Presence Of Apical Periodontitis Research Articles

COVID-19 Severity in Patients With Apical Periodontitis: A Case Control Study

ObjectivesApical periodontitis has been associated with systemic inflammatory biomarkers that have also been associated with COVID-19 severity. This study was designed to test the hypothesis that the presence of apical periodontitis could be associated with increased risk of COVID-19 complications. MethodsA case control study (N = 949) was performed using the medical and dental records of patients diagnosed with COVID-19 in the State of Qatar between March 2020 and February 2021. Cases comprised COVID-19 patients (n = 63) who experienced complications (death, intensive care unit admissions, mechanical ventilation), and controls were COVID-19 patients (n = 886) who recovered without such complications. The presence of periapical apical periodontitis was assessed on the radiographic records taken prior to COVID-19 infection. Associations between apical periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood biomarkers were assessed in both groups and compared using the Kruskal–Wallis test. ResultsCOVID-19 complications were found to be associated with the presence of apical periodontitis (adjusted odds ratio = 2.72; 95% CI, 1.30–5.68; P = .008). Blood analyses revealed that COVID-19 patients with apical periodontitis had higher levels of white blood cells and haemoglobin A1c than the patients without apical periodontitis. ConclusionsThe presence of apical periodontitis could be associated with increased risk of COVID-19 complications.

Chronic alcohol and nicotine consumption as catalyst for systemic inflammatory storm and bone destruction in apical periodontitis.

To assess the periapical alveolar bone pattern and the serum levels of proinflammatory cytokines, biochemical markers and metabolites in rats subjected to chronic alcohol and nicotine consumption and induced apical periodontitis. Twenty-eight male Wistar rats were divided into four groups: Control, Alcohol, Nicotine and Alcohol+Nicotine. The alcohol groups were exposed to self-administration of a 25% alcohol solution, while the other groups were given only filtered water. The nicotine groups received daily intraperitoneal injections of a nicotine solution (0.19 μL of nicotine/mL), whereas the other groups received saline solution. Periapical lesions were induced by exposing the pulps of the left mandibular first molars for 28 days. After euthanasia, the mandibles were removed and the percentage bone volume, bone mineral density, trabecular thickness, trabecular separation and trabecular number of the periapical bone were measured using micro-computed tomography images. Serum samples were collected for analysis of proinflammatory cytokines (IL-1β, IL-4, IL-6 and TNF-α), biochemical and metabolomic analysis. Statistical analysis was performed with a significance level of 5%. Nonparametric data were analysed using the Kruskal-Wallis test followed by Dunn's test, while one-way anova followed by Tukey's test was performed for parametric data. The groups exposed to alcohol or nicotine consumption exhibited an altered bone pattern indicating lower bone density and higher levels of IL-1β, IL-6 and TNF-α compared to the Control group (p < .05). Significant differences were observed among the groups in the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, cholesterol, triglycerides, urea, creatinine, albumin, uric acid, bilirubin and calcium. Metabolomic analysis revealed significant differences in glycine, phosphocholine, lysine, lactate, valine, pyruvate and lipids (CH2 CH2 CO), n(CH2 ) and n(CH3 ). Most of these parameters were even more altered in the simultaneous consumption of both substances compared to single consumption. Alcohol and nicotine chronic consumption altered several metabolic markers, impaired liver and kidney function, increased the production of systemic proinflammatory mediators and harmed the periapical bone microarchitecture in the presence of apical periodontitis. The simultaneous consumption of alcohol and nicotine intensified these detrimental effects.

Odontogenic Factors Associated with Maxillary Sinus Schneiderian Membrane Thickness and their Relationship to Chronic Sinonasal Symptoms: An Ambispective Cohort Study.

Odontogenic sinusitis is a common maxillary sinus disease. It develops due to the violation of the Schneiderian membrane due to pathological, iatrogenic, or traumatic causes from dental and dentoalveolar structures. The aim of this cohort study was to investigate local and systemic factors associated with Schneiderian mucosal thickening (MT) in patients referred for evaluation of apical periodontitis (AP) and examine their relationship with chronic sinonasal symptoms. Cone-beam computed tomography (CBCT) scans of 197 patients referred for evaluation of endodontic diseases were reviewed. Mucosal thickening in relation to the affected tooth was measured in the coronal section in millimeters at the maximum area perpendicular to the bone. Based on this measurement, the sinus floor was categorized for MT as present (>1 mm) or absent (<1 mm). The sociodemographic and clinical characteristics of the study participants were assessed and compared according to the presence or absence of MT. Furthermore, the relationship between odontogenic sinusitis and chronic sinonasal symptoms was assessed using a chronic sinusitis survey. Male patients had a higher MT than female patients. The presence of periapical lesions and inadequate endodontic treatment were significantly associated with MT. The multivariate logistic regression model showed that the presence of AP increased the odds of MT by approximately 2.5 times (p = 0.028), and nasal obstruction was significantly higher in patients diagnosed with mucosal thickness at different times of their follow-up period (p = 0.018). MT was 2.5 times more likely in the presence of apical periodontitis, and nasal obstruction was the most significant factor associated with the presence of MT.

