Treatment Of Apical Periodontitis Research Articles

Evaluation of Temperature Increase From Joule Heat in Numerical Tooth Model by Applying 500 kHz Current for Apical Periodontitis Treatment-Effect of Applied Voltage and Tooth Conductivity.

For apical periodontitis treatments, a new method with the insertion of an electrode into the root canal of a tooth and application of a current at 500 kHz to sterilize the area by Joule heat has attracted attention. However, few studies have quantified the temperature increase in the root canal. This study aimed to investigate the basic characteristics of the temperature increase in a simple and standard tooth model when energizing a current at 500 kHz to the numerical tooth model with typical electrical and physical properties. We developed a numerical model of a standard tooth (dentin) and periodontal tissues consisting of an alveolar bone, cortical bone, and gingiva, and physiological saline in a root canal and calculated the temperature increase inside the numerical model by a coupled analysis of current and heat when a voltage was applied across the electrodes. The calculated results for the different applied voltages showed a temperature increase at the apical portion of the root canal, which increased with the applied voltage even for the same total supplied energy. The temperature increase occurred at the apical portion of the root canal as the tooth conductivity decreased. When the tooth conductivity was high, a current passed through the dentin, which led to a decrease in the temperature at the apical portion of the root canal. However, a chemical solution with a higher conductivity in the root canal tended to increase the temperature at the apical portion of the root canal, regardless of the tooth conductivity. More efficient approaches for increasing the spatial and temporal temperature for the tooth model target are needed. © 2021 Bioelectromagnetics Society.

Copper-Calcium Hydroxide and Permanent Electrophoretic Current for Treatment of Apical Periodontitis.

Endodontic failure has been and continues to be a problem for endodontics-specialists. Complicated anatomy, numerous foramens, and accessory canals are an environment for microorganisms to infect the teeth. The purpose of the present work was to evaluate the regeneration of copper–calcium hydroxide (Cupral)-endodontically treated teeth diagnosed with apical periodontitis using an electrophoresis technique. In total, 132 patients, aging from 19 to 65 years old, underwent endodontic treatment mono- and multi-radicular teeth, with complicated canals from January 2019 to June 2020. The patients were divided into two groups: (i) the control group—which included 54 patients (n = 62 teeth) receiving endodontic paste (Calcipast + 1) and, as final filling, the AH-PlusTM cement—and (ii) the Cupral group, which included 78 patients (n = 80 teeth) receiving Cupral paste plus the electrophoretic current and, as final filling, the Atacamit-alkaline cement. The clinical cases were periodically observed along an 18-month follow-up period via radiography. Data were expressed as focal size of the lesions (mean ± standard error (SEM) of all the radiographic outcomes) observed in each group at each interval point. Statistical analysis was performed using the Student’s t-test that allowed us to compare the control and Cupral groups; the statistical significance was set at p < 0.05 and p < 0.01, where the latter was highly significant. Before treatments, the focal sizes were 4.8 mm and 4.95 mm for control and Cupral-treated groups, respectively. After 6 months, the mean focal sizes were 3.9 mm and 2.14 mm for the control and Cupral groups, respectively. After 12 months, in the control group, the mean focal size was measured at 2.8 mm, while, in Cupral group, the lesion size decreased down to 0.31 mm and a highly dynamic regeneration of the destructive focal-bone occurred. After 18 months, the lesions were further significantly reduced in the control group (mean values of 2.62 mm), while they were barely detectable in the Cupral group (0.2 mm). In conclusion, we provide initial evidence that the Cupral-electrophoresis methodology is effective in treating destructive periodontitis of teeth with problematic canals up to 18 months, thus allowing teeth preservation.

Medications for intracanal dressing used in the multivisit treatment of apical periodontitis

Introduction: Apical periodontitis is caused usually by bacterial infection in the root canal. Enterococcus faecalis is considered to be the main pathogen associated with periapical lesions. The main goal of endodontic treatment is to remove as many bacteria as possible from the root canal system and then create an environment in which other organisms cannot survive. Unfortunately, this cannot always be obtained with mechanical processing and proper irrigation of the root canal system only. Aim : The purpose of this article is to present and compare the main materials used to treat the root canal. Materials and Methods: In this review of the literature related articles and publications will be reviewed and the results of researches on the topic will be summarized. Results: The review of all the included related articles and publications shows that a significant number of intracanal medicaments can be used in order to treat existing inflammatory processes inside the root canals and reduce the number of pathogenic microorganisms. Some of them have a questionable effect on the health of the periapical tissues and therefore their use has been limited in modern endodontics. Conclusion: According to the available literature-based evidence, the two-visit treatment of teeth diagnosed with asymptomatic apical periodontitis, which includes a placement of an intracanal medication, provides good results in the reduction of the inflammatory process in the periapical tissues and the amount of pathogenic microorganisms.

