Chronic Apical Periodontitis Research Articles

Postobturation Pain of three Novel Calcium Silicate-based sealers with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis: prospective clinical trial

BackgroundBioceramic-based root canal sealers are increasingly important in root canal treatment because of their biocompatible properties. This study aimed to evaluate postobturation pain incidence and intensity after root canal obturation with NeoSealer Flo, MTA-Bioseal, and GuttaFlow bioseal calcium silicate-based sealers and AH Plus epoxy resin-based sealer in patients with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis.MethodsA total of 120 participants with single-rooted teeth were included and randomly divided into four groups according to the root canal sealer used (n = 30). The patients were subsequently categorised based on the pulp vitality (vital or nonvital) in each group (n = 15) and all teeth were obturated in a single-visit. The postobturation pain scores were recorded on a visual analogue scale (VAS) at 6 h, 24 h, 48 h, 72 h, 7 d and 30 d. Moreover, analgesic intake was also noted at 24 h and 48 h. The Mann–Whitney U test, Kruskal‒Wallis H test, Friedman test, and Spearman’s correlation test were used, and a p value < 0.05 was considered significant.ResultsVAS scores were highest for the 6 h > 24 h > 48 h ≈ 72 h ≈ 7 d ≈ 30 d time intervals for both pulp status in each root canal sealer. A significant decrease in the VAS score was observed for all sealers from 6 h to 48 h (p 0.05). Nonvital cases had lower VAS scores at all time intervals. Analgesic intake was greater in the first 24 h (p < 0.05) in vital cases (p < 0.05) and also in females than males.ConclusionThe level of pain experienced after obturation was similar in patients with different pulp status for all the root canal sealers. Analgesic intake was greater in vital cases and females within 24 h.Trial registrationClinicalTrial.gov, NCT06515756, record date: 2024-07-17, retrospectively registered.

The comorbid pathology in patients with chronic apical periodontitis

The purpose of this study was to study the relationship between teeth after endodontic treatment and/or with apical periodontitis, in patients with a number of systemic diseases and smokers among the adult population of Yaroslavl.Materials and methods of research. Medical history data were collected, including age, gender, presence of cardiovascular diseases, diabetes mellitus, allergies, smoking habits and data on endodontic dental treatment of 421 patients (10,540 teeth). The prevalence of depulpated teeth and the periodontal condition were assessed by orthopantomograms. The periapical status was classified according to the periapical Index PAI (PAI), chronic apical periodontitis was defined as PAI-score ≥3. The statistical analysis was carried out using the Stata/MP v. program.17.0 (StataCorp LLC, Texas 77845-4512, USA) using chi-square tests, odds ratio and confidence intervals (95%).The results and their discussion. The overall prevalence of chronic apical periodontitis and the prevalence of teeth after endodontic treatment was 2.2 and 4.2%, respectively. The high prevalence of depulpated teeth increased the likelihood of chronic apical periodontitis (p&lt;0.0001). In the group of men, there was a higher percentage of teeth with chronic apical periodontitis (p&lt;0.0001), a lower percentage of teeth after endodontic treatment (p=0.05) and a greater number of residual roots (with complete destruction of the crown of the tooth) (2.3%). Smokers were more likely to have teeth with chronic apical periodontitis (p=0.002) and the prevalence of teeth after endodontic treatment (p=0.045). A positive correlation was observed between the prevalence of teeth after endodontic treatment and diabetes mellitus (p=0.040).Conclusion. A higher prevalence of chronic apical periodontitis and/or teeth after endodontic treatment in smokers and patients with diabetes mellitus may indicate a relationship between the condition of the oral cavity and a number of systemic diseases.

Periapical cemento-osseous dysplasia masquerading as asymptomatic chronic apical periodontitis in a Chinese woman: A case report.