Microbiota present in combined endodontic-periodontal diseases and its risks for endocarditis.

Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria that enter the bloodstream and establish infections in the inner linings or valves of the heart, including blood vessels. Despite the availability of modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Oral microbiota is considered one of the most significant risk factors for IE. The objective of this study was to evaluate the microbiota present in root canal (RC) and periodontal pocket (PP) clinical samples in cases with combined endo-periodontal lesions (EPL) to detect species related to IE using NGS. Microbial samples were collected from 15 RCs and their associated PPs, also from 05 RCs with vital pulp tissues (negative control, NC). Genomic studies associated with bioinformatics, combined with structuring of a database (genetic sequences of bacteria reported for infective endocarditis), allowed for the assessment of the microbial community at both sites. Functional prediction was conducted using PICRUSt2. Parvimonas, Streptococcus, and Enterococcus were the major genera detected in the RCs and PPs. A total of 79, 96, and 11 species were identified in the RCs, PPs, and NCs, respectively. From them, a total of 34 species from RCs, 53 from PPs, and 2 from NCs were related to IE. Functional inference demonstrated that CR and PP microbiological profiles may not be the only risk factors for IE but may also be associated with systemic diseases, including myocarditis, human cytomegalovirus infection, bacterial invasion of epithelial cells, Huntington's disease, amyotrophic lateral sclerosis, and hypertrophic cardiomyopathy. Additionally, it was possible to predict antimicrobial resistance variants for broad-spectrum drugs, including ampicillin, tetracycline, and macrolides. Microorganisms present in the combined EPL may not be the only risk factor for IE but also for systemic diseases. Antimicrobial resistance variants for broad-spectrum drugs were inferred based on PICRUSt-2. State-of-the-art sequencing combined with bioinformatics has proven to be a powerful tool for conducting studies on microbial communities and could considerably assist in the diagnosis of serious infections. Few studies have investigated the microbiota in teeth compromised by combined endo-periodontal lesions (EPL), but none have correlated the microbiological findings to any systemic condition, particularly IE, using NGS techniques. In such cases, the presence of apical periodontitis and periodontal disease can increase IE risk in susceptible patients.

Association between second mesiobuccal missed canals and apical periodontitis in maxillary molars of a Chilean subpopulation.

To determine the frequency of missed second mesiobuccal canals (MB2) and apical periodontitis in maxillary molars of a Chilean subpopulation using cone beam computed tomography (CBCT). Two previously calibrated operators evaluated CBCTs with a total of 588 upper molars, of which 179 endodontically treated molars were selected. Axial tomographic slices were used to study the frequency and association between the presence of apical periodontitis and untreated MB2 canals. Of the 179 endodontically treated molars, 45.78% (84) presented MB2 missed canals. Of the upper molars that presented MB2 missed canals, 70% were associated with apical periodontitis, which was statistically significant (p< 0.0001). Sixty-two corresponded to first molars (74%) and 22 to second molars (26%). Of the first molars, 34 (54.8%) presented with apical periodontitis and MB2 missed canals (p< 0.0001), while 12 (54.4%) of the second molars presented this association (p = 0.081). MB2 missed canals are associated with a high degree of apical periodontitis and may be an important predictor of endodontic prognosis of upper molars. Key words:Endodontics, apical periodontitis, cone beam computed tomography, missed canals, maxillary molars.

