Relación entre diabetes mellitus y periodontitis apical de origen endodóntico. Revisión narrativa / Relationship between diabetes mellitus and apical periodontitis of endodontic origin. Narrative review

La diabetes mellitus es una enfermedad metabólica que se caracteriza por tener un aumento en los niveles de glucemia, causando un estado inflamatorio sistémico que puede afectar la cicatrización de las lesiones periapicales presentes en la periodontitis apical, una enfermedad inflamatoria crónica causada por una infección endodóntica cuyo desarrollo está regulado por la respuesta inmunitaria del huésped. La diabetes podría interactuar con la periodontitis apical al desencadenar la modulación inmunitaria, pudiendo afectar la respuesta clínica de las lesiones periapicales e interferir con la cicatrización después del tratamiento endodóntico. El objetivo de esta revisión de la literatura es analizar la evidencia respecto a la relación entre la diabetes mellitus y la presencia y severidad de la periodontitis apical de origen endodóntico. Se recopilaron artículos de las bases de datos PubMed, Scopus y Web of Science entre los años 2016 y 2021. Se eligieron 31 artículos pertinentes para el estudio. En el 41,6% de los estudios se encontró una mayor presencia de periodontitis apical en pacientes con diabetes asociada a una lesión apical más compleja y comprometida. Un 25% de los estudios encontró que los pacientes diabéticos mal controlados presentan mayor presencia de periodontitis apical. Un 25% de los estudios encontró que niveles altos de HbA1c se asocian a la presencia de periodontitis apical. Se encontró una relación entre la diabetes y la periodontitis apical, por lo que la diabetes debe ser considerada como un factor preoperatorio importante en el desarrollo y severidad de la periodontitis apical, sin embargo, se deben realizar estudios experimentales más estandarizados para poder determinar con mayor exactitud esta relación, además de poder indagar la bidireccionalidad entre ambos.(AU)

Diabetes mellitus is a metabolic disease that is characterized by an increase in blood glucose levels, causing a systemic inflammatory state that can affect the healing of periapical lesions present in apical periodontitis, a chronic inflammatory disease caused by an endodontic infection whose development is regulated by the host's immune response. Diabetes could interact with apical periodontitis by triggering immune modulation, being able to affect the clinical outcome of periapical lesions and interfering with healing after endodontic treatment. The objective of this literature review is to analyze the evidence regarding the relationship between diabetes mellitus and the presence and severity of apical periodontitis of endodontic origin. Articles were collected from the PubMed, Scopus and Web of Science databases between the years 2016 and 2021. 31 relevant articles were included for this study. In 41.6% of the studies a greater presence of apical periodontitis was found in patients with diabetes associated with a more complex and compromised apical lesion. 25% of the studies reported that poorly controlled diabetic patients had a greater presence of apical periodontitis. 25% of the studies reported high levels of HbA1c in association with apical periodontitis. A relationship was found between diabetes and apical periodontitis, which means diabetes should be considered as an important preoperative factor in the development and severity of apical periodontitis; however, more standardized experimental studies should be carried out to determine this relationship more accurately, in addition to being able to investigate a bidirectionality between the two.(AU)

EVALUATION OF INTRAOPERATIVE PAIN OCCURRENCE AND NEED FOR SUPPLEMENTAL ANESTHESIA DURING EMERGENCY DENTAL CARE

Aims: This study aimed to evaluate the intraoperative pain (IOP) occurrence in situations of symptomatic irreversible pulpitis (SIP) and symptomatic apical periodontitis (SAP). Materials and Methods: Patients who sought emergency care presenting a diagnosis of SIP or SAP were included. IOP was measured with a Visual Analogue Scale (VAS) after five minutes of local anesthesia, during access to the pulp chamber, root canal exploration and at the end of procedures. In cases where pain was reported during treatment, supplementary anesthesia was performed. Pain scores were recorded and analyzed using a generalized estimating equation model with posthoc comparisons. Results: 56 patients were included. 35 had a diagnosis of SIP; and 21 a diagnosis of SAP. Mean preoperative pain scores for SAP and SIP were 6.69 (±1.54) and 6.39 (±1.48), respectively (p>0.05). In patients with SIP, significant differences were observed between: preoperative scores and other time points; scores after five minutes of local anesthesia and other time points; scores during pulp chamber access and at the end of procedures; and scores during root canal exploration and at the end of procedures (p<0.05). In patients with SAP, significant differences were observed between preoperative pain scores with all other time points (p<0.05). Chi-square test indicated an association between diagnosis and the need for supplementary anesthesia (p<0.05). Conclusions: In conclusion, there is a strong relationship between reduction of moderate/severe pain after application of local anesthesia. The need for supplemental anesthesia is significantly associated to the diagnosis of symptomatic irreversible pulpitis.

Comparative evaluation of hydrogen peroxide and chlorhexidine mouthwash on salivary interleukin-1ß levels in patients with type 2 diabetes mellitus and chronic periodontitis: a randomized controlled clinical trial / Evaluación comparativa de enjuague bucal con peróxido de hidrógeno y clorhexidina sobre los niveles de interleucina-1ß salival en pacientes con diabetes mellitus tipo 2 y periodontitis crónica: ensayo clínico controlado aleatorio