Cemento-osseous dysplasia (COD) belongs to a group of fibrous osseous disorders that can masquerade as periapical inflammatory conditions in the jawbones. We present a rare case of COD occurring in a patient who also had periapical periodontitis concurrently. When faced with a patient exhibiting no symptoms, diagnosis may be challenging. COD is a fibrous osseous disorder similar to periapical chronic inflammatory conditions and other cysts in the jaw bones on the radiograph. There is a rare case of COD occurring in a 49-year-old Chinese woman who also had chronic periapical periodontitis concurrently. The lesions were incidentally discovered in the mandibular anterior tooth region during the patient's imaging examination. The patient exhibited no symptoms, and diagnosing the conditions may be challenging due to the confusingly similar radiological features that present as a radiolucent lesion in the periapical region. The final diagnosis was made through pulp vitality tests, cone beam computed tomography (CBCT), and clinical examinations. The COD was recommended for annual follow-up. Root canal therapy has been performed for chronic apical periodontitis. According to the diagnostic process of COD, a thorough history check, multiple clinical examinations, and imaging studies should be emphasized to prevent misdiagnosis and avoid unnecessary or inappropriate therapies. The patient was followed up for 6 years. The recovery of chronic apical periodontitis in tooth #31 and the transformation of osteolytic and osteogenesis of COD had been observed in CBCT.

Beyond The Usual Suspects: A Challenging Case Of Radix Entomolaris With Endodontic-Periodontal Lesion: A Case Report

The purpose of this case report is to present an unusual endodontic periodontal lesion along with radix entomolaris in tooth 46 in a 31-year-old female patient with intermittent pain and sensitivity to hot and cold stimuli. Clinical examination revealed deep dentinal caries and periodontal pocket depth of 5mm in tooth #46.The radiographic examination revealed an extra distal root with a periapical radiolucency in tooth #46. patient was diagnosed with irreversible pulpitis and chronic apical periodontitis, with secondary periodontal involvement due to an endodontic-periodontal lesion. Non-surgical root canal treatment was performed, followed by canal obturation with resin-based sealer and final restoration with a porcelain fused to metal crown. After a 3-month follow-up, the patient remained asymptomatic, radiographs showed bone reposition, and periodontal probing depth decreased, indicating successful treatment.

Primary endodontic infections - key issue in pathogenesis of chronic apical periodontitis

Primary endodontic infections - key issue in pathogenesis of chronic apical periodontitis

Comparative Evaluation of the Effectiveness of Rotary and Reciprocating Single File Systems on Postoperative Pain After Biomechanical Preparation in Patients With Chronic Apical Periodontitis: A Randomized Clinical Trial

Comparative Evaluation of the Effectiveness of Rotary and Reciprocating Single File Systems on Postoperative Pain After Biomechanical Preparation in Patients With Chronic Apical Periodontitis: A Randomized Clinical Trial

Analysis of errors in endodontic treatment according to cone-beam computed tomography

AIM. The aim of the study was to study the frequency of errors in endodontic treatment according to cone beam computed tomography.MATERIALS AND METHODS. 71 cone beam computed tomography (CBCT) scans of patients treated by random sampling who sought treatment and consultation in the period 2022–2023 were studied. 256 teeth previously subjected to endodontic treatment with the presence or absence of radiological signs of chronic apical periodontitis were examined. The assessment of the quality of root canal obturation and the features of the anatomical structure of teeth was carried out. The data of the «Ray RAYSCAN alpha 3D» cone beam computed tomograph were studied using the OnDemand3DDental program. The results were considered statistically significant at p&lt; 0.05.RESULTS. In 57.42% of cases, there were no signs of periapical pathology, and in 42.58%, foci of bone destruction in the periapical region were observed. Homogeneously, 58.59% of root canals were sealed to the apex. In 16.79% of cases, the removal of filling material outside the root canal was noted. 10.54% of teeth with insufficient root canal filling depth and 6.64% of teeth with a missing root canal were also identified.CONCLUSIONS. There is a decrease in the incidence of the most common errors of endodontic treatment. The method of cone beam computed tomography is important at the stage of diagnosis and planning of endodontic treatment to assess the features of the internal structure of the tooth.