Radiographic Assessment of Root Canal Filling for Undergraduate, Graduate Students, and Endodontic Specialist

Introduction: The aim of this study was to assess the radiographic technical quality of root canal therapy performed by three different groups of undergraduate, graduate and endodontic specialists conducted in the Jordan University of Science and Technology (JUST) Dental Teaching Center. Method and Material: The sample comprised of 320 subjects aged 18- 60 years old attended for endodontic treatments. Patients who had endodontic treatments were divided into three treatment groups according to their treatment providers (undergraduate students, graduate students and endodontic specialists). Periapical radiographic assessment sheet was attached to the patient’s file. This part included criteria for radiographic assessment for the quality of root canal filling. The following information were recorded, tooth type, quality of radiograph, taperness, length, and density of root canal filling, level of obturation in comparison to cement-enamel junction(CEJ), presence of apical periodontitis, location and size of apical periodontitis, presence of root resorption, presence of break in lamina dura, presence of widening of PDL space, presence of condensing apical periodontitis, presence of internal resorption, presence of missed canals, Presence of ledged canals, Presence of fractured instruments, presence of furcal lesions, pulpal diagnosis and restoration after endodontic treatment. Teeth were treated using at least three, long cones paralleling technique, radiographs (preoperative, working-length and postoperative) of a high quality that showed the entire length of the root and the periapical area. Two investigators using a magnifying lens and an X-ray viewer examined the radiographs independently. The results were compared and a final consensus was agreed. In case of disagreement, a third investigator was asked to read the radiograph and a final agreement was reached. Measurement was recorded and was taken as a caliber for periapical radiographs film reading. ...........

Apical Periodontitis and Cardiovascular Disease in Adults: A Systematic Review with Meta-Analysis.

A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to support this association. This review aims to appraise the relationship between apical periodontitis and cardiovascular disease based on data from observational studies. The databases Medline (via PubMed) and EMBASE (via Scopus) were searched up to August 2020 for observational studies (case-control, cross-sectional, and cohort) assessing the association of apical periodontitis with cardiovascular disease among adults. Pooled relative risk/odds ratio and 95% confidence interval (CI) were estimated using a random-effects model. Sensitivity analyses and random-effects meta-regressions were performed. The initial search yielded 2537 documents, of which 15 were eligible for inclusion, including 8 cross-sectional studies, 5 case-control studies, and 2 cohort studies. The majority of studies enrolled both men and women, with mean age ranging from 41 to 66 years. In cross-sectional studies, the presence of apical periodontitis was significantly associated with cardiovascular disease with a combined odds ratio of 1.53 (95% CI: 1.02-2.29, p = 0.039; I2 = 75.0%; p < 0.001). In the case-control studies, the combined odds ratio did not show a significant association of apical periodontitis with cardiovascular disease (OR = 1.24; 95% CI: 0.67-2.29, p = 0.494; I2 = 82.1%; p < 0.001). The pooled risk ratio from the 2 cohort studies showed (RR = 1.27; 95% CI: 0.71-2.27, p = 0.413; I2 = 69.1%; p = 0.072) also showed no significant association between apical periodontitis and cardiovascular disease. These results should be interpreted with caution due to the high heterogeneity. Data derived from cross-sectional studies suggest a weak association between apical periodontitis and cardiovascular disease. As the results were not consistent across study designs, further research is recommended, namely longitudinal studies with long-term follow-up. PROSPERO database (CRD42020204379).

Systemic conditions of diabetic patients diagnosed with apical periodontitis

ABSTRACT Objective: This study aimed to evaluate the association between glycemic control status in type 2 diabetes mellitus (T2DM) patients and apical periodontitis. Methods: Twenty-seven patients were involved in this study. The survey was based on anamnesis, intra and extra oral examination and radiographic evaluation. Diabetes mellitus information involved type of diabetes and blood glucose analysis. Patients were divided according to their metabolic control status (glycemic controlled and poorly controlled T2DM patients). Results: A higher fasting blood glucose level (p = 0.004) and a higher percentage of HbA1c (p = 0.0001) were demonstrated in poorly controlled T2DM patients when compared to glycemic controlled T2DM. However, the frequency of apical periodontitis and the elapsed time since diabetes mellitus diagnosis were higher in controlled T2DM patients, reaching 64%. Nevertheless, controlled T2DM patients presented a higher number of apical periodontitis cases (p &lt; 0.05). Findings support that controlled patients T2DM presented higher presence of apical periodontitis than poorly controlled T2DM ones. In these patients, the time elapsed since the diagnosis was higher, which may have provided a longer period of oscillation and/or uncontrolled metabolism. Conclusions: Therefore, it might contribute to the development and maintenance of apical periodontitis in glycemic controlled patients of this study.

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.