Introduction: Periodontal inflammation causes dysbiosis and change in the microbiota. Nonsurgical periodontal therapy (NSPT) helps in removal of plaque and restoring periodontal health. Various adjunctive therapy like use of mouthwash helps in maintenance of periodontal health and reducing inflammatory load. Materials and Methods: A total of 108 subjects diagnosed with type 2 diabetes mellitus and periodontitis were divided into three groups: Group 1 received NSPT and rinsing with 0.2% chlorhexidine mouthwash for 3 months, Group 2 received NSPT and rinsing with 1.5% hydrogen peroxide mouthwash for 3 months, Group 3- received NSPT only (control group). The clinical parameters measured included Plaque Index (PI), Gingival Index (GI), Bleeding on probing (BOP) and probing (PD) at baseline, 1, 2, 3 months follow up. Salivary interleukin 1ßlevels were measured at baseline and 3 months interval. Results: Group 1, 2 and 3 showed significant reduction in PI, GI, BOP and PD at 1 and 3 months follow up (p<0.05). However, Intergroup comparison of clinical parameters showed significant reduction in group 1 and 2 when compared with group 3 (p<0.05). Salivary interleukin 1-ß levels showed significant reduction from baseline to 3 months in all the three groups and intergroup comparison didn't show any significant changes, (p>0.05). Conclusions: Hydrogen peroxide mouthwash as an adjunct to NSPT can be considered as a safe and effective measure to reduce periodontal inflammation in type 2 diabetes mellitus patients with chronic periodontitis.

Introducción: La inflamación periodontal causa disbiosis y cambios en la microbiota. La terapia periodontal no quirúrgica (NSPT) ayuda a eliminar la placa y restaurar la salud periodontal. Diversas terapias complementarias, como el uso de enjuague bucal, ayudan a mantener la salud periodontal y reducir la carga inflamatoria. Materiales y Métodos: Un total de 108 sujetos diagnosticados con diabetes mellitus tipo 2 y periodontitis se dividieron en tres grupos: el grupo 1 recibió NSPT y enjuague con enjuague bucal de clorhexidina al 0,2% durante 3 meses, el grupo 2 recibió NSPT y enjuague con enjuague bucal de peróxido de hidrógeno al 1,5% durante 3 meses, y el Grupo 3 recibió NSPT únicamente (grupo de control). Los parámetros clínicos medidos fueron el índice de placa (PI), el índice gingival (GI), el sangrado al sondaje (BOP) y al sondaje (PD) al inicio del estudio, 1, 2, y 3 meses de seguimiento. Los niveles de interleucina 1ß en saliva se midieron al inicio y a los 3 meses. Resultado: Los grupos 1, 2 y 3 mostraron una reducción significativa en IP, GI, BOP y PD al mes y 3 meses de seguimiento (p<0,05). Sin embargo, la comparación intergrupal de los parámetros clínicos mostró una reducción significativa en los grupos 1 y 2 en comparación con grupo 3 (p<0,05). Los niveles de interleucina 1-ß salival mostraron una reducción significativa desde el inicio hasta los 3 meses en los tres grupos y la comparación entre grupos no mostró ningún cambio significativo (p>0,05). Conclusión: El enjuague bucal con peróxido de hidrógeno como complemento de la NSPT puede considerarse una medida segura y eficaz para reducir la inflamación periodontal en pacientes con diabetes mellitus tipo 2 y periodontitis crónica.

Effects of furcation involvement on molar survival in periodontally treated patients / Efectos de la furcación sobre la supervivencia molar en pacientes sometidos a tratamiento periodontal

Objective: This study aims to analyze the survival time of molar tooth according to furcation involvement (FI) classification among periodontally treated patients under a supportive periodontal care program. Materials and Methods: A retrospective study was con-ducted among 77 periodontitis patients with 240 molars who had undergone periodontal therapy that were followed up with supportive periodontal therapy (SPT) for at least five years. Periodontitis patients' data were retrieved from the periodontic clinical record. The clinical parameters of all involved molars and treatment modality were recorded at baseline and SPT. Results: A total of 69 (28.8%) molars were extracted during active periodontal therapy, while 17 (7.1%) were lost during SPT. The 5-year survival rate of molars was 83.5% (95% confidence interval [CI], 76.9-88.4) for FI=0 (n=141), 81.0% (95% CI, 56.9-92.4) for FI=I (n=18), 50.0% (95% CI, 33.8-64.2) for FI=II (n=21), and 25.0% (95% CI, 6.9-48.8) for FI=III (n=4). Additionally, the 10-year survival rate for molars with FI = III was 12.5% (95% CI, 1.0-39.2), which was lower than that of molars with FI = 0 (77.1%; 95% CI, 69.7-83.0). Conclusions: The presence of a high degree of FI classifica-tion, especially Class III, is associated with a lower survival rate of molars among periodontally treated patients. Retention of molars is possible on a long-term basis through a maintenance program of periodontal therapy.

Objetivo: Este estudio tiene como objetivo analizar el tiempo de supervivencia de los molares según la clasificación de implicación de la furcación (IF) entre pacientes tratados periodontalmente bajo un programa de cuidado periodontal de apoyo. Materiales y Métodos: Se realizó un estudio retrospectivo entre 77 pacientes con periodontitis con 240 molares que habían sido sometidos a terapia periodontal y fueron seguidos con terapia periodontal de soporte (TPS) durante al menos cinco años. Los datos de los pacientes con periodontitis se recuperaron de la Historia Clínica de Periodoncia. Los parámetros clínicos de todos los molares involucrados y la modalidad de tratamiento se registraron al inicio y en el TPS. Resultado: Se extrajeron un total de 69 (28,8%) molares durante la terapia periodontal activa, mientras que 17 (7,1%) se perdieron durante la TPS. La tasa de supervivencia de los molares a 5 años fue del 83,5% (intervalo de confianza [IC] del 95%, 76,9-88,4) para FI=0 (n=141), del 81,0% (IC del 95%, 56,9-92,4) para FI=I ( n=18), 50,0% (IC 95%, 33,8-64,2) para FI=II (n=21) y 25,0% (IC 95%, 6,9-48,8) para FI=III (n=4). Además, la tasa de supervivencia a 10 años para los molares con FI = III fue del 12,5 % (IC del 95 %, 1,0-39,2), que fue inferior a la de los molares con FI = 0 (77,1 %; IC del 95 %, 69,7-83,0). Conclusión: La presencia de un alto grado de clasificación FI, especialmente Clase III, se asocia con una menor tasa de supervivencia de los molares entre los pacientes tratados periodontalmente. La retención de los molares es posible a largo plazo mediante un programa de mantenimiento de terapia periodontal.

