A8, myeloperoxidase, peroxiredoxin and lactotransferrin. This group also had 43 down-regulated proteins (P < 0.05), comprising immunoglobulin, neutrophil defensin, pyruvate kinase and alpha-enolase. The qualitative analysis considered only the exclusive proteins of each group. For the symptomatic group, 318 complete proteins and 29 fragments were identified, such as dedicator of cytokinesis protein, intersectin, prostaglandin, phospholipase DDHD2 and superoxide dismutase. For the asymptomatic group, 326 complete proteins and 37 fragments were identified, including azurocidin, C-reactive protein, collagen alpha, cathepsin, heat shock and laminin. CONCLUSIONS: Quantitative differences in the expression of common proteins in cases of symptomatic and asymptomatic AP were found, which were mostly related to host immune response in both groups. Exclusive proteins in the symptomatic group were mainly related to the host response to the presence of viruses in endodontic infections, oxidative stress and proteolytic enzymes. The results provide a basis for a better understanding of cellular and molecular pathways involved in AP, establishing specific proteomic profiles for symptomatic and asymptomatic conditions.


Assuntos
Periodontite Periapical , Proteômica , Humanos , Fosfolipases
14.
BMC Oral Health ; 21(1): 41, 2021 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482797

RESUMO

BACKGROUND: This study aimed to assess the effect of a 980-nm diode laser following chemomechanical root canal preparation on the severity of post-operative pain (PP) after root canal treatment (RCT). METHODS: This study included asymptomatic, single-rooted teeth with a periapical index (PAI) score of 3 or 4. All the patients received RCT, including dressing with calcium hydroxide (Ca(OH)2), during two visits. The patients were randomly divided into two groups (n:30): a control group, in which the final irrigation was performed using 5 ml of 2.5% sodium hypochlorite (NaOCI), followed by 5 ml of 17% and ethylenediaminetetraacetic acid (EDTA) and 5 ml of distilled water, and a laser group, in which the root canals were irradiated using a 980-nm diode laser after the final irrigation at both visits. The pain levels after both visits were evaluated using a visual analogue scale (VAS) after 8 h, 24 h, 48 h and 7 d. In addition, the time intervals to medication intake were recorded. The collected data were statistically analysed using the chi-square and Mann-Whitney U test (p < 0.05). RESULTS: The average pain level in the control group 24 h after the first visit was significantly higher than that in the laser group (p < 0.05). The average pain level 24 h and 48 h after the second visit was significantly higher in the control group (p < 0.05). The levels of PP 24 h after the first visit were higher than those after the second visit only in the control group (p < 0.05). After the first visit, analgesic use in the control group was significantly higher after 8 h (40%) and 24 h (23%) as compared with that in the laser group (p < 0.05). CONCLUSIONS: Root canal irradiation with a diode laser may reduce PP after RCT in single-rooted teeth with a PAI score of 3 or 4. TRIAL REGISTRATION: Effect of the Diode Laser on Post-operative Pain After Endodontic Treatment in Teeth with Apical Periodontitis: NCT04486196. Registered 24 July 2020-Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04486196.


Assuntos
Lasers Semicondutores , Periodontite Periapical , Cavidade Pulpar , Humanos , Lasers Semicondutores/uso terapêutico , Dor Pós-Operatória , Periodontite Periapical/cirurgia , Irrigantes do Canal Radicular , Preparo de Canal Radicular , Tratamento do Canal Radicular/efeitos adversos , Hipoclorito de Sódio/uso terapêutico
15.
Niger J Clin Pract ; 24(1): 8-16, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33473019