Digital Orthopantomography vs Cone Beam Computed Tomography—Part 2: A CBCT Analysis of Factors Influencing the Prevalence of Periapical Lesions

Cone beam computed tomography (CBCT) is the most refined and affordable method available today for the examination of an incoming patient for different dental pathologies. The aim of this paper is to evaluate the significance of some factors influencing the prevalence of apical periodontitis. An ortopantomography (OPT) and CBCT scan of the dental arches were examined for each of the selected 45 patients. The presence of apical periodontitis (AP) was compared for CBCT and OPT examination. Sensitivity, specificity, predictive values, and accuracy were calculated for CBCT, using OPT as a reference. The impact of protective/risk factors on the development of AP was examined. CBCT showed higher sensitivity (250%), predictive values (111%), accuracy (111%), and specificity (101%) than OPT. It was found to have higher sensitivity in all the dentition areas, especially where empty anatomical spaces or more radiotransparent structures have a strict relationship with the tooth apex and periapical structures like upper front area, premolar areas, and, especially, in the upper molar area. The prevalence of AP increased from 16 to 17% in the case of insufficient conservative restoration or 25% in the case of microleakage, 35-42% in the case of prosthetic restoration, 56-67% for posts, and 60 and 85%, respectively, for inadequate endodontic treatment and missed canals. CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between the apex and important anatomical structures exists. Different risk factors with different relevance are identified. As CBCT-examined results show, coronal restorations are moderate-risk factors, while insufficient endodontic treatments and posts are high-risk factors for the development of AP.

Evaluation of the relationship between obturation length and presence of apical periodontitis by CBCT: an observational cross-sectional study.

The aim of this study was to evaluate the relationship between length of root canal obturation (RCO) and the presence of apical periodontitis (AP) in different dental groups using cone-beam computed tomography (CBCT) analysis. A total of 392 roots with canal treatment performed for more than 4years were evaluated using CBCT. Distances from the apex to the tip of filling material were measured and classified as more than 2mm short of the apex, approximately 1-2mm short of the apex, at the apex, and beyond the apex. Odds ratio, confidence interval, and the χ2 test were used for statistical analyses. The frequency of AP was significantly greater in molars than in the other tooth groups (p < 0.05). Moreover, RCO that ended 1-2mm short of the apex was associated with a lower prevalence of AP in molars and premolars (p < 0.05) and in anterior teeth (p < 0.1) when compared with RCO at the apex, more than 2mm short of the apex, or beyond the apex. When the RCO reached the apex, there was no difference in the presence of AP among dental groups (p > 0.05). The length of RCOs can influence the presence of AP, with molars showing a higher prevalence. RCOs ending 1-2mm short of the apex are associated with an absence of AP. The length of obturation is related to the presence of apical peridontitis and consequently to the success of endodontic treatment.

Treatment Outcomes of 4 Vital Pulp Therapies in Mature Molars

IntroductionVital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical periodontitis. MethodsBlinded participants (N = 302) were randomly allocated to 4 study arms. Random allocation was disregarded when visible pulp exposures did not happen after complete caries removal and the tooth was transferred to the IPC arm. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Participants were followed up for 1 year. ResultsThe groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. The 3- and 12-month success rates of the VPT techniques were comparable in the IPC (98.7% and 100%, respectively), DPC (98.4% and 94.7%, respectively), MP (98.4% and 91.4%, respectively), and FP (93.5% and 95.5%, respectively) arms, respectively (P > .05). ConclusionsIn deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes.

Periapical Status and Quality of Root Canal Fillings in a Moroccan Subpopulation.

Aim The aim of the study was to assess the prevalence of apical periodontitis (AP) and quality of root canal fillings in an adult Moroccan subpopulation. Methods In the study 508 patients were included, attending the Conservative Dentistry Clinic at the Faculty of Dentistry of Casablanca. 508 panoramic and 709 periapical radiographs were observed. The periapical status of all teeth (with the exception of third molars) was examined according to Ørstavik's periapical index. The statistical analysis was performed with the software Epi Info Version 6.04dfr, April 2001. Results A total of 12719 teeth were examined. 45.3% of patients had apical periodontitis. 4.2% of teeth were treated endodontically and 70.4% of these treatments were inadequate. 91,5% with inadequate endodontic treatment presented apical periodontitis, while only 8,2% with adequate endodontic treatment had apical periodontitis. The lower molars and the upper premolars were the most affected teeth. The presence of apical periodontitis was correlated significantly with insufficient root canal fillings (p < 0.05). Conclusions The present study found a high prevalence of apical periodontitis in this Moroccan population. Inadequate root canal fillings were associated with an increased prevalence of apical periodontitis.

