Periapical Index Score Research Articles

Effect of a 980-nm diode laser on post-operative pain after endodontic treatment in teeth with apical periodontitis: a randomized clinical trial

BackgroundThis 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).MethodsThis 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).ResultsThe 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).ConclusionsRoot 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

Association between concentration of active MMP-9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis - a preliminary study.

To investigate the correlation between the concentration of active-matrix metalloproteinases-9 (aMMP-9) in pulpal blood and the outcome of pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis (SIP). Forty permanent molar teeth with a clinical diagnosis of SIP and normal apical tissues with periapical index (PAI) score≤2 and ten permanent teeth (8 molars and two premolars) with a diagnosis of normal pulp that required root canal treatment for prosthetic reasons from patients between the ages of 15-35years were recruited. All clinical procedures were performed under local anaesthesia and rubber dam isolation. After access opening, the coronal pulp tissue was amputated up to the canal orifice. A 100μL volume of the pulpal blood was collected using a micropipette and transported to the laboratory. Sodium hypochlorite (2.5 %) was used as a haemostatic agent, and mineral trioxide aggregate (MTA) was used as the pulp capping material. The tooth was restored with composite at the same visit. Teeth with normal pulps were treated with single-visit root canal treatment. Patients with pulpotomy were recalled at 6 and 12months. Outcome assessment of teeth with pulpotomy was carried out at 12months and was categorized as success (asymptomatic patients with PAI score≤2) or failure (symptomatic patients or PAI score≥3). Quantification of aMMP-9 in pulpal blood was achieved using a fluorometric assay. The following statistical analyses were performed to assess the data: t-test, Fisher's exact test, kappa coefficient, non-parametric test, Wilcoxon rank-sum test, Spearman rank correlation test and receiver operating characteristic curve (ROC). The success rate of pulpotomy was 88 % at 12-months. There was a significant difference between the median concentrations of aMMP-9 in pulpal blood of teeth with normal pulps (52 (12-96)ngmL-1 :) and SIP (193.3 (25.8-607.7)ngmL-1 :) (P=0.0003) and successful (132.3 (25.8-548.3)ngmL-1 :) and failed cases (512.4 (334.8-607.7ngmL-1 :) (P=0.0015) of MTA pulpotomy. A significant association was established between aMMP-9 concentration and outcome of pulpotomy. The area under the receiver operating characteristics curve (0.9484, 95%CI) suggested excellent discriminatory power of aMMP-9 concentration in pulpal blood to predict the pulpotomy outcome. The pulpal blood concentration of aMMP-9 was significantly associated with the outcome of pulpotomy in teeth with symptomatic irreversible pulpitis, where it may be used as a potential prognostic biomarker.

Impact of root canal treatment on high-sensitivity C-reactive protein levels in systemically healthy adults with apical periodontitis - a preliminary prospective, longitudinal interventional study.

To assess the influence of root canal treatment on serum high-sensitivity C-reactive protein (hsCRP) levels in systemically healthy human adults. Fifteen individuals aged 20-40years diagnosed with apical periodontitis [Periapical Index (PAI) score ≥3] who were otherwise healthy took part in this prospective interventional study. Patients with moderate to severe periodontitis, systemic diseases and traditional cardiac risk factors (hypertension, diabetes, dyslipidemia and smoking) were excluded. Root canal treatment was completed in two visits with an inter-appointment calcium hydroxide intracanal medicament. After 6months, healing of apical periodontitis was evaluated clinically and radiographically, and serum hsCRP levels were recorded. A paired sample T-test was used to compare the mean hsCRP values between the pre- and post-treatment groups. The Mann-Whitney U test was used to compare hsCRP values between patients with PAI scores of 3 and 4, and the Wilcoxon signed-rank test was used to compare pre- and postoperative PAI scores. The mean preoperative baseline serum hsCRP level was 2.88±1.06mgL-1 which can be associated with a moderate risk for cardiovascular disease (CVD). Based on the preoperative hsCRP levels, eight of the 15 patients were categorized as high risk (hsCRP>3mgL-1 ) and the other seven as medium risk (hsCRP 1-3mgL-1 ) for CVD. The mean preoperative hsCRP value of patients with a PAI score of 3 was 2.88±1.19mgL-1 , and the mean preoperative hsCRP of patients with a PAI score of 4 was 2.87±0.15mgL-1 , which was not significantly different (P=0.942). Six months after root canal treatment, the mean PAI score had significantly reduced from 3.2±0.42 to 1.4±0.69 (P=0.003). The PAI score had reduced to ≤2 in 87% of the patients, and the mean serum hsCRP levels had significantly reduced to 1.34±0.52mgL-1 (P<0.001). Ten of the 15 patients had a reduction in their CVD risk status. This study suggests that root canal treatment can reduce serum hsCRP levels in systemically healthy individuals with apical periodontitis.