Periodontal status in adult patients with leukemia: a literature review / Condição periodontal em pacientes adultos com leucemia: revisão de literatura

Periodontal disease is a highly prevalent chronic inflammatory disease that affects the tissues that support the teeth, while leukemia is a type of malignous cancer that affects the production of blood cells. Recent studies suggest that immune response and microbial disbiosis related to periodontal disease may be associated with an increased risk of developing leukemia and may affect its prognosis, as well as leukemia type and treatment may also have effects on the periodontium, demanding a interdiscipinary approach of these patients. The aim of this study was to conduct a literature review to assess the association between periodontal disease and leukemia in adult patients. An electronic database serch using the descriptors was performed. Clinical studies with periodontal examination in adult individuals with leukemia were selected. After literature search, 9 studies were reviewed. Gingival bleeding and periodontal pockets were frequent findings. Periodontitis prevalence varied among studies, ranging from 29% to 82,4% in patients diagnosed with leukemia. The relationship between periodontal disease and leukemia is complex and multifaceted and there are few studies available in adults, with heterogeneous exam protocols. Still, the high prevalence of gingivitis and periodontitis found in the studies suggest that periodontal diagnosis and treatment could be a helpful tool to prevent further complications in leukemia treatment.

A doença periodontal é uma doença inflamatória crônica altamente prevalente e que afeta os tecidos que sustentam os dentes, enquanto a leucemia é um tipo de câncer maligno que afeta a produção de células sanguíneas. Estudos recentes sugerem que a resposta imune e a disbiose microbiana relacionada a doença periodontal podem estar associadas a um risco aumentado de desenvolver leucemia e pode afetar o prognóstico da doença, assim como o tipo de leucemia e o tratamento também podem ter efeitos no periodonto, exigindo uma abordagem interdisciplinar desses pacientes. O objetivo deste estudo foi realizar uma revisão de literatura para avaliar a associação entre doença periodontal e leucemia em pacientes adultos. Foi realizada uma busca eletrônica em bancos de dados utilizando os descritores. Foram selecionados estudos clínicos com exame periodontal em indivíduos adultos com leucemia. Após busca na literatura, 9 estudos foram revisados. Sangramento gengival e bolsas periodontais foram achados frequentes. A prevalência da periodontite variou entre os estudos, sendo de 29% a 82,4% em pacientes diagnosticados com leucemia. A relação entre doença periodontal e leucemia é complexa e multifacetada e existem poucos estudos disponíveis em adultos, com protocolos de exames heterogêneos. Ainda assim, a alta prevalência de gengivite e periodontite encontrada nos estudos sugere que o diagnóstico e o tratamento periodontal podem ser uma ferramenta útil para prevenir maiores complicações no tratamento da leucemia.

Relación entre la periodontitis y la enfermedad cerebrovascular isquémica

La periodontitis es un trastorno inmunoinflamatorio de etiología microbiana causado por gérmenes únicos en la cavidad bucal que pueden diseminarse a través del torrente sanguíneo, activan la respuesta inflamatoria del huésped y favorecen la formación, maduración y exacerbación de la placa de ateroma. Varios estudios clínicos han investigado la posible relación entre la enfermedad periodontal y las enfermedades consecuentes de la aterosclerosis como la cardiopatía isquémica y la enfermedad cerebrovascular isquémica. Se realizó una revisión bibliográfica exhaustiva de artículos científicos publicados en las bases de datos: Pubmed, Medline, LILACS, Scielo, en el período comprendido entre el 2012 y el 2022, en idioma español e inglés. Se utilizaron como descriptores: periodontitis, enfermedad cerebrovascular y aterosclerosis. Los reportes incluidos indican que la enfermedad cerebrovascular y la enfermedad aterosclerótica presentan las alteraciones con mayores asociaciones con la periodontitis, sin embargo, se necesitan estudios más amplios para determinar el papel de la severidad y extensión de la periodontitis en estas enfermedades.

Periodontitis is an immunoinflammatory disorder of microbial etiology caused by unique germs in the oral cavity that can spread through the bloodstream, activate the host's inflammatory response and promote the formation, maturation and exacerbation of atheromatous plaque. Several clinical studies have investigated the possible relationship between periodontal disease and diseases resulting from atherosclerosis such as ischemic heart disease and ischemic cerebrovascular disease. An exhaustive bibliographic review of scientific articles published in the databases: Pubmed, Medline, LILACS, Scielo, in the period between 2012 and 2022, in Spanish and English was carried out. The following were used as descriptors: periodontitis, cerebrovascular disease and atherosclerosis. The included reports indicate that cerebrovascular disease and atherosclerotic disease present the alterations with the greatest associations with periodontitis, however, larger studies are needed to determine the role of the severity and extent of periodontitis in these diseases.