Characteristics of teeth referred to a public dental specialist clinic in endodontics

To investigate referrals to a specialist clinic in endodontics in relation to previously root filled teeth and to determine how many of these teeth had a history of symptoms and the extent to which antibiotics were prescribed. The total number of referrals to the specialist clinic in endodontics in Gothenburg, Sweden, in 2011 was investigated retrospectively by means of patient records. The endodontic status together with the presence or absence of symptoms was registered. The following variables were also examined: gender, age, tooth number and lower or upper jaw. Additionally for root filled teeth, the type of restoration, the technical quality of the root filling and the presence of apical periodontitis were registered. The use of antibiotics was examined for all of the included teeth. Statistical analysis was performed using generalized estimating equationmethods applied to univariable and multivariable logistic regression. A total of 1117 patient records were investigated, including 1341 referred teeth. Pain and/or swelling were recorded for 658 (54.3%) teeth. Symptoms were significantly more associated with females (P<0.0001) and molar teeth (P<0.0001). Seven hundred twenty-nine (54.4%) of the referred teeth were root filled, and of these, 377 (56.0%) were associated with pain and/or swelling. Root filled teeth restored with a post and core were less frequently related to symptoms (P=0.009). One hundred sixty-two (22.3%) root filled teeth were treated with antibiotics, which was significantly more frequent than for non-root filled teeth (P<0.0001). Also, root filled teeth with an adequate root filling were significantly associated with more frequent antibiotics prescriptions (23.8%) than root filled teeth with an inadequate root filling (17.0%) (P=0.0010). Root filled teeth constituted the majority of cases referred to this specialist clinic in endodontics. The majority of these teeth were associated with symptomatic conditions, and antibiotics were prescribed to approximately 20% of the patients referred for a root filled tooth. The findings suggest that symptomatic root filled teeth may be a substantial clinical problem in general dentistry and contribute to avoidable prescription of antibiotics.

The impact of smoking on marginal bone loss in a 10-year prospective longitudinal study.

The aim of this epidemiologic study was to determine the impact of smoking on marginal bone loss in a subsample derived from an original randomly selected adult sample, after adjusting for oral and general factors. The number of participants at baseline in this 10-year longitudinal study was 616 (mean age: 42 years, range 21-63 years). The participants underwent a full-mouth radiographic survey. After recall in 2003, 473 (77%) of the participants accepted and completed an identical survey. In 2008, the survey was repeated, and 301 (48.9%) individuals were included in this study. The marginal bone level of each tooth was measured in mm. Age, gender, smoking habits, number of teeth, apical periodontitis, crowns and initial marginal bone level were also recorded for each individual. Only individuals who did not report a change in smoking habits during the 10-year period were included in the study. Multiple regression analyses were used to evaluate crude and adjusted associations between smoking and marginal bone loss. At the first, radiographic survey smokers had a statistically significantly more reduced marginal bone level (in average 0.9 mm) than nonsmokers. After 10 years, a progression of a mean marginal bone loss of > 2 mm was statistically significantly more common in smokers than in nonsmokers (7.1% and 0%, respectively). Furthermore, a marginal bone loss of 1-2 mm was observed in 29% of the smokers and 19% of the nonsmokers, and ≤ 1 mm marginal bone loss was found in 69% of smokers and 81% of nonsmokers. Even after adjusting for initial marginal bone level, gender, age, and also presence of apical periodontitis and crowns, the difference in progression of marginal bone loss was still statistically higher in smokers (on average 0.36 mm). The smokers started out with a more reduced marginal bone level than nonsmokers. However, even after adjusting for the initial marginal bone level, the progression of marginal bone loss in smokers was more pronounced than in nonsmokers. This shows that smoking is a factor with significant impact on the marginal bone level and can be assumed to be a true risk factor for marginal bone loss.

Radiographic evaluation of periapical status and frequency of endodontic treatment in a turkish population: a retrospective study.

The aim of this study was to determine the frequencies of apical periodontitis and endodontic treatment in a Turkish population using a retrospective analysis of orthopantomograms. The sample consisted of orthopantomographs of 250 subjects who had been referred to our clinic for an initial visit between the years of 2013 and 2014. The periapical status of all teeth (with the exception of third molars) was examined using periapical index scoring system (PAI). Data were analyzed statistically using the Chi-squared test at the significance level of p<0.05. The study sample comprised 6196 teeth belonging to 250 patients. Out of 6196 examined teeth, the frequencies of apical periodontitis and endodontic treatment was 1.8% and 3.7%, respectively. Gender had no effect on the presence of apical periodontitis or the frequency of endodontic treatment. The frequency of apical periodontitis and endodontic treatment increased with age, but it did not show statistical significance among different age groups. This study provides epidemiological data about apical periodontitis and endodontic treatment in a Turkish population.