Combination of Nonsurgical Endodontic and Vital Pulp Therapy for Management of Mature Permanent Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis and Apical Periodontitis

IntroductionThis prospective study evaluated the outcome of a combination of nonsurgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP). MethodsInstitutional ethical clearance was obtained. Mandibular molar teeth (N = 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of ≥3 in either 1 of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n = 30), single-visit NSET was performed using a standardized operating protocol. In the NSET-VPT group (n = 30), subsequent to full pulpotomy, at the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed upon application of a 2.5% sodium hypochlorite pressure pack), a mineral trioxide aggregate radicular barrier was placed, and it was covered with light-cured resin-modified glass ionomer cement. NSET was performed in the root exhibiting a PAI score ≥3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48, and 72 hours. Teeth were followed up clinically and radiographically at 12 months. The presence/absence of symptoms and the change in PAI scores were noted. The data were statistically analyzed. ResultsThe success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was no significant difference (P > .05). ConclusionsThe combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multirooted mandibular teeth with SIP and AP.

Correlation between the clinically diagnosed inflammatory process and periapical index scores in severely painful endodontically involved teeth.

AimTo assess and correlate three distinct states of severely painful endodontically derived inflammation with their depiction on periapical radiographs using periapical index (PAI) scores.MethodologyDuring a period of 15 months, 368 consecutively enrolled patients with suspected endodontic emergency conditions were examined at the University of Zurich, Center of Dental Medicine. Cases with a severely painful (numeric rating scale, NRS‐11 > 6) endodontically involved tooth and a clear pulpal and apical diagnosis (n = 162) were selected (one tooth per patient). Teeth were divided into three groups according to the clinically diagnosed main location of the inflammatory process: level 1: pulp (positive response to cold test), level 2: periodontium (no response to cold without swelling) and level 3: periapical tissues (no response to cold with swelling). Periapical radiographs were obtained using a digital unit and analysed by two calibrated observers. For level 2, which had the highest PAI variance (n = 76), the PAI scores were further scrutinized regarding their dependence on tooth location and the duration of pain. Data were analysed using chi‐squared and non‐parametric tests, alpha = 0.05.ResultsOverall, the PAI scores correlated well with the clinically diagnosed main location of periapical inflammation (Spearman’s rho = 0.5131, P < 0.001), with level 1 having the lowest scores by far (P < 0.001) and level 2 having significantly lower scores compared to level 3 (P < 0.05). However, a PAI score of 5 was found in merely 3 teeth within the entire cohort, and 49% of the teeth in the level 2 group had no radiolucency (PAI < 3). Within level 2, the PAI scores were not dependent on tooth location but were substantially (P < 0.001) higher for teeth which had hurt for more than one week, and for root filled teeth.ConclusionsFor the analysed, severely painful endodontically involved teeth, the clinically diagnosed main location of inflammation was reflected by the periapical index. PAI scores were not significantly influenced by anatomical noise, yet in some cases under‐estimated the clinical situation.

Revisiting Orstavik’s PAI score to produce a reliable and reproducible assessment of the outcomes of endodontic treatments in routine practice

Orstavik's periapical index is widely used for radiographic assessment of periapical status. This study analyses the reliability and reproducibility of a modified guide for the interpretation of the periapical index (PAI) scores recorded by undergraduate students. Two groups of 4th-year students were asked to assess the PAI scores of 100 X-rays two or three times depending on the group. The reliability of their judgment was evaluated by comparing the students' assessments to those of a standard, based on the evaluations made by three teachers. Short-term stability was evaluated for two lengths of interval separating the Test and Retest phases, respectively, 1week for Group 1 and 2weeks for Group 2. Long-term stability was evaluated by having Group 1 repeat the Retest phase after 15months. Overall mean success rates ranged from 61% to 65% according to the student group and the study phase. Intergroup comparisons showed no statistical difference. The reliability of the PAI score evaluation by students was excellent in both groups. Short-term and long-term stability were also excellent regardless of the duration of the interval between the study's phases. The image misinterpretations are discussed according to the study phases and the PAI score values. Undergraduate students can be trained to use the modified guide for scoring PAI for self-evaluation of the outcomes of the root canal treatments and re-treatments they are asked to perform during their clinical sessions.