Periodontitis and osteoporosis: a two-sample Mendelian randomization analysis

Abstract The incidences of periodontitis and osteoporosis are rising worldwide. Observational studies have shown that periodontitis is associated with increased risk of osteoporosis. We performed a Mendelian randomization (MR) study to genetically investigate the causality of periodontitis on osteoporosis. We explored the causal effect of periodontitis on osteoporosis by MR analysis. A total of 9 single nucleotide polymorphisms (SNP) were related to periodontitis. The primary approach in this MR analysis was the inverse variance-weighted (IVW) method. Simple median, weighted median, and penalized weighted median were used to analyze sensitivity. The fixed-effect IVW model and random-effect IVW model showed no significant causal effect of genetically predicted periodontitis on the risk of osteoporosis (OR=1.032; 95%CI: 0.923-1.153; P=0.574; OR=1.032; 95%CI: 0.920-1.158; P=0.588, respectively). Similar results were observed in simple mode (OR=1.031; 95%CI: 0.780-1.361, P=0.835), weighted mode (OR=1.120; 95%CI: 0.944-1.328, P=0.229), simple median (OR=1.003; 95%CI: 0.839-1.197, P=0.977), weighted median (OR=1.078; 95%CI: 0.921-1.262, P=0.346), penalized weight median (OR 1.078; 95%CI: 0.919-1.264, P=0.351), and MR-Egger method (OR=1.360; 95%CI: 0.998-1.853, P=0.092). There was no heterogeneity in the IVW and MR-Egger analyses (Q=7.454, P=0.489 and Q=3.901, P=0.791, respectively). MR-Egger regression revealed no evidence of a pleiotropic influence through genetic variants (intercept: -0.004; P=0.101). The leave-one-out sensitivity analysis indicated no driven influence of any individual SNP on the association between periodontitis and osteoporosis. The Mendelian randomization analysis did not show a significant detrimental effect of periodontitis on the risk of osteoporosis.

Apical periodontitis in endodontically-treated teeth: association between missed canals and quality of endodontic treatment in a Colombian sub-population. A cross-sectional study / Periodontite apical em dentes tratados endodonticamente: associagao entre canais nao localizados e qualidade do tratamento endodontico em uma populagao colombiana: Um estudo transversal

ABSTRACT A high prevalence of post-treatment apical periodontitis associated to variables such as endodontic treatment quality and missed canals has been reported. Aim The aim of this study was to evaluate the quality of endodontic treatment and the frequency of missed canals associated with teeth with apical periodontitis (AP) through CBCT in a Colombian sub-population. Material and Method This was a crosssectional study assessing 318 cone beam computed tomography (CBCT) scans of endodontically treated teeth from Colombian individuals. The scans were taken using J Morita X550 (J Morita Corporation, Osaka, Japan), with voxel size 0.125 to 0.20 mm. All endodontically treated teeth were assessed for quality of treatment, presence of missed canals and AP. All samples were analyzed by two endodontics specialists and an radiology specialist. Chi-square or Fisher's test and odds ratio were calculated to identify the association and risk relationship between the presence of AP and the study variables. Results Missed canals were found in 18.61% (86/462), and 95.3% were associated with AP. The frequency of AP was 62.34% (288/462) for all the evaluated teeth. AP was found in 27.43 % (79/288) of the teeth with adequate endodontic treatment, in contrast to 72.57% (209/288) of the teeth with inadequate treatment (P<0.01). The frequency of missed canals was highest in maxillary molars, with 55.23% (58/105), with 96.55% presenting AP. The second mesiobuccal canal was the most frequently missed canal, 88.52% (54/61), with AP in 90.74% (49/54) of the cases. Conclusion There was a high frequency of teeth with missed canals and PA. More than half of the teeth with missed canals were maxillary molars, with MB2 being the most common canal, commonly presenting apical periodontitis.

RESUMO Uma alta prevalência de periodontite apical pós-tratamento associada a variáveis como qualidade do tratamento endodôntico e fracasso do tratamento é relatada na literatura. O objetivo deste estudo foi avaliar a qualidade do tratamento endodôntico e a frequência e fracasso do tratamento associados a dentes com periodontite apical (PA) por meio de tomografia computadorizada de feixe cônico (TCFC) em uma subpopulação colombiana. Material e Método Este foi um estudo transversal que avaliou 318 tomografias computadorizadas de dentes tratados endodonticamente de indivíduos colombianos. Os exames foram realizados utilizando o tomógrafo J Morita X550, com tamanho de voxel de 0,125 a 0,20 mm. Todos os dentes tratados endodonticamente foram avaliados quanto à qualidade do tratamento, presença de canais não localizados e AP. Todas as amostras foram avaliadas por dois especialistas em endodontia e um especialista em radiologia. Foram calculados o teste qui-quadrado ou de Fisher e a razão de chances para identificar associação e relação de risco entre a presença de PA e as variáveis do estudo. Resultados Foram encontrados canais não localizados em 18,61% (86/462) e 95,3% estavam associados à PA. A frequência de AP foi de 62,34% (288/462) para todos os dentes avaliados. AP foi encontrada em 27,43% (79/288) dos dentes com tratamento endodôntico adequado, em contraste com 72,57% (209/288) dos dentes com tratamento inadequado (P<0,01). A frequência de canais não localizados foi maior nos molares superiores, com 55,23% (58/105), sendo que 96,55% apresentavam PA. O canal mésio-palatino (MB2) apresentou maior frequência de canal não localizado (88,52% - 54/61), com PA em 90,74% (49/54) dos casos. Conclusão Houve alta frequência de dentes com canais não localizados e com PA. Mais da metade dos dentes com canais não localizados eram molares superiores, sendo o MB2 é o canal com a maior frequência, comumente apresentando periodontite apical.