Single Visit Root Canal Treatment of Teeth with Chronic Periapical Periodontitis

The treatment of periodontitis aims to eliminate the etiological factor, i.e. microorganisms and their toxins; to influence the inflammatory process in the periapical tissues and to stimulate the healing process; to provide an airtight filling of the root canal to isolate the apical periodontium from contact with saliva in the oral cavity. The removal of the etiological factor is associated with mechanical and chemical treatment of the root canal. Since most endodontic problems are of microbial origin, their removal is considered the most important step in root canal therapy. The number of visits for treatment of infected root canals is one of the most discussed topics in endodontics. Endodontic treatment through multiple visits is a traditionally accepted method. However, an alternative protocol involving one visit has been proposed. The aim of this study was to determine the degree of clinical success in teeth diagnosed with chronic asymptomatic apical periodontitis treated by a single-visit method. Thirty one patients aged 16 to 69 years with a confirmed diagnosis of chronic asymptomatic apical periodontitis were included in the study. All proven cases are subject to treatment in a single stage. Based on the data obtained from this task, it is clear that adequate isolation and adherence to the simplified generally accepted irrigation protocol are sufficient to obtain good healing results.

Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial.

Clinical and radiographic evaluation of the efficacy of platelet-rich fibrin (PRF) and treated dentin matrix (TDM) in regenerative endodontic treatment and periapical healing of nonvital immature permanent teeth with chronic apical periodontitis. Twenty-four children aged between 7 and 11 years, each presenting with a nonvital immature permanent upper central incisor, were selected. They were randomly allocated into two groups (n = 12), group I (PRF) and group II (TDM). Baseline clinical findings were recorded, and preoperative cone-beam computed tomography (CBCT) was taken. Follow-up was done clinically for 15 months at 3-month intervals (3, 6, 9, 12, and 15 months), and CBCT was taken at the end of the 15-month follow-up. Root length, apical diameter, radiographic root area (RRA), and size of the periapical lesion were quantitively assessed at the end of follow-up period and compared to the preoperative CBCT. Clinical success was 100% in both groups by the end of the follow-up period. Radiographically, after a 15-month follow-up, there was a significant increase in root length and RRA, and there was also a significant reduction in apical diameter and lesion size within each group (p < 0.05). However, there was no statistically significant difference between both groups regarding the mean percentage of increase in root length and mean percentage of reduction of apical diameter (p > 0.05). On the other hand, PRF showed more increase in RRA and more reduction in lesion size, with a statistically significant difference between both groups (p < 0.05). Both PRF and TDM were clinically successful. Platelet-rich fibrin showed better radiographic outcomes and periapical healing. Platelet-rich fibrin is a viable scaffold to aid further root development and resolution of periapical lesions of nonvital immature permanent teeth. Further studies with different forms of TDM are needed to assess the efficacy of TDM in regenerative endodontic treatment of nonvital immature permanent teeth. How to cite this article: Asal MA, Elkalla IH, Awad SM, et al. Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):563-574.

Antibacterial Efficacy of Rotary and Reciprocating Instrumentation Techniques.

To clinically evaluate the effectiveness of rotary (ProTaper Next [PTN]) and reciprocating (Wave One Gold [WOG]) instrumentation techniques in eliminating bacteria from the root canals of teeth with apical periodontitis during a single-visit root canal treatment. Forty patients were randomly assigned to the WOG or PTN instrumentation techniques groups. A single-visit root canal treatment was performed on all the patients. In both groups, root canals were irrigated with 10 ml of sodium hypochlorite (NaOCl) and the final irrigation protocol was applied. Microbiological samples from the root canal were collected initially (Sample 1), after chemo-mechanical instrumentation (Sample 2), and after the final irrigation protocol (Sample 3). Quantification of bacteria at each stage of root canal treatment was performed using the culture method (colony-forming units [CFUs]), and bacterial species were identified using MALDI-TOF mass spectrometry. There were 55 aerobic and anaerobic bacterial species identified. Chemo-mechanical root canal treatment with both instrumentation techniques and the final irrigation protocol significantly reduced the number of CFUs (p<0.001). There were no statistically significant differences in antibacterial efficacy between WOG and PTN groups (p>0.05). Although both root canal instrumentation techniques were highly effective in removing bacteria from the necrotic canals of teeth with chronic apical periodontitis, no complete eradication of bacteria was found in any sample.

