Impairment of the angiogenic process may contribute to lower success rate of root canal treatments in diabetes mellitus.

Abstract

To investigate the association between root canal treatment outcome, diabetes mellitus, and alterations of the angiogenic process. A retrospective observational study was conducted in healthy (control group, CG) and diabetic (type II diabetes mellitus group, DG) patients after root canal treatment. The follow-up appointments were performed to clinically and radiographically observe symptoms, the healing of periapical lesions and the quality of root fillings. In the animal model study, diabetic Goto-Kakizaki (GK) rats and control Wistar rats were used. After 21days of pulp exposure and the development of apical periodontitis (AP), the mandibles were removed for scintigraphic, radiographic, histopathological and molecular analyses. Chi-square tests were performed to examine the variables related to endodontic outcome and differences between animal groups were assessed using the Student's t-test. The group of patients with diabetes had a significantly lower rate of success following root canal treatment than the CG (p<.001). Logistic regression suggested that diabetes is a risk factor for success of root canal treatment. In the animal study, GK rats had significantly higher fasting glycaemia at t0 and t21 (p<.001) and triglycerides levels (p<.05) and area under the curve (AUC) during the insulin tolerance test at t21 (p<.001). AP area was significantly greater in GK rats (p<.05). Histologically, diabetic rats had increased signs of periodontal ligament inflammation 21days after the induction of apical periodontitis, with fibro-hyaline matrix filling and vessel with undefined walls. Wistar rats had significantly increased vascular endothelial growth factor (VEGF) levels and VEGF/Ang-2 ratio 21days after AP induction (p<.08; p<.07). GK rats had intrinsically lower levels of VEGF than control rats (p<.05), which did not change after AP. Diabetes mellitus should be considered as an important factor in the prognosis of root canal treatment and its outcomes over time. Future strategies to improve angiogenesis and tissue repair should be pursued to achieve better root canal treatment outcomes in diabetic patients.