German Dentists' Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey.

Currently, there is no standard treatment protocol for apical periodontitis (AP). Thus, restorable teeth might get extracted and replaced prosthetically. This study evaluated German dentists’ preferred AP treatment decisions and the influencing factors for selecting tooth retention by initial/repeated surgical/non-surgical root-canal treatment (RCT) or extraction with/without prosthetic replacement. Through an online-survey, participants (n = 260) rated different treatment options for four case scenarios with AP in anterior/posterior teeth without/with previous RCT. Statistical analysis included the Friedman test for intra-case comparisons and Chi-squared test for factor-associations (p ≤ 0.05). Tooth retention using initial/repeated RCT was ranked first in all scenarios and rated as (very) appropriate by most participants, while implant-supported crowns (ISC) and apicoectomy had the second ratings. ISC were preferred more on posterior teeth or previous root-canal-treated teeth. Rating levels of treatment options displayed significant differences for all case scenarios. Posterior tooth retention by RCT demonstrated a significant association with work experience. Tooth retention with previous RCT displayed a significant correlation with dentists’ privately insured patients. Most dentists preferred tooth preserving with initial/repeated RCT, while others selected non-evidence-based choices. This reflects a lack of consensus of AP treatment decisions in Germany. Fixed treatment guidelines and further evaluation of treatment–decision-correlated factors are recommended for correct treatment planning.

Assessment of the functional efficacy of root canal treatment with high-frequency waves in rats.

The purpose of this study was to develop a high-frequency wave therapy model in rats and to investigate the influence of high-frequency waves on root canal treatment, which may provide a novel strategy for treating apical periodontitis. Root canal treatments with and without high-frequency wave irradiation were performed on the mandibular first molars of 10-week-old male Wistar rats. The mesial roots were evaluated radiologically, bacteriologically, and immunohistochemically. At 3 weeks after root canal treatment, lesion volume had decreased significantly more in the irradiated group than in the non-irradiated group, indicating successful development of the high-frequency therapy model. The use of high-frequency waves provided no additional bactericidal effect after root canal treatment. However, high-frequency wave irradiation was found to promote healing of periapical lesions on the host side through increased expression of fibroblast growth factor 2 and transforming growth factor-β1 and could therefore be useful as an adjuvant nonsurgical treatment for apical periodontitis.

Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis

Background Previous studies have linked apical periodontitis (AP) to inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of AP and root canal treatment (RCT) in patients with ulcerative colitis (UC) and Crohn´s disease (CD). Material and Methods A cross-sectional study, including 28 patients with Crohn´s disease and 26 with ulcerative colitis, was conducted. AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student’s t test, 2 test and multivariate logistic regression were used in the statistical analysis. Results Multivariate logistic regression run with age, gender, number of teeth, number of RFT, periodontal disease and the type of IBD as covariates, taking as dependent variable and outcome “periapical status” (0 = no tooth with RPL; 1 = at least one tooth with RPL), showed that both UC and CD patients had the prevalence apical periodontitis (OR = 1.03; C.I. 95% = 0.25 – 4.31; p = 0.97). The multivariate analysis, including all the above covariates, shows that both in UC and CD patients the prevalence of RCT was similar (OR = 0.76; C.I. 95% = 0.17 – 7.31; p = 0.73). Periapical status was significantly associated with endodontic status (OR = 42.72; C.I. 95% = 3.87 – 472.15; p = 0.002), regardless of IBD type. Conclusions The results of the present study show similar frequency of AP and RFT in both UC and CD patients. The type of IBD does not appear to affect the prevalence of radiographically detectable periapical lesions or the prevalence of root canal treatment. Key words:Apical periodontitis, Crohn’s disease, inflammatory bowel disease, toot canal treatment, ulcerative colitis.

The effect of treated apical periodontitis before heart valve surgery on C-reactive protein levels.

Dental infections produce significant increases in systemic inflammatory responses manifested by cytokines and acute-phase reactants. This study evaluated the postoperative C-reactive protein (CRP) levels according to patients having teeth treated or not treated for apical periodontitis (AP) before heart valve surgery. Preoperative, postoperative third- and fifth-day CRP levels, and the previous dental data of 91 patients were investigated. Whether the patients had been treated for AP and whether they used antibiotic prophylaxis for this treatment were determined by examining the previous data. The analysis of covariance (ANCOVA) was used for statistical analysis. There were no statistically significant differences in the preoperative CRP levels and the third-day CRP levels between all patients treated and those not treated for AP (p>.05). The mean fifth-day CRP levels of the patients with teeth treated for AP were significantly lower than those of the patients with teeth not treated for AP (p<.05). Antibiotic prophylaxis had a significant effect on the fifth-day CRP levels. The decrease in CRP levels after AP treatment may contribute to alleviating heart valve disease and maintaining cardiac health.