The effect of type 2 diabetes mellitus on changes in the fractal dimension of periapical lesion in teeth after root canal treatment: a fractal analysis study.

This single-centre retrospective case-control study evaluated fractal dimension (FD) changes in radiographs of periapical lesions using a fractal analysis in healthy individuals and type 2 diabetes mellitus (DM) patients following root canal treatment. The study data consisted of two groups: the DM group which contained a total of 46 mandibular molar teeth in 37 patients with no systemic disease other than type 2 DM, and the control group which contained a total of 52 mandibular molar teeth in 41 patients without systemic disease. Periapical radiographs were obtained prior to root canal treatment and 1year post-treatment. Fractal analysis was performed by selecting a region of interest on the periapical radiographs. For both groups, the FD changes in lesion area were calculated and compared. In addition, periapical status was evaluated using the periapical index (PAI) scores on periapical radiographs for both groups. Data were analysed using dependent-sample t-test, independent-sample t-test, Wilcoxon signed-rank test and Mann-Whitney U-test. In both groups, FD values were increased significantly 1year post-treatment as compared with those prior to treatment (P<0.05). The time-dependent increase in FD was significantly greater in the control group (P<0.05). Time-dependent increases in FD did not differ between genders (P>0.05). There was a significant decrease in PAI scores in both type 2 DM and control groups depending on time (P<0.05). No significant difference was found between the groups in terms of time-related decreases in PAI scores (P>0.05). An increase in the FD of the periapical lesion area was observed 1year after root canal treatment. DM had a negative effect on FD increase.

Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients\u2014a retrospective pilot study

ObjectivesThere is little evidence about the effect of different treatment protocols for grade 3 endo-periodontal lesions without root damage in patients with periodontitis according to the new classification of periodontal disease. The aim of this study is to evaluate the impact of endodontic treatment on the achievement of periodontal healing.Materials and methodsTeeth with the initial diagnosis endo-periodontal lesion without root damage grade 3, treated with a standardized endodontic treatment protocol, were included in this study. A retrospective analysis was performed to assess the impact on periodontal healing by evaluating probing pocket depth (PPD), clinical attachment gain (CAL), and periapical index score (PAI).ResultsNineteen teeth and 13 patients were included. A mean reduction of 3.19 ± 3.41 mm in PPD was recorded. The mean CAL gain was 2.33± 3.75 mm. Five teeth (45.4%) showed an improvement of PAI and were classified as treatment success.ConclusionsThe results failed to show a highly predictable treatment outcome for endo-periodontal lesion grade 3 without root damage in patients with periodontitis. However, endodontic therapy alone resulted in treatment success for some of the teeth, which would otherwise have had a poor prognosis.Clinical relevanceEndo-periodontal lesions can often be challenging for dentists in daily clinical practice. To date, there is not much evidence for practitioners to rely on. Therefore, this study aims to strengthen the evidence for the management and treatment of endo-periodontal lesions. Although the outcome is not highly predictable yet, teeth with the initial diagnosis endo-periodontal lesion without root damage grade 3 can benefit from an endodontic treatment.

“Effect of local application of simvastatin in bone regeneration of peri-apical defects-a clinico-radiographic study

ObjectiveThe present study evaluates and compares the effectiveness of Simvastatin (SIM), Hydroxyapatite (HA), and platelet-rich fibrin (PRF) in bone regeneration of periapical defects. Material& methodThirty-nine patients were selected and randomized into three groups, Group 1: HA (n = 13), Group 2: PRF (n = 13), Group 3: SIM (n = 13). After completion of RCT and apicoectomy, the grafts were placed locally in the defect and sutured. ResultsAt the end of twelve months, postoperative symptoms and radiographic analysis assessed the outcome of the treatment ConclusionIntragroup analysis of CBCT- Periapical Index (PAI) scores at 6th and 12th month revealed a significant change in the SIM group (p = 0.018 and 0.001 respectively), compared to PRF (p = 0.026 and 0.001 respectively) and HA (p = 0.053 and 0.039 respectively). Intergroup analysis of change in the level of CBCT-PAI score was highly significant (p = 0.003).SIM caused a more considerable change in the level of CBCT-PAI score compared to other groups, thereby indicating a faster rate of bone regeneration.