Relationship between periapical lesions and sinus changes on multi-slice computed tomography sean / Relagao entre lesoes periapicais e alteragóes sinusais na tomografia computadorizada multislice

ABSTRACT Differentiating orofacial odontogenic pain/disorders from pain/disorders associated with maxillary sinusitis is important to avoid unnecessary dentalprocedures and to properly refer patients to colleagues/dentists and vice versa. Aim To analyze the association between apical lesions and sinus changes and to evaluate the agreement between the diagnoses of an endodontist, a radiologist, an oral and maxillofacial surgeon, and an otolaryngologist. Materials and Method 385 axial, coronal, and sagittal MSCT scans were selected using an image archiving andcommunication system (PACS). The examinations had been performed between 2018 and 2022. Results Apical lesions were observed in 36.10% of sinusitis cases, 73.8% of unilateralsinusitis cases, 48.7% of sinus floor discontinuity cases, and 67.2% of cases in which endodontic treatment had been performed. Agreement between the diagnoses made by the endodontist and those made by the other investigators was high for most study variables (k > 0.60). The exceptions were mucosal thickening, for which agreement between the endodontist and the other investigators was intermediate (k=0.397), and the presence of periapicallesions (k=0.010), previous endodontic treatment (k=0.013), and mucosal thickness (k=0.024), for which agreement between endodontists and radiologists was low. Conclusions: There was an association between sinus changes and apical lesions.

RESUMO Diferenciar a dor/desordens odontogénicas orofaciais da dor/desordens as sociadas á sinusite maxilar é importante para evitar procedimentos odontológicos desnecessários e para encaminhar adequadamente os pacientes aos colegas/dentistas e vice-versa. Objetivo Analisar a associagdo entre lesoes apicais e alteragóes sinusais e avaliar a concordáncia entre os diagnósticos de um endodontista, um radiologista, um cirurgido bucomaxilofacial e um otorrinolaringologista. Material e Método foram avaliadas 385 imagens. Resultados Aslesoes apicais foram observadas em 36,10% dos casos de sinusite, em 73,8% dos casos de sinusite unilateral, em 48,7% dos casos de descontinuidade do assoalho do seio e em 67,2%odos casos em que o tratamento endodontico havia sido realizado. A concordancia entre os diagnósticos feitos pelo endodontista e os feitos pelos outros pesquisadores foi alta para a maioria das variáveis do estudo (k > 0,60). As excegoes foram o espessamento da mucosa, para o qual a concordáncia entre o endodontista e os outros pesquisadores foi intermediária (k=0,397) e a presenga delesoes periapicais (k=0,010), tratamento endodontico prévio (k=0,013) e espessura da mucosa (k=0,024), para os quais a concordáncia entre endodontistas e radiologistas foi baixa. Conclusoes Houve uma associagdo entre as alteragóes sinusais e aslesoes apicais.

Bidirectional casual effects between periodontitis and Sjögren's syndrome: a Mendelian randomization study / 口腔疾病防治

Objective@#To evaluate the bidirectional association between periodontitis and Sjögren's syndrome using the Mendelian randomization (MR) method.@*Methods@#Genome-wide association study (GWAS) data of periodontitis (N = 45 563) and Sjögren's syndrome (N = 214 435) were selected to meet the requirements of the same ethnicity and different regions. Inverse variance-weighted (IVW), MR-Egger, and weighted median (WM) tests were used to evaluate the causal effect. Cochran's Q statistics, MR-Egger intercept, MR-PRESSO and leave-one-out analysis were used as sensitivity analyses to assess the stability and reliability of the results.@*Results@#After screening, the GWAS data of Sjögren's syndrome were based on the Finnish region, and the periodontitis GWAS data were based on the UK region, both of which originated from European ancestry. Using IVW (OR = 1.017, 95% CI = 0.956-1.082), MR-Egger (OR = 0.985, 95% CI= 0.956-1.082), and WM (OR =1.021, 95% CI = 0.948-1.099), no causal effect of Sjögren's syndrome on periodontitis was found using any of the three methods. Conversely, no causal effect of periodontitis on Sjögren's syndrome was found (IVW, OR = 1.024, 95% CI = 0.852-1.230; MR-Egger, OR = 0.978, 95% CI = 0.789-1.212; WM, OR = 1.024, 95% CI = 0.846-1.260). The sensitivity analyses indicated that the results were stable and reliable. Cochran's Q test and MR-PRESSO revealed that there was no significant heterogeneity among the instrumental variables, which included single nucleotide polymorphisms (SNPs). The intercept of MR-Egger regression indicated no pleiotropy in the included SNPs. No individual SNP was found that significantly affected the results using the leave-one-out method.@*Conclusion@#This study does not support a bidirectional causal effect between periodontitis and Sjögren's syndrome.

Application status of risk assessment models for periodontal disease / 口腔疾病防治

@#Risk assessment models for periodontal disease provide dentists with a precise and consolidated evaluation of the prognosis of periodontitis, enabling the formulation of personalized treatment plans. Periodontal risk assessment systems have been widely applied in clinical practice and research. The application fields of periodontal risk assessment systems vary based on the distinctions between clinical periodontal parameters and risk factors. The assessment models listed below are commonly used in clinical practice, including the periodontal risk calculator (PRC), which is an individual-based periodontal risk assessment tool that collects both periodontal and systemic information for prediction; the periodontal assessment tool (PAT), which allows for quantitative differentiation of stages of periodontal disease; the periodontal risk assessment (PRA) and modified periodontal risk assessment (mPRA), which are easy to use; and the classification and regression trees (CART), which assess the periodontal prognosis based on a single affected tooth. Additionally, there are orthodontic-periodontal combined risk assessment systems and implant periapical risk assessment systems tailored for patients needing multidisciplinary treatment. This review focuses on the current application status of periodontal risk assessment systems.