One visit endodontic on asymtomatic mummificated mandibular molar

Background. The main goal of root canal treatment is the prevention or treatment of apical periodontitis, which leads to the preservation of natural teeth. Traditionally, root canal treatment is carried out in a number of visits, using extra disinfecting agents in addition to irrigant used during cleaning and shaping procedures that primarily aim to reduce or eliminate microorganisms and their byproducts. from the root canal system before it is obtained. Recent advances in Endodontic technology, attracting dental experts and endodontists to perform root canal treatment in one visit. Numerous studies evaluate the effectiveness of single-versus multiple-appointment root canal treatment have been published, which reported no significant differences in effectiveness (healing rates) between these two treatment regimens.Purpose : preservation of the integrity of the molar teeth that have symptomatic complaints by taking proper care with a short visit time. Caset: A 21-year-old woman presents with concern in her lower left tooth, the patient tells that the tooth had been treated before at the dentist when she was a child. On clinical examination there is a composite restoration in occlusal tooth # 36, non vital teeth. On periapical radiology there are radiopaque on pulp chamber and a diffuse radiolucent area in the apical area of tooth # 36, then the diagnosis then determined Previously initiated therapy with asymptomatic apical periodontitis. Case Management : Tooth # 36 treated with one visit root canal treatment, Treatment is continued with fiber post installation and crown, patients no longer complain of pain after treatment. Teeth function normally again. Conclusion: One visit root canal treatment can successfully eliminate patient complaints and restore tooth function.

Клинический случай лечения хронического апикального периодонтита, осложненного одонтогенным гайморитом

Клинический случай лечения хронического апикального периодонтита, осложненного одонтогенным гайморитом

Minimally invasive endodontics and permanent restorations of endodontically treated teeth: literature review

The primary goal of endodontic therapy is the long-term survival of a functional tooth through the prevention and/or treatment of apical periodontitis. However, successful endodontic outcomes depend on many factors, such as the structural integrity of the tooth after root canal preparation and the quality of the final restoration. The field of endodontics is continuously changing due to the introduction of new techniques and technological advances. Currently, minimally invasive endodontics is considered as the recommended approach during root canal therapy, with permanent restorative decisions saved for the postoperative period. Various materials and techniques have been developed and/or proposed to increase the life span of endodontically treated teeth while maintaining adequate root strength and maintaining the balance between biological, mechanical, adhesive, functional, and esthetic parameters. This critical review aims to assess the literature on recent trends in conservative endodontic treatment and adhesive dentistry for the restoration of endodontically treated teeth.

Essential Endodontology: Prevention and Treatment of Apical Periodontitis

Essential Endodontology: Prevention and Treatment of Apical Periodontitis

Antibacterial Efficacy of Muringa Seed Extract and Potato Peel Extract Against Enterococcus faecalis.

Background:Elimination of infection and prevention of reinfection should be the main goal in the treatment of apical periodontitis. The most challenging part of endodontics is the complete disinfection of root canal system. Herbal alternatives have emerged as the more biofriendly approach in root canal irrigation and disinfection.Aim and Objective:The aim of this study was to evaluate the antimicrobial efficacy of natural extracts like muringa seed and potato peel extract against Enterococcus faecalis.Materials and Methods:The antimicrobial activity was determined using agar diffusion test. The solutions were divided into three groups: Group I- Muringa seed extract, Group II- potato peel extract, and Group III-5.25% sodium hypochlorite. The zones of inhibition of growth were recorded. The strain used for this study was Enterococcus faecalis ATCC 29212.Results and Conclusion:Muringa seed extract (Group I) demonstrated the best result among the tested solutions. Although there was no significant difference between potato peel extract (Group II) and 5.25% sodium hypochlorite (Group III). Within the limitations of this study, herbal extracts tested has shown significant antimicrobial action against Enterococcus faecalis.

Prevalence of Apical Periodontitis in patients with Multiple Myeloma.