Apical periodontitis healing and postoperative pain following endodontic treatment with a reciprocating single-file, single-cone approach: A randomized controlled pragmatic clinical trial.

This trial assessed post-operative pain and healing of apical periodontitis following endodontic therapy with a reciprocating system compared to a crown-down technique with hand files and lateral compaction filling. One-hundred and twenty nonvital anterior teeth with apical periodontitis were randomly treated using either a reciprocating single file followed by matching-taper single-cone filling or a hand file and lateral compaction filling. Postoperative pain was assessed during the 7 days after the treatment, using a visual analogue scale and a verbal rating scale. Apical healing was assessed using the periapical index score after a 12-month follow-up. The hypothesis tested was that both protocols were equivalent and present similar effectiveness in healing periapical lesions. Data were analyzed through two one-sided tests, t-tests, as well as Mann-Whitney and Chi-squared tests (α = 0.05). Logistic regression was used to investigate the association of clinical and demographic factors with the success of treatment. Regardless of the assessment time, no difference in incidence (38%-43% at first 24h), intensity of postoperative pain, and incidence of flare-up (≈ 3%) was observed between the two endodontic protocols. Both protocols resulted in a similar healing rate of apical periodontitis. After 12 months, the success rate ranged from 73% to 78% and the difference between the treatments fell within the pre-established equivalence margin (-0.1; -0.41 to 0.2). Endodontic treatment combining a reciprocating single file with matching-taper single cone showed similar clinical effectiveness to the treatment using hand-file instrumentation and the lateral compaction filling.

Apical periodontitis and glycemic control in type 2 diabetic patients: Cross-sectional study.

BackgroundThe objective of this study was to analyze the possible relationship between the glycemic control and the prevalence of apical periodontitis in type 2 diabetic patients. The null hypothesis was that apical periodontitis is not associated with glycemic control. Material and MethodsIn a cross-sectional design, the radiographic records of 216 type 2 diabetic patients (65.0 ± 10.7 years), 117 men (54.2%) and women (45.8%), were examined. Glycated hemoglobin (HbA1c) was used to assess glycemic control, considering an HbA1c level < 6.5% as well-controlled diabetes. Apical periodontitis was diagnosed as radiolucent periapical lesions using the periapical index score. The Student t test, chi-square test, and logistic regression analysis were used in the statistical analysis. ResultsThe average HbA1c value was 7.0 ± 2.2%. Forty seven (21.8%) had HbA1c levels under 6.5% (mean ± SD = 6.0 ± 2.2%), being considered well-controlled patients, and 169 (78.2%) had an HbA1c level ≥ 6.5% (mean ± SD = 7.8 ± 2.24%), being considered poor controlled patients. Forty four per cent of diabetics had apical periodontitis, 12.5% had root-filled teeth, and 52.3% had root filled teeth with radiolucent periapical lesions. No significant differences were observed in any of these three variables between patients with good or poor glycemic control. In the multivariate logistic regression analysis the presence of radiolucent periapical lesions in at least one tooth did not correlate significantly with HbA1c levels (OR = 1.4; 95% C.I. = 0.70 – 3.09; p = 0.31). ConclusionsThe results reveal no association of glycemic control with the prevalence of apical periodontitis or root canal treatment in diabetic patients. Key words:Apical periodontitis, diabetes mellitus, endodontic medicine, glycated haemoglobin.

The Apical Extent of Mineral Trioxide Aggregate Apical Barrier Does not Influence the Treatment Outcome in a Nonvital Immature Permanent Anterior Tooth: A Split-Mouth Clinical Study.