Effect of pulp revascularization on pulp necrosis with periapical periodontitis in young permanent teeth / 中国基层医药

Objective:To investigate the efficacy of pulp revascularization in the treatment of pulp necrosis with periapical periodontitis in young permanent teeth and its effect on the levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in gingival crevicular fluid.Methods:From January 2021 to August 2021, 72 young patients with permanent teeth exhibiting pulp necrosis and apical periodontitis who were treated at Haiyang People's Hospital were included in this study. These patients were subsequently divided into a study group ( n = 35) and a control group ( n = 37), depending on their respective treatment methods. The control group underwent conventional apical angioplasty, whereas the study group underwent pulp revascularization. A comparative analysis was conducted to assess the clinical efficacy of both treatments. Additionally, levels of VEGF and bFGF in gingival crevicular fluid were measured before and after surgery, and these values were compared between the two groups. Relevant clinical indicators and the incidence of adverse reactions were also compared between the study and control groups. Results:The overall response rate in the study group was 94.3% (33/35), which was significantly higher than 70.3% (26/37) in the control group ( χ2 = 7.01, P < 0.05). Prior to surgery, there were no notable differences in VEGF level, bFGF level, root length, or root canal thickness between the two groups (all P > 0.05). However, after surgery, VEGF level, bFGF level, root length, and root canal thickness in the study group were (43.25 ± 4.87) ng/L, (40.72 ± 4.83) ng/L, (8.95 ± 0.27) mm, and (3.08 ± 0.24) mm, respectively. These values were (39.90 ± 4.80) ng/L, (36.05 ± 4.66) ng/L, (8.55 ± 0.18) mm, and (2.90 ± 0.20) mm, respectively, in the control group. There were significant differences in VEGF level, bFGF level, root length, and root canal thickness between the two groups ( t = 2.96, 4.18, 5.67, 2.88, all P < 0.05). After surgery, the scores for apical inflammation, root development, and Visual Analogue Scale (VAS) in the study group were significantly higher than those in the control group ( t = 7.61, 4.83, 9.47, all P < 0.001). The incidence of adverse reactions in the study group was 2.9% (1/35), which was significantly lower than 21.6% (8/37) in the control group ( χ2 = 5.79, P < 0.05). Conclusion:Pulp revascularization exhibits superior curative effects compared with conventional apical angioplasty for the treatment of pulp necrosis and apical periodontitis in young permanent teeth. This treatment effectively alleviates pain, markedly improves tooth function, and has a low incidence of adverse reactions, highlighting its clinical value as a therapeutic option.

Research progress on distribution characteristics and pathogenesis of periapical microorganisms in chronic periapical periodontitis / 中国基层医药

Periapical periodontitis arises from the interaction between microbial factors and the inflammatory response of the host's periapical tissues. In this process, bacteria and their byproducts serve as the primary drivers for the initiation, progression, and spread of the disease. Pulp infections and periapical lesions are primarily dominated by gram-negative bacteria. The endotoxin lipopolysaccharide component of these bacteria plays a crucial role in pulp infection, triggering clinical symptoms, inflammatory reactions, and bone tissue resorption. Similarly, lipoteichoic acid and lipopolysaccharide from gram-positive bacteria exhibit similar pathogenic characteristics, causing damage to pulp and periapical tissues. The aim of this review is to delve deeper into the distribution patterns and pathogenesis of periapical microorganisms in chronic periapical periodontitis.

Clinical effect of apical microsurgery combined with guided bone regeneration on refractory apical periodontitis / 局解手术学杂志

Objective To investigate the clinical effect of apical microsurgery combined with guided bone regeneration(GBR)on refractory apical periodontitis and masticatory function.Methods A total of 82 patients with refractory apical periodontitis admitted to our hospital from June 2019 to September 2021 were selected as the study subjects,and they were divided into the control group and the com-bined group according to the random number table,with 41 cases in each group.The control group was treated with apical microsurgery,and the combined group was treated with apical microsurgery combined with GBR.The clinical efficacy,masticatory function and the levels of bone absorption markers[Wnt3a,osteoprotegerin(OPG),receptor activator of nuclear factor-κB ligand(RANKL)]of patients in the two groups were compared.Results The total effective rate of the combined group(100%)was higher than that of the control group(85.37%),the difference was statistically significant(P<0.05).The masticatory efficiency and bite force of patients in both groups increased gradually 3,6 and 12 months after operation(P<0.05),which were higher in the combined group compared with the control group(P<0.05).The tooth mobility of patients in both groups decreased gradually 3,6 and 12 months after operation,and the tooth mobility of patients 3 and 6 months after operation in the combined group were lower than those in the control group(P<0.05).The levels of Wnt3a and OPG of patients 1 week after operation in both groups increased,which were higher in the combined group compared with the control group(P<0.05).The RANKL level of gingival crevicular fluid of patients 1 week after operation in both groups decreased,and which was lower in the combined group compared with the control group(P<0.05).Conclusion The microapical surgery combined with GBR is effective for refractory apical periodontitis,which can effectively inhibit bone resorption,and improve masticatory function.

Clinical observation of antibacterial photodynamic therapy assisted subgingival curettage for the treatment of chronic periodontitis / 口腔疾病防治

Objective@#To investigate the efficacy of antibacterial photodynamic therapy (aPDT) as an adjunct to subgingival scaling and root planning in the treatment of chronic periodontitis.@*Methods@#This study followed medical ethics guidelines, and informed consent was obtained from all patients. Sixteen patients were recruited for this randomized split-mouth controlled trial. The control group underwent subgingival scaling and root planning (SRP), while the experimental group received subgingival scaling and root planing plus aPDT treatment using Perowave® with a toluidine blue O solution photosensitizer. The probing pocket depth (PD), recession, plaque index (PLI), bleeding index (BI) and proportion of positive sites of bleeding on probing (BOP) (BOP%) at all sites were examined at baseline (before treatment) and at 1, 3 and 6 months after treatment.@*Results@#Follow-up was completed for 13 patients. On the control side, 356 teeth were tested at 2 136 sites. A total of 360 teeth on the test side and 2 160 sites were included in the study. Before treatment, there was no significant difference in the baseline indicators between the two groups. After treatment, both groups showed significant improvement in clinical parameters, including PD, PLI, BI, and BOP%,compared with baseline. At 3 months, the BOP% and PLI in the experimental group were significantly lower than those in the control group (P<0.05). The improvement in BOP% and PLI in the experimental group was significantly greater than that in the control group 3 months after treatment (P<0.05).@*Conclusion@#aPDT, as an adjuvant treatment to SRP for chronic periodontitis, can improve gingival bleeding and control periodontal inflammation in the early stage.