Comparision of interleukin-1β concentrations in posttreatment endodontic disease and other pulpal and periapical conditions - A clinical study.

To evaluate interleukin (IL)-1β concentrations in periapical tissue fluid (PTF) in persistent apical periodontitis requiring endodontic retreatment and to compare the levels of IL-1β with chronic apical periodontitis, symptomatic irreversible pulpitis (SIP), normal pulpal, and periapical tissues. The patients were selected based on inclusion and exclusion criteria and divided into 4 groups based on the pulpal and periapical status: Posttreatment endodontic diseases (PTED): Teeth with PTED due to failed primary root canal treatment having periapical radiolucency. PNAP: Teeth requiring root canal treatment due to pulpal necrosis having periapical radiolucency. SIP: Teeth with symptoms of SIP with healthy periapical tissues). Intentional root canal treatment (IRCT): Teeth requiring IRCT (healthy pulp and periapical tissues). The access cavity was redefined and the preexisting filling was removed using H-files. The root canals were minimally enlarged followed by collection of PTF using paper points, in the case of group PTED. For groups PNAP, SIP, and IRCT, conventional access cavity preparation was done followed by enlargement of canals till 20, 0.02. PTF was collected using 15, 0.02 size absorbent points 2 mm beyond the apex. Levels of IL-1β was assessed by enzyme-linked immunosorbent assay. A statistically significant difference was seen in levels of IL-1β in all the groups. The highest concentration was seen in group PTED (85.07 ± 11.57 pg/mL) followed by group PNAP (37.60 ± 10.94 pg/mL), group SIP (8.40 ± 1.99 pg/mL), and the least was seen in group IRCT (3.47 ± 1.36 pg/mL). The levels of IL-1β were highest in PETD cases followed by PNAP, SIP, and IRCT. This indicates the severity of inflammation in PETD cases as compared to other endodontic diseases.

Matrix metalloproteinase 9 level changes in gingival crevicular fluid samples of teeth with acute and chronic apical periodontitis

Matrix metalloproteinase 9 level changes in gingival crevicular fluid samples of teeth with acute and chronic apical periodontitis

Evaluation of the Effectiveness and Safety of One-Time Endodontics in the Treatment of Chronic Apical Periodontitis with Sinus Tract in Pediatric Deciduous Teeth

Objective: To observe the effectiveness and safety of one-time endodontics in the treatment of chronic apical periodontitis with sinus tract in pediatric deciduous teeth. Methods: 109 cases of children with chronic apical periodontitis with sinus tract in the deciduous teeth treated in our hospital from January 2022 to December 2023 were selected and grouped by the randomized numerical table method, with 54 cases in the experimental group and 55 cases in the control group. The experimental group was treated with one-time endodontics and the control group was treated with conventional endodontics. Results: After the treatment, the total effective rate of treatment was higher in the experimental group than in the control group (P &lt; 0.05); the incidence of adverse events was lower in the experimental group than in the control group (P &lt; 0.05); the satisfaction of the children’s family members was higher in the experimental group than in the control group (P &lt; 0.05); the pain duration was lower in the experimental group than in the control group (P &lt; 0.05). Conclusion: In the experimental group, children with chronic apical periodontitis with sinus tract of the deciduous teeth were given one-time endodontic treatment, and the results of its implementation were relatively good.

Is SWEEPS better than PUI in reducing intracanal bacteria and inflammation in cases of apical periodontitis?