Objective:The study aimed to compare treatment outcomes when MTA apical plugs are placed to different apical extents in nonvital immature permanent anterior teeth with an open apex.Methods:Six participants (five male & one female) between the age group of 8-18 years exhibiting bilateral traumatized nonvital immature permanent maxillary anterior teeth (n=12) with non-blunderbuss canal (Cvek’s stage 4) were included. Standardized endodontic procedures were performed, and an inter-appointment calcium hydroxide medicament placed for one week. Based on the apical position of the MTA apical barrier, two study groups were defined. Accordingly, Group I {(n=6) (4mm MTA plug up to the radiographic root end)} and Group II {(n=6) (4 mm MTA plug 2 mm short of the radiographic root-end)}. Teeth were obturated after twenty-four hours with thermoplasticized gutta-percha technique. They were evaluated clinically and radiographically at 12 and 24 months. Radiographs were assessed for periapical healing based on the periapical index (PAI) scores that were dichotomized as score <3 as healed and ≥3 as not healed. The data were compared using Mann Whitney U test, Kruskal Wallis and post hoc analysis.Results:At 24 months, all teeth in Group I and II were healed clinically and radiographically. On inter-group comparison, radiographically, all teeth (n=12) exhibited a PAI score <3 and were categorized as healed (P=1.00).Conclusion:The apical extent of MTA plug does not influence the treatment outcome. The clinician can place MTA apical plug either up to or 2 mm short of the radiographic root-end.

Assessment of apical periodontitis in relation to quality of root canal fillings and coronal restorations in a Turkish subpopulation: A retrospective cone-beam computed tomography study

Introduction: This study aims to investigate the prevalence of apical periodontitis (AP) and relate the quality of root canal fillings (RCFs) and coronal restorations (CRs) with using cone-beam computed tomography (CBCT) in a Turkish subpopulation. Materials and Methods: A total of 824 CBCT scans were performed at the Dicle University Faculty of Dentistry between January 2015 and December 2017. The age, sex, root canal-treated teeth of each patient, quality of RCF and CR, and CBCT periapical index (CBCTPAI) scores of teeth were calculated and recorded. Data were statistically analyzed. Results: Among 333 patients, 152 (45.6%) patients were male and 181 (54.3%) were female. The mean age was 30.1 ± 5.3 years. The total number of endodontically treated teeth was 550, and 76.2% had AP. In 238 (43.3%) teeth with inadequate RCF, AP rate was 89.4%. There was a significant correlation between the density of the RCF and AP (P Conclusions: The RCF quality, adequate CR, and the type of CR are related to AP.

Assessment of the quality of endodontic re-treatment and changes in periapical status on a postgraduate endodontic clinic

ObjectiveThe aim of this study was to assess endodontic retreatment outcomes based on quality of obturation and healing. Materials and MethodsA total number of 223 radiographs of patients who had received endodontic retreatment during the period (2008–2015) at a postgraduate teaching clinic were selected. Unreadable radiographs were all excluded. From the original sample of 223 in total 24 radiographs were discarded. The final sample thus consisted of 199 root canal fillings. All radiographs were individually evaluated for the density of the root filling as well as the distance between the end of the root canal filling and radiographic apex based on a six-point scoring system. Subsequently, patients were reviewed and follow up periapical radiographs were exposed. The outcome of healing was assessed using the Periapical Index (PAI) scoring system. The data were analysed using Chi Square test (p < 0.05). ResultsThe study revealed that 78.9 % of the endodontic retreatments were both homogeneity and length acceptable. The corresponding figure was only 13.1 % before endodontic retreatment. Conversely, homogeneity and length unacceptable before endodontic retreatment was 47.2 % reducing to a mere 2.5 % after retreatment. The results were statistically significant (P < 0.001). There was over 80 % improvement in periapical healing following endodontic retreatment and this was also statistically significant (P < 0.001). ConclusionThere was a significant improvement in outcome after endodontic retreatment on the postgraduate endodontic clinic. The success rate of endodontic retreatment was over 70 % which is in line with the endodontic literature. Radiographic follow up confirmed some 81 % improvement in healing rate following endodontic retreatment. Clinical SignificanceEndodontic re-treatment cases are normally categorised as high complexity and as such referral to specialist settings should be considered to help improve treatment outcomes.

Prevalence of Candida albicans in primary endodontic infections associated with a higher frequency of apical periodontitis in type two diabetes mellitus patients

To identify the prevalence of C. albicans in primary endodontic infections of type two diabetes mellitus (T2DM) patients and compare their clinical and radiographical characteristics with a non-diabetic control group, establishing the possible relationship between primary endodontic infection, T2DM, and C. albicans, since diabetes mellitus (DM), influences the development, course, and response to the treatment of apical periodontitis, but the presence of Candida albicans (C. albicans) has not been considered before. A total of 120 patients were selected and divided into two groups: 60 T2DM diagnosed patients and 60 non-diabetic controls. A clinical examination and radiographic analysis were performed to establish a periapical index score (PAI). Root canal samples were taken. Deoxyribonucleic acid (DNA) was extracted, and specific primers were used to identify C. albicans by polymerase chain reaction (PCR). A twofold increase in the prevalence of C. albicans in T2DM patients was observed in contrast to control patients (p = 0.0251). Sixty-five percent of T2DM patients with positive C. albicans scored a ≥ 3 PAI, while only 27% of the patients without C. albicans had a ≥ 3 PAI score (p = 0.0065). Long-term DM patients presented C. albicans more frequently (p < 0.0001). In this study, long-term T2DM patients carried C. albicans in their root canals more frequently when having a primary endodontic infection. Furthermore, this C. albicans presence seems to be related to a higher frequency of apical periodontitis.