RESUMO

Aims: This clinical study aimed to evaluate the effect of different clinical practices with endodontic emergency treatment on postoperative pain in mandibular permanent molar teeth with symptomatic apical periodontitis. Methods: In the present study, root canal treatment was applied to 100 patients who met the inclusion criteria. Patients were randomly assigned to 5 groups (control, nonsteroidal anti-inflammatory drug [NSAID], NSAID and antihistaminic drug combination, placebo drug, and intracanal cryotherapy) using a web program. In the first visit, after preparation with the WaveOne Gold file system, calcium hydroxide (Ca(OH)2) medicament was placed on the root canals. However, after the treatment of the patients was completed, six patients patients were excluded from the study because they did not come to the control appointment 7 days later. After the removal of Ca(OH)2 medicament in the second session, the root canals were obturated according to cold lateral condensation technique and final restorations of the teeth were performed. Patients' preoperative and postoperative pain values (4-8-12-24-48 and 72 hours) determined by visual analog scale (VAS) were recorded. The data were analyzed statistically using analysis of variance, Kruskal-Wallis test, Friedman test, Wilcoxon test, and Chi-square test. Results: According to the results of our study; there was no significant difference between the groups in terms of age, gender, preoperative pain, and postoperative analgesic requirement (P > 0.05). In all groups, there were significant differences between the values of different times (P < 0.05). While initial pain values were higher than the hours after treatment (P < 0.05), there was no significant difference between postoperative pain values (P > 0.05). When the groups in terms of pain scales measured at different times compared with each other; in all times there was no significant difference between the groups (P > 0.05). Conclusion: It was observed that all clinical practices significantly reduced preoperative pain.


Assuntos
Periodontite Periapical , Humanos , Dente Molar/cirurgia , Dor Pós-Operatória , Periodontite Periapical/complicações , Periodontite Periapical/cirurgia , Estudos Prospectivos , Preparo de Canal Radicular , Tratamento do Canal Radicular
16.
J Endod ; 47(4): 600-605, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33387552

RESUMO

INTRODUCTION: This study evaluated the effects of a high-fat diet (HFD) on the progression of apical periodontitis (AP) in rats. METHODS: Eight-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. RESULTS: Radiographs 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). CONCLUSIONS: Findings suggest that an HFD can influence the progression and severity of AP.


Assuntos
Dieta Hiperlipídica , Periodontite Periapical , Animais , Dieta Hiperlipídica/efeitos adversos , Fígado , Periodontite Periapical/diagnóstico por imagem , Ratos , Ratos Wistar , Triglicerídeos
17.
Int Endod J ; 54(5): 712-735, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33378579

RESUMO

BACKGROUND: Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. OBJECTIVES: To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. METHODS: A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. RESULTS: The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2  = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2  = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2  = 98.5%) and 3% (95% CI 2%-3%; I2  = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2  = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2  = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2  = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2  = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2  = 98.3%). DISCUSSION: The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. CONCLUSIONS: Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.


Assuntos
Periodontite Periapical , Dente não Vital , Adulto , Estudos Transversais , Humanos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/epidemiologia , Prevalência , Obturação do Canal Radicular , Tratamento do Canal Radicular
18.
Int Endod J ; 54(6): 902-915, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33369764

RESUMO

AIM: To examine the role of palmitic acid in lipopolysaccharide (LPS)-stimulated chemotaxis of macrophages and the potential contribution of saturated fatty acid in signalling during the pathogenesis of apical periodontitis. METHODOLOGY: J774, a mouse macrophage cell line, was used in the experiments. After treatment with LPS, proteolytic maturation of sterol regulatory element-binding protein-1c (SREBP-1c) and expression of fatty acid synthase (FASN) were examined by Western analysis. Levels of palmitic acid were measured by reverse phase-high performance liquid chromatography-mass spectrometry. Knockdown of SREBP-1c and FASN was accomplished by small interfering RNA technology. Secretion of CC-chemokine ligand 2 (CCL2) and cellular chemotaxis were assessed by enzyme-linked immunosorbent assay and transwell migration assay, respectively. Sulfo-N-succinimidyl oleate (SSO) treatment was used to inhibit fatty acid signalling in vitro and also in a rat model of apical periodontitis. All data were first subjected to Levene's test. In vitro data were then analysed using ANOVA followed by Tukey's multiple comparison test. Data from animal experiments were analysed by independent t-tests. The significant level was set at 0.05. RESULTS: LPS stimulated proteolytic maturation of SREBP-1c and FASN expression in macrophages and significantly enhanced palmitic acid synthesis (P < 0.05). Knockdown of SREBP-1c attenuated LPS-enhanced FASN expression. Knockdown of FASN significantly suppressed LPS-enhanced palmitic acid synthesis (P < 0.05). LPS and exogenous palmitic acid significantly enhanced CCL2 secretion and macrophage chemotaxis (all P < 0.05). Inhibition of FASN expression significantly alleviated LPS-augmented CCL2 secretion (P < 0.05). SSO significantly suppressed CCL2 secretion and macrophage chemotaxis augmented by LPS and palmitic acid (all P < 0.05). In a rat model of induced apical periodontitis, SSO treatment significantly attenuated progression of apical periodontitis and macrophage recruitment (all P < 0.05). CONCLUSIONS: LPS/SREBP-1c/FASN/palmitic acid signalling contributed to tissue destruction caused by bacterial infection. Modulation of lipid metabolism and signalling may be helpful for the management of apical periodontitis.