To evaluate the efficacy of SWEEPS mode of the Er: YAG laser(SL) and passive ultrasonic irrigation(PUI) in the eradication of microorganisms and in the inflammation detection by IL-1β. Thirty patients with chronic apical periodontitis(AP) were allocated into two groups: Group SL–SWEEPS laser activated irrigation(n = 15) and Group PUI–passive ultrasonic irrigation(n = 15). Bacteriological samples were taken before(S1) and after chemomechanical preparation(S2), and then after final irrigation activation(S3). The levels of total bacteria and Streptococci were measured by means of PCR. Blood samples were collected before and 3rd day after treatment. Enzyme-linked immunosorbent assay was used to measure the levels of IL-1β. The bacterial reduction showed no differences between groups after chemo-mechanical treatment and after irrigant activation(p = 0.590). Post-treatment IL-1β levels were lower than pretreatment levels in both groups(p < 0.001). SL or PUI application in addition to chemomechanical preparation has similar effects on total bacterial level and inflammation detected by IL-1β in patients with AP.

Gut microbiota dysbiosis links chronic apical periodontitis to liver fibrosis in nonalcoholic fatty liver disease: Insights from a mouse model.

In this study, we investigated the systemic implications of chronic apical periodontitis (CAP). CAP may contribute to the nonalcoholic fatty liver disease (NAFLD) progression through the gut microbiota and its metabolites, which are related to the degree of fibrosis. Sixteen 7-week-old male apolipoprotein E knockout (apoE-/-) mice were randomly divided into two groups: the CAP and Con groups. A CAP model was established by sealing the first- and second-maxillary molars with bacterium-containing cotton balls. Apical lesions were evaluated by micro-CT. Histological evaluations of NAFLD were performed using second harmonic generation/two-photon excitation fluorescence (SHG/TPEF) assays. Additionally, we comprehensively analyzed the gut microbiota using 16S rRNA gene sequencing and explored metabolic profiles by liquid chromatography-mass spectrometry (LC-MS). Immunofluorescence analysis was used to examine the impact of CAP on tight junction proteins and mucin expression. Transcriptome assays have elucidated gene expression alterations in liver tissues. Micro-CT scans revealed an evident periapical bone loss in the CAP group, and the total collagen percentage was increased (Con, 0.0361 ± 0.00510%, CAP, 0.0589 ± 0.00731%, p < .05). 16S rRNA sequencing revealed reduced diversity and distinct taxonomic enrichment in the CAP group. Metabolomic assessments revealed that differentially enriched metabolites, including D-galactosamine, were enriched and that 16-hydroxyhexadecanoic acid and 3-methylindole were depleted in the CAP group. Immunofluorescence analyses revealed disruptions in tight junction proteins and mucin production, indicating intestinal barrier integrity disruption. Liver transcriptome analysis revealed upregulation of Lpin-1 expression in the CAP group. This study provides comprehensive evidence of the systemic effects of CAP on liver fibrosis in NAFLD patients by elucidating alterations in the gut microbiota composition and metabolism.

Clinical and economic efficiency of surgical treatment of patients with chronic apical periodontitis

Clinical and economic efficiency of surgical treatment of patients with chronic apical periodontitis

Effect of vitamin D in the treatment of chronic apical periodontitis in patients with osteopenia

Effect of vitamin D in the treatment of chronic apical periodontitis in patients with osteopenia

Milk-derived small extracellular vesicles inhibit the MAPK signaling pathway through CD36 in chronic apical periodontitis

BackgroundSmall extracellular vesicles derived from milk (Milk-sEVs) have the advantages of easy availability, low cost, low toxicity, and inhibition of inflammation. CD36 mediates inflammation stress in a variety of disease states. The purpose of this study was to investigate the role of Milk-sEVs in inhibiting fibroblast inflammation through CD36 and provide reference data for the treatment of chronic apical periodontitis. ResultsThe addition of Milk-sEVs resulted in decreased expression of inflammation-related factors in L929 cells, and transcriptome sequencing screened for the DEG CD36 in the Milk-sEV treatment group under inflammation. The mouse model of apical periodontitis was successfully established, and CD36 expression increased with the development of inflammation. Transfection of si-CD36 into L929 cells reduced inflammation by inhibiting activation of the MAPK signaling pathway. ConclusionsCD36 expression increased with the development of apical periodontitis. In the setting of LPS-mediated inflammation, Milk-sEVs inhibited activation of the MAPK signaling pathway by decreasing the expression of CD36 in L929 cells and thereby reducing inflammation.