Background Aim Previous reports have been analyzed the prevalence/association of apical periodontitis (AP) with systemic diseases. The present study aims to analyze the prevalence of healthy/diseased periapex and endodontic treatments in patients with Multiple Myeloma (MM) and compare the results with those of control subjects. Material and Methods Methodology Panoramic radiographs of 50 individuals with MM were evaluated and compared with 50 controls that were sex and age matched exactly with the diseased group. Radiographic analysis was performed by 2 two experienced endodontists under standardized conditions. The periapical status (presence or not of AP) was assessed using the periapical index (PAI). Data included systemic health, technical quality of root fillings, total number of teeth, quality of restoration, and periapical status. Statistical evaluation of differences between groups included used chi-squared tests and Fisher’s exact tests. Results The prevalence of root canal-treated teeth was 10.11% in the MM group and 12.05% in the control group (p=0.90). The average root canal-treated teeth in the test group was 2,34 and 2.48 in the control group, where the difference was statistically significant (p=0.05). AP in 1 or more teeth was found in 86 % and in 78% of the patients in the MM and the control groups, respectively. When analyzed by subject, there was no statistically significant difference in the prevalence of AP (p>0.72). Similarly there was also no statistically significant difference in the prevalence of PA (p=0.85), when analyzed by tooth, AP was found in 63.2% and 62.9% in MM and control groups. Conclusions The presence of AP and endodontic treatment was not significantly different in individuals with MM compared with control subjects. Future studies are needed to elucidate and confirm the association between MM and AP. Key words:Apical periodontitis, multiple myeloma, endodontics, root canal treatment, systemic disease.

CLINICAL AND MICROBIOLOGICAL ASSESSMENT OF ROOT CANAL DECONTAMINATION IN CHRONIC APICAL PERIODONTITIS USING THE ULTRASOUND

The aim: To study the effectiveness of chronic apical periodontitis treatment by the combined use of ultrasonic treatment of root canals and multicomponent antimicrobial gel according to the results of clinical and microbiological researches. Materials and methods: 64 patients with chronic apical periodontitis at the age of 18-56 years were treated. Patients were divided into two groups: the main and control. In the main group the root canals of 36 teeth were sonicated in combination with multicomponent antimicrobial gel, in the control - 35 teeth were treated by a standard method. The content of the root canals for microbiological studies was obtained before endodontic treatment and before permanent obturation. Frequency of content and number of bacteria in the samples were evaluated. Results: All samples before treatment were positive for the presence of variable bacterial flora, among which Staphylococcus epidermidis (43.9%), Enterococcus faecalis (37.9%), Streptococcus spp. (24.8%), Candida albicans (24.4%), Fusibacterium (9.4%) were the most dominant, their number was 7.4-4.8 lg CFU/ml. Repeated research after the proposed and standard method of root canal decontamination has shown a significant decrease in microflora. According to the data of clinical and microbiological examination, the method which was developed by us revealed a positive result in 86% of cases compared with 63% when treated by the standard method. Conclusions: The effectiveness of a complex treatment method with combined use of the ultrasonic irrigation and multicomponent antimicrobial gel for root canals decontamination in chronic apical periodontitis is demonstrated. Significant reduction of microflora growth and destruction of microbial associations, good penetration of multicomponent antimicrobial gel into endodontic structures due to ultrasound compared with a standard method were achieved.

MMP9 protects against LPS-induced inflammation in osteoblasts.

The matrix metalloproteinase (MMP) family is widely involved in the destruction of the pulp and apical tissues in the inflammatory process. MMP9 is closely related to oral inflammation. Nevertheless, the specific function of MMP9 during oral inflammation, as well as its mechanism, is not well understood. Our previous studies found that in experimentally induced apical periodontitis, more severe inflammation occurred in MMP9 knockout mice compared with the wild type mice. Moreover, the pathology phenomenon of alveolar bone destruction was even more evident in MMP9 knockout mice compared with the wild type mice. We proposed that MMP9 has “anti-inflammatory” properties. We aimed to study the effects of MMP9 on inflammatory response as well as on bone formation and bone destruction. We found a specific relationship between MMP9 and inflammation. qRT-PCR and Western blot revealed that the production of IL-1β, TNF-α, RANK, RANKL, TLR2, and TLR4 was reduced by MMP9 in LPS-stimulated MC3T3-E1 cells. Meanwhile, the expressions of OPG and OCN were increased by MMP9 in LPS-stimulated cells. MMP9 plays a protective role in LPS-induced inflammation, thereby providing new clues to the prevention and treatment of apical periodontitis.

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.