Research progress on histone acetylation/methylation in oral diseases / 口腔疾病防治

@#Histone acetylation and methylation can affect chromatin conformation and regulate a variety of biological activities. Abnormal histone acetylation and methylation modifications are related to the occurrence and development of a variety of oral diseases. Histone acetylation and methylation increase or decrease in an orderly manner to regulate the development of teeth. Fluoride ions can destroy the balance between histone acetylation and methylation, which may be related to the occurrence of dental fluorosis. In addition, histone acetylation and methylation are involved in the regulation of oral inflammatory diseases. In the inflammatory microenvironment, the expression of histone acetyltransferase GCN5 decreases, and the expression of Dickkopf 1 (DKK1) decreases, activating the Wnt/β-catenin pathway and ultimately inhibiting the osteogenic differentiation of periodontal ligament stem cells. Enhancer of zeste homolog 2 (EZH2) and H3K27me3 levels were decreased in inflamed dental pulp tissues and cells. EZH2 inhibition inhibited the expression of interleukin (IL)-1b, IL-6 and IL-8 in human dental pulp cells under inflammatory stimulation. Histone acetylation/methylation modifications can interact with multiple signaling pathways to promote the occurrence and development of oral tumors and are related to the high invasiveness of salivary gland tumors. Small molecule drugs targeting histone acetylation and methylation-related enzymes can regulate the level of histone methylation/acetylation and have shown potential in the treatment of oral and maxillofacial diseases. For example, the histone deacetylase inhibitor vorinostat can inhibit the secretion of inflammation-related cytokines; it also promotes the maturation of odontoblasts and the formation of dentin-related matrix, demonstrating its potential in pulp preservation. Understanding the role of histone acetylation/methylation modifications in the occurrence and development of oral diseases will help promote research on epigenetic modifications in oral diseases and provide new perspectives for disease diagnosis and treatment.

Causal relationship between periodontitis and asthma: a two-sample Mendelian randomization study / 口腔疾病防治

Objective@#To explore the bidirectional causal relationships between periodontitis and asthma using the two-sample Mendelian randomization (MR) method to provide a basis for exploring the etiology and formulating preventive and therapeutic measures of periodontitis and asthma.@*Methods@#We performed two-sample bidirectional Mendelian randomization analysis using publicly released European genome-wide association studies (GWAS) statistics for periodontitis (n = 34 615) and asthma (n = 408 422). The inverse variance weighted (IVW) method was employed as the main approach to estimate the bidirectional causal relationships between periodontitis and asthma. In addition, weighted median (WM), MR-Egger regression, maximum likelihood, and Mendelian randomization robust adjusted profile score (MR-RAPS) were used as supplementary analyses. Sensitivity analyses were conducted using Cochran's Q test, Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO), and leave-one-out analysis.@*Results@#A total of 12 and 43 single-nucleotide polymorphisms (SNPs) were included as instrumental variables for periodontitis and asthma, respectively. The results of IVW, WM, MR-Egger regression, maximum likelihood, and MR-RAPS showed that periodontitis was not causally related to the risk of asthma (IVW: OR: 1.003, 95% CI: 0.973-1.035, P = 0.828, WM: OR: 0.990, 95% CI: 0.951-1.031, P = 0.641; MR-Egger regression: OR: 0.988, 95% CI: 0.960-1.028, P = 0.573; maximum likelihood: OR: 1.003, 95% CI: 0.972-1.035, P = 0.834; MR-RAPS: OR: 1.002, 95% CI: 0.970-1.036, P = 0.890) among the European population, and no causal effect of asthma on periodontitis was found (IVW: OR: 1.021, 95% CI: 0.938-1.111, P = 0.633, WM: OR: 1.011, 95% CI: 0.894-1.142, P = 0.866; MR-Egger regression: OR: 1.042, 95% CI: 0.824-1.319, P = 0.731; maximum likelihood: OR: 1.021, 95% CI: 0.938-1.112, P = 0.631; MR-RAPS: OR: 1.017, 95% CI: 0.931-1.110, P = 0.713) among the European population. Cochran's Q test showed no heterogeneity among the included instrumental variables, MR-PRESSO test found no horizontal pleiotropy, and the leave-one-out method did not identify outlier SNPs.@*Conclusion@#The results of this study, based on European genetic data, do not support a bidirectional causal association between periodontitis and asthma in the European population.

A preliminary study on compliance of supportive treatment of patients with periodon-titis after implant restoration therapy / 北京大学学报(医学版)