Oral management for a patient with trismus accompanied by Isaacs’ syndrome: a case report

BackgroundIsaacs’ syndrome, also known as neuromyotonia or peripheral nerve hyperexcitability, is a rare disorder that affects the peripheral nervous system. Clinical findings include cramps, fasciculations, and myokymia; however, there are few reports of dental treatment for trismus.Case presentationA patient with trismus due to Isaacs’ syndrome experienced swelling and pain in the gingiva surrounding his right lower first molar. He was diagnosed with chronic apical periodontitis by a dentist near his home. However, the patient was informed that dental treatment and medication could not be administered because of the presence of Isaacs’ syndrome, and he visited the Geriatric Dentistry and Perioperative Oral Care Center at Kyushu University Hospital 2 weeks later. The patient’s painless mouth-opening distance (between incisors) was 20 mm at that time, and medication, including amoxicillin capsules and acetaminophen, was administered because the dental extraction forceps or endodontic instruments were difficult to insert into the oral cavity for treatment. Two months after his initial visit, the patient visited us complaining of pain in the same area. However, he had recently undergone plasmapheresis treatment in neurology to alleviate limited mouth opening and systemic myalgia, resulting in a pain-free mouth-opening distance of approximately 35 mm. During this temporary period in which he had no restriction in mouth opening, we performed tooth extraction and bridge restoration on the mandibular right first molar and created an oral appliance for sleep bruxism.ConclusionsPlasmapheresis therapy transiently reduced trismus, rendering dental interventions feasible, albeit temporarily. This case report underscores the importance of close collaboration between neurologists and dentists who encounter similar cases while furnishing valuable insights to inform dental treatment planning.

Unveiling the oral-gut connection: chronic apical periodontitis accelerates atherosclerosis via gut microbiota dysbiosis and altered metabolites in apoE−/− Mice on a high-fat diet

The aim of this study was to explore the impact of chronic apical periodontitis (CAP) on atherosclerosis in apoE−/− mice fed high-fat diet (HFD). This investigation focused on the gut microbiota, metabolites, and intestinal barrier function to uncover potential links between oral health and cardiovascular disease (CVD). In this study, CAP was shown to exacerbate atherosclerosis in HFD-fed apoE−/− mice, as evidenced by the increase in plaque size and volume in the aortic walls observed via Oil Red O staining. 16S rRNA sequencing revealed significant alterations in the gut microbiota, with harmful bacterial species thriving while beneficial species declining. Metabolomic profiling indicated disruptions in lipid metabolism and primary bile acid synthesis, leading to elevated levels of taurochenodeoxycholic acid (TCDCA), taurocholic acid (TCA), and tauroursodeoxycholic acid (TDCA). These metabolic shifts may contribute to atherosclerosis development. Furthermore, impaired intestinal barrier function, characterized by reduced mucin expression and disrupted tight junction proteins, was observed. The increased intestinal permeability observed was positively correlated with the severity of atherosclerotic lesions, highlighting the importance of the intestinal barrier in cardiovascular health. In conclusion, this research underscores the intricate interplay among oral health, gut microbiota composition, metabolite profiles, and CVD incidence. These findings emphasize the importance of maintaining good oral hygiene as a potential preventive measure against cardiovascular issues, as well as the need for further investigations into the intricate mechanisms linking oral health, gut microbiota, and metabolic pathways in CVD development.