ОЦЕНКА ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ХРОНИЧЕСКОГО АПИКАЛЬНОГО ПЕРИОДОНТИТА НА ОСНОВАНИИ ДЕНСИТОМЕТРИЧЕСКОГО И МИКРОБИОЛОГИЧЕСКОГО МЕТОДОВ ИССЛЕДОВАНИЯ

Relevanct of the research topic. One of the possible causes of apical periodontitis is the infectious inflammatory process of the periapical periodontal tissues. The microflora of the root canal system is represented by various microorganisms, among which streptococci, enterococci and staphylococci most often prevail. The complex anatomy of the root canal system ensures the growth and reproduction of microorganisms, and the endodontic treatment does not always contribute to their qualitative and quantitative reduction. &#x0D; Purpose ― study of the effectiveness of endodontic treatment of chronic apical periodontitis in the near and long term.&#x0D; Methods. We observed 110 patients aged 20 to 30 years with apical periodontitis, bone density analysis and microbiological examination of the contents of the root canal. Depending on the obtained clinical and laboratory data, the patients were divided into two clinical groups: in group I endodontic treatment of 55 teeth was carried out according to the scheme developed by us; in group II — 55 teeth using the standard method of treatment. &#x0D; Results. In endodontic treatment of chronic apical periodontitis, treatment of the root canal system with a diode laser promotes better decontamination of the microflora. Coal mining introduction into the root canal system and in the region of the transition folds of the platelet autoplasma leads to an increase of the reparative process in the periapical region (p≤0.05).&#x0D; Summary. The inclusion in the Protocol of endodontic treatment of apical periodontitis of treatment of the root canal system with a diode laser and injection of platelet autoplasm is a more effective method of treatment in comparison with the traditional one.

Сучасні уявлення про етіологію та лікування періапікальних вогнищ запалення

Сучасні уявлення про етіологію та лікування періапікальних вогнищ запалення

АНАЛИЗ ПРИЧИН НЕУДАЧ ЭНДОДОНТИЧЕСКОГО ЛЕЧЕНИЯ И УДАЛЕНИЯ ЗУБОВ С ДИАГНОЗОМ «ХРОНИЧЕСКИЙ АПИКАЛЬНЫЙ ПЕРИОДОНТИТ»

Object. Causes of failure of endodontic treatment and causes of tooth extraction with a diagnosis of chronic apical periodontitis. Purpose ― to analyze the causes of failure of endodontic treatment and the causes of tooth extraction with a diagnosis of chronic apical periodontitis to determine ways to improve the effectiveness of conservative treatment. Methodology. A retrospective analysis of 864 medical records of a dental patient and 532 results of x-ray examinations of patients who underwent tooth extraction was carried out. 198 dentists-therapists of the city of Tyumen and the South of the Tyumen region were interviewed to determine the shortcomings of endodontic treatment. During the survey, doctors expressed their subjective opinion about the main reasons for the failure of therapeutic treatment of teeth with apical periodontitis and the reasons for their subsequent tooth extraction. Results. According to the survey, the failure of conservative treatment is most often associated with non-compliance with treatment protocols and the complexity of the anatomical structure of the root canals, as well as the inability to adequately clean the root canal system. A retrospective analysis of the data related to tooth extraction revealed that the main cause of tooth extraction is chronic apical periodontitis, which accounts for 69 %. The main reason for the removal of teeth diagnosed with chronic apical periodontitis was a significant destruction of the crown. Summary. In the course of this work, we justified the need to improve existing methods of conservative treatment of apical periodontitis. Improvement of endodontic treatment should be aimed at the development and implementation of effective methods of root canal cleaning and irrigation solution activation. In order to improve the prognosis of endodontic treatment and reduce the proportion of tooth extractions for periodontitis, it is necessary to improve the quality of the final restoration and to monitor its tightness.

Temporal-controlled bioactive molecules releasing core-shell nano-system for tissue engineering strategies in endodontics

Temporal-controlled release of bioactive molecules is of key importance in the clinical translation of tissue engineering techniques. We engineered a core-shell nano-system (TD-NS) that sequentially released transforming growth factor-β1 (TGF-β1), a chemotactic/proliferating growth factor and dexamethasone (Dex), an osteo/odontogenic agent in a temporal-controlled manner. In stage-1, there was a rapid release of TGF-β1, reaching a concentration of 2 ng/mL of TGF-β1 in 7 days to 14 days, which tapers subsequently. In stage-2, Dex was released linearly from 9 days to 28 days. The TD-NS group showed a significantly higher (P < 0.05) osteo/odontogenic differentiation compared to the control and free TGF-β1 group (Free-TD) that was further corroborated with animal models/histochemical examination. The findings from this study highlighted the potential of temporal-controlled delivery of TGF-β1 and Dex from a single nano-carrier to direct spatial and temporal-control for a cell-free tissue engineering strategy in the treatment of apical periodontitis.