Apical periodontitis and incident cardiovascular events in the Baltimore Longitudinal Study of Ageing.

To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) - as the sum of AP and RCT sites - were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Ageing (BLSA). This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. The total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean = 17.4± 11.1 years) following dental examination. Relative risks (RRs) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE. Mean age at baseline was 55.0 ±16.8 years and 51.4% were men. Sixty-two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age ≥60 years (RR = 3.07, 95% CI =1.68-5.62), hypertension (RR = 2.0, 95% CI = 1.16-3.46) and EB ≥3 (RR = 1.77, 95% CI = 1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to nonsignificance after adjustments (RR = 1.97, 95% CI = 0.83-4.70). EB in midlife was an independent predictor of CVE amongst community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP.

Periapical Status and Quality of Root Canal Obturation in Elderly Population: A Systematic Review

The aim of this study was to investigate the relationship between root fillings and the presence of apical periodontitis in studies with samples containing elderly patients. The data were obtained by means of a systematic review of studies that evaluated the quality of root fillings and their relationship with periapical health. 1,376 potentially relevant articles were selected, of which 667 were repeated and 16 were duplicates. 693 abstracts were analyzed, with 608 of these being excluded and 85 selected for reading in full. Fourteen (14) articles were included, totaling data of 135,566 teeth. Of these, 13,704 (10.1%) had endodontic fillings, with 6,455 (47.1%) being considered adequate and 7,249 (52.9%) inadequate. Among the teeth with apical periodontitis, 2,084 (32.3%) had adequate endodontic fillings and 3,749 (51.6%) had inadequate fillings. There was a significant correlation between the quality of endodontic fillings considered adequate and lower frequency of apical periodontitis in elderly patients.

Effect of radiation dose on the prevalence of apical periodontitis—a dosimetric analysis

The objective of this study is to analyse the effect of the radiation dose of oral radiotherapy for cancer on the presence of apical periodontitis in patients without dental pre-screening or specific preventive measures. All selected patients had been diagnosed with cancer in the head and neck region and presented in the dental clinic post radiotherapy with side effects (mainly radiation caries). The panoramic radiographs of these patients were examined for several parameters, including tooth decay and apical periodontitis. The total radiation dose per tooth was determined. A total of 36 patient files were included, which accounted for 628 teeth to be scored. Tooth decay was present in 88.2% of teeth. Radiographic signs of apical periodontitis were found in 9.1% of the teeth. Teeth with apical periodontitis had significantly more caries present. The radiation dose was significantly higher for teeth with apical periodontitis (37.2 vs. 24.9Gy). Binary logistic regression found the radiation dose to be the only explanatory variable in the presence of apical periodontitis. This study found that in zones with higher radiation dose, inflammation of the jawbone due to bacterial infection of the root canal is more likely to develop. This is probably due to bone changes post radiotherapy. An increase of this prevalance of apical periodontitis in irradiated bone found in this study needs to be taken into account in the dental evaluation before the start of radiotherapy.

Endodontic Application of Cone-Beam Computed Tomography in South Korea

Introduction This study aimed to investigate the incidence of cone-beam computed tomography (CBCT) associated with endodontic procedures during 2009 in South Korea and to retrospectively evaluate information from CBCT with large field of view (FOV), which is popular in South Korea. Methods The Health Insurance Review and Assessment agency, which reviews all medical and dental expenses covered under the Korean National Health Insurance (NHI) system, was queried for data on the nationwide number of CBCTs associated with some treatment procedures. To compare digital periapical radiography and CBCT retrospectively, 470 roots of 257 root canal–infected teeth were enrolled. Results In total, 13,209 cases of NHI-covered CBCT were performed in South Korea during 2009, excluding cases for implant restoration and orthodontics. In total, 1253 and 95 CBCT cases were combined with root canal length measuring and apicoectomy, respectively. In a retrospective comparison, CBCT with large FOV provided more information about the presence of apical periodontitis, distortion of cortical bone, and identification of root compared with digital periapical radiography. Conclusions CBCT with large FOV is useful in nonsurgical endodontic treatment and provides more information compared with digital periapical radiography.