Clinical outcomes of non-surgical multiple-visit root canal retreatment: a retrospective cohort study.

This study aimed to investigate the effects of several clinical factors on the success and survival rates of multiple-visit non-surgical root canal (NSRC) retreatment. Failed endodontically treated 236 teeth in 161 patients (18-72years, 48% males; and 52% females) were retreated between March 2014 and December 2015 and were enrolled in this study. Two calibrated examiners evaluated the preoperative, intraoperative, and postoperative outcomes using the periapical index (PAI) scores. The teeth were classified as healed (healthy apical tissues, PAI ≤ 2, no signs or symptoms), healing (no signs and symptoms, PAI > 2 but reduced from the initial PAI score), and not-healed (presence of apical periodontitis, signs and/or symptoms, PAI > 2). The teeth scored as healed and healing was considered to be successful, while the not-healed ones were considered as failures. Of the 236 teeth, 135 (57.3%) in 103 patients (63.9%) were lost to follow-up, yielding to follow-up of 101 teeth (42.7%) in 58 patients (36%). Three teeth were extracted yielding to an overall success rate of 85.1%, at a mean observation time of 33.8months. The teeth with periapical lesions < 5mm had an 88.6% success rate, while those ≥ 5mm had an 80% success rate (P > 0.05). While, age, gender, preoperative, intraoperative, and postoperative factors did not significantly affect the outcomes (P > 0.05), tooth type significantly affected the success rate (P<0.05). The most frequently failed teeth were the mandibular first molars (P<0.05). Based on these results, the multiple-visit NSRC retreatment exhibited a favorable success rate and could be offered for the endodontically failed teeth.

Association between C-reactive protein, neutrophil to lymphocyte ratio and the burden of apical periodontitis: a case-control study

Objective: Endodontic originated chronic apical periodontitis (AP) is an inflammatory disease of periapical tissue. High-sensitivity C-reactive protein (hsCRP) as an inflammatory marker and hemogram indexes provide valuable information to clinicians for diagnosis, screening and follow-up of various diseases. The aim of this study was to investigate AP in terms of its association with hemogram indices and hsCRP levels.Material and methods: Study includes 104 patients with AP and 40 participants as the control group. 160 teeth were diagnosed as AP through digital radiographic images and scored with respect to Periapical Index (PAI) scoring. Afterwards, patients were categorized into 3 grades in accordance with both the number and the severity of AP. AP grade 0 was considered for the control group with regard to a new scoring system. Patients with only one tooth involved with AP with a PAI score of 3 or 4 were categorized as an AP Grade 1, when a patient had more than one tooth with a PAI score of 3 or 4 he was classified as an AP Grade 2 and a patient with at least one tooth scored as a PAI 5 was rated as an AP Grade 3. Hemograms and hsCRP levels were measured for each individual to establish a correlation with inflammatory markers.Results: The neutrophil/lymphocyte ratio (NLR) levels of patients with AP Grade 3 were significantly higher than all other AP grades (p < .05). hsCRP levels in patients with an AP Grade 2 and 3 were higher than both AP Grade 0 and 1 (p < .05).Conclusions: hsCRP levels of patients were reliable predictive indicators for AP severity in correlation with the new proposed scoring system for AP.