Assuntos
Lipopolissacarídeos , Periodontite Periapical , Animais , Ácidos Graxos , Macrófagos , Camundongos , Ratos , Proteína de Ligação a Elemento Regulador de Esterol 1
19.
PLoS One ; 15(12): e0244585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378378

RESUMO

OBJECTIVE: The indiscriminate prescription of antibiotics has led to the emergence of resistance microbes worldwide. This study aimed to investigate the antibiotic prescribing practices amongst general dental practitioners and specialists in managing endodontic infections in the United Arab Emirates (UAE). DESIGN: General dental practitioners and specialists in the UAE were invited to participate in an online questionnaire survey which included questions on socio-demographics, practitioner's antibiotic prescribing preferences for various pulpal and periapical diseases, and their choice, in terms of the type, dose and duration of the antibiotic. The link to the survey questionnaire was sent to 250 invited dentists. Data were analyzed by descriptive statistics and chi-square tests for independence and level of significance was set at 0.05. RESULTS: A total of 174 respondents participated in the survey (response rate = 70%). The respondents who prescribed antibiotics at least once a month were 38.5% while 17.2% did so, more than three times a week; amoxicillin 500 mg was the antibiotic of choice for patients not allergic to penicillin (43.7%), and in cases of penicillin allergies, erythromycin 500 mg (21.3%). There was a significant difference in the antibiotic prescribing practices of GDPs compared to endodontists and other specialties especially in clinical cases such as acute apical abscesses with swelling and moderate to severe pre-operative symptoms and retreatment of endodontic cases (p<0.05). Approximately, three quarters of the respondents (78.7%) did not prescribe a loading dose when prescribing antibiotics. About 15% respondents prescribed antibiotics to their patients if they were not accessible to patients due to a holiday/weekend. CONCLUSIONS: In general, the antibiotic prescribing practices of UAE dentists are congruent with the international norms. However, there were occasions of inappropriate prescriptions such as in patients with irreversible pulpitis, necrotic pulps with no systemic involvement and/or with sinus tracts.


Assuntos
Antibacterianos/uso terapêutico , Doenças da Polpa Dentária/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Periodontite Periapical/tratamento farmacológico , Padrões de Prática Odontológica , Amoxicilina/uso terapêutico , Antibacterianos/classificação , Estudos Transversais , Eritromicina/uso terapêutico , Feminino , Humanos , Internet , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Emirados Árabes Unidos
20.
Ned Tijdschr Tandheelkd ; 127(12): 677-681, 2020 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-33367294

RESUMO

A healthy adult male patient presented himself, 11 days after a fixed orthodontic appliance was placed, with a sudden pink discoloration of the dental crown of tooth 21. The emergency dentist on call diagnosed the discoloration as non-painful peri-apical periodontitis, partly on the basis of a radiograph, and recommended endodontic treatment of tooth 21. Prior to endodontic treatment, the patient was first seen by the orthodontist who had initiated treatment. Tooth 21 was investigated and reacted normally to percussion and palpation but did not react to the cold test. The patient was referred to an endodontist who made the likely diagnosis: 'Transient apical breakdown'. No endodontic treatment was carried out and the orthodontic treatment was not interrupted. Six weeks after the discoloration appeared, visible recovery was evident.


Assuntos
Periodontite Periapical , Descoloração de Dente , Adulto , Dente Pré-Molar , Humanos , Masculino , Descoloração de Dente/diagnóstico , Descoloração de Dente/etiologia
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