Healing of Apical Periodontitis in Patients with Inflammatory Bowel Diseases and under Anti–tumor Necrosis Factor Alpha Therapy

IntroductionWe evaluated healing after nonsurgical primary/secondary endodontic treatment of apical periodontitis (AP) in patients with inflammatory bowel diseases (IBDs) treated with anti–tumor necrosis factor alpha biologic medications (BMs). MethodsNineteen patients with 22 teeth affected by AP from the gastroenterology unit of the hospital with IBDs under treatment with BMs formed the study group (the IBD group). Fourteen patients with 22 teeth with AP, matched by age and sex, without systemic diseases and not taking medications formed the control group. Teeth underwent primary or secondary root canal treatments and clinical and radiographic follow-up every 3 months for 24 months. The periapical index score was recorded, and 2 trained and calibrated endodontists evaluated and compared radiographs (weighted kappa values, κ = 0.8). The Mann-Whitney, t, chi-square, Fisher, and Bruner-Langer tests and analysis of variance–type statistics were used as appropriate. ResultsThe recall rate was 100%. All teeth in the IBD patients and 81% in the control patients healed (P = .108). Initial healing was appreciable at 3 months in the IBD group and 6 months in the control group (P = .174). Overall healing was reached at 6 and 10.5 months in the IBD and control groups, respectively (P = .106). At any time of the experiment, teeth in the IBD patients showed a higher probability of healing (P < .05). Both groups exhibited a similar decrement of the periapical index (P = .291), more significant for the IBD at the 3-month follow-up (P < .05). The 2 BMs used showed a similar trend of healing (P = .628). ConclusionsThe treatment of AP in patients taking BMs had no complications; furthermore, it was associated with faster healing than the controls. These results support the possible therapeutic aid of BMs in treating AP.

Impact of orthodontic treatment on the integrity of endodontically treated teeth

The purpose of this study was to evaluate the periapical status of endodontically treated teeth and the integrity of endodontic treatment before and after orthodontic treatment. This retrospective study was conducted by evaluating 128 teeth with root canal treatment (RCT). The teeth were obtained from 72 patients (23 males, 49 females) who had undergone fixed orthodontic treatment. Panoramic radiographs were taken and were evaluated before the start and after the completion of orthodontic treatment. Apical periodontitis (AP) was evaluated by the periapical index (PAI) and the probability index (PRI) of periapical bone destruction. Other variables related to the quality of root canal fillings were included, such as RCT quality index, length, and homogeneity, and coronal restoration. According to the PRI, the proportion of teeth with periapical bone destruction was significantly higher after orthodontic treatment. Overall, there was no significant change in the PAI scores after orthodontic treatment. However, the quality of the endodontic treatment moderated the change in the PAI score, as well as the change in the PRI. There was no significant increase in PAI and PRI scores after orthodontic treatment for adequately treated teeth. However, the risk for periapical lesions and bone destruction after orthodontic treatment was significantly increased for teeth receiving inadequate endodontic treatment compared with those receiving adequate endodontic treatment. Increased PAI and PRI after orthodontic treatment correlated with the quality of endodontic treatment.

Apical surgery vs apical surgery with simultaneous orthograde retreatment: A prospective cohort clinical study of teeth affected by persistent periapical lesion

Aim: This prospective clinical study analyzed the 24-month outcome of conventional apical surgery retro-filled with calcium-silicate cement versus apical surgery with simultaneous orthograde retreatment by means of clinical and radiographic criteria. Materials and methods: This study included 83 teeth affected by persistent periapical lesions in 68 patients. Mean age was 52 years (median = 51 years; range 19-81 years). Twenty-eight cases were treated with apical surgery, 16 cases with apical surgery with simultaneous orthograde retreatment and 39 cases with orthograde retreatment in previously treated teeth established as control group. Periapical index score (PAI) was used as radiographic criteria. Teeth were examined at 6 months, 1 and 2 years and classified as healed (without any symptoms and PAI 2), healing (without any symptoms and PAI = 3) or diseased (with symptoms or PAI 4 and not functional) on the basis of radiographic and clinical criteria. At 24 months evaluation, healed and healing were considered as success and diseased and fracture as failure. Multilevel GLM model and an ordered logistic regression as statistical analysis was made with level of significance set at p &lt; 0.05. Results: Total drop-out was 7% (n = 6). After 6—9 months, 6 teeth (3 from apical surgery, 2 from simultaneous treatment and 1 from orthograde retreatment) were extracted for root fracture. Twenty-four-month success rate of apical surgery group was 78% (n = 17), apical surgery with simultaneous orthograde retreatment presented 81% (n = 10) and orthograde retreatment success was 80% (n = 24). There was no statistically difference between the groups at 24 months (p = 0.890). Conclusions: Both surgical techniques revealed a high percentage of healing, similar to that reported by previous studies. Apical surgery with simultaneous orthograde retreatment showed a faster healing after 12 months comparing to the control group.