Objective:To find out factors influencing the compliance of supportive treatment of patients with periodontitis who have received implant restoration therapy.Methods:Patients who had completed periodontal and implant restoration treatment for more than 5 years in Department of Periodontology,Pe-king University Hospital of Stomatology were subjected to inclusion between March 2022 and August 2023.A questionnaire was compiled to gather the information including patients'basic information(gen-der,age,and educational background etc.),smoking habits,general health conditions,oral hygiene habits,willingness to undertake periodontal and dental implant supportive treatment,actual fact on sup-portive treatment recorded in medical records,whether medical advices were correctly remembered,and reasons affected them to implement supportive therapy.The questionnaires were handed out to the above patients and filled during the process of follow-up treatment.Chi-square test,univariate and multivariate analysis of Logistic regression were employed to explore the correlations of these factors and the patients'compliance.Results:In the study,92 patients and questionnaires were collected and analyzed.The re-sults indicated that oral hygiene habits and whether medical advices were correctly remembered had sig-nificant correlation with compliance(P＜0.05).Time constraint(47.0％)and difficulty in appointment registration(24.8％)were the top 2 reasons obstructed them to undertake supportive treatment.Al-though the vast majority of the patients indicated willingness to perform follow-ups,55.4％of them wouldn't come back until the dentist called them back.The results of our study also indicated that the patients placed significantly less importance on the health of natural teeth than implants.Conclusion:In order to improve the compliance of supportive treatment,we suggest that dentists should put more empha-sis on oral hygiene instruction,and knowledge regarding periodontitis should also be added as part of pa-tient education contents.In the early stages of treatment,the patient should develop the habit of regular follow-up checks,More attention and patience should be given to elderly patients and those with lower level of education;use language that is easy to understand and printed medical instructions to help them remember.Patients can memorize better from refined doctors'advice,reinforcing care knowledge and refining medical advices can promote better follow-up treatment results.Motivating patients based on their characteristics is critical to improving compliance.

Changes of parameters associated with anemia of inflammation in patients with stage Ⅲ periodontitis before and after periodontal initial therapy / 北京大学学报(医学版)

Objective:To investigate the differences and similarities of parameters associated with ane-mia of inflammation between patients with stage Ⅲ periodontitis and periodontally healthy volunteers,and to explore the influence of periodontal initial therapy on those indicators.Methods:Patients with stageⅢ periodontitis and periodontally healthy volunteers seeking periodontal treatment or prophylaxis at De-partment of Periodontology,Peking University School and Hospital of Stomatology from February 2020 to February 2023 were enrolled.Their demographic characteristics,periodontal parameters(including pro-bing depth,clinical attachment loss,bleeding index),and fasting blood were gathered before periodontal initial therapy.Three months after periodontal initial therapy,the periodontal parameters of the patients with stage Ⅲ periodontitis were re-evaluated and their fasting blood was collected again.Blood routine examinations(including white blood cells,red blood cells,hemoglobin,packed cell volume,mean cor-puscular volume of erythrocytes,and mean corpuscular hemoglobin concentration)were performed.And ferritin,hepcidin,erythropoietin(EPO)were detected with enzyme-linked immunosorbent assay(ELISA).All data analysis was done with SPSS 21.0,independent sample t test,paired t test,and analysis of co-variance were used for comparison between the groups.Results:A total of 25 patients with stage Ⅲperiodontitis and 25 periodontally healthy volunteers were included in this study.The patients with stageⅢ periodontitis were significantly older than those in periodontally healthy status[(36.72±7.64)years vs.(31.44±7.52)years,P=0.017].The patients with stage Ⅲ periodontitis showed lower serum he-moglobin[(134.92±12.71)g/L vs.(146.52±12.51)g/L,P=0.002]and higher serum ferritin[(225.08±103.36)μg/L vs.(155.19±115.38)μg/L,P=0.029],EPO[(41.28±12.58)IU/L vs.(28.38±10.52)IU/L,P＜0.001],and hepcidin[(48.03±34.44)μg/L vs.(27.42±15.00)μg/L,P=0.009]compared with periodontally healthy volunteers.After adjusting the age with the co-variance analysis,these parameters(hemoglobin,ferritin,EPO,and hepcidin)showed the same trends as independent-sample t test with statistical significance.Three months after periodontal initial therapy,all the periodontal parameters showed statistically significant improvement.The serum hemoglobin raised[(146.05±15.48)g/L vs.(133.77±13.15)g/L,P＜0.001],while the serum ferritin[(128.52± 90.95)μg/Lvs.(221.22±102.15)μg/L,P＜0.001],EPO[(27.66±19.67)IU/L vs.(39.63± 12.48)IU/L,P=0.004],and hepcidin[(32.54±18.67)μg/L vs.(48.18±36.74)μg/L,P=0.033]decreased compared with baseline.Conclusion:Tendency of iron metabolism disorder and ane-mia of inflammation was observed in patients with stage Ⅲ periodontitis,which can be attenuated by periodontal initial therapy.

Relationship between short-chain fatty acids in the gingival crevicular fluid and peri-odontitis of stage Ⅲ or Ⅳ / 北京大学学报(医学版)

Objective:To analyze the concentration of formic acid,propionic acid and butyric acid in gingival crevicular fluid(GCF)of patients with stages Ⅲ and Ⅳ periodontitis,and their relationship with periodontitis.Methods:The study enrolled 37 systemically healthy patients with periodontitis and 19 healthy controls who visited Department of Periodontology,Peking University School and Hospital of Sto-matology from February 2008 to May 2011.Their GCFs were collected from the mesial-buccal site of one molar or incisor in each quadrant.Periodontal clinical parameters,including plaque index(PLI),probing depth(PD),bleeding index(BI),and attachment loss(AL).Concentrations of formic acid,propionic acid and butyric acid in the supernatant of the GCFs were analyzed by high-performance capil-lary electrophoresis(HPCE).The prediction ability of formic acid,propionic acid and butyric acid with the risk of periodontitis and the differences between grade B and grade C periodontitis were analyzed.Results:In this study,32 patients with stage Ⅲ and 5 patients with stage Ⅳ were enrolled,including 9 patients with grade B and 28 patients with grade C.Clinical periodontal variables in the patients with pe-riodontitis were significantly higher than those in the control group(P＜0.001).Formic acid was signifi-cantly lower in periodontitis than that in the control group[5.37(3.39,8.49)mmol/L vs.12.29(8.35,16.57)mmol/L,P＜0.001].Propionic acid and butyric acid in periodontitis were significantly higher than those in the control group:Propionic acid,10.23(4.28,14.90)mmol/L vs.2.71(0.00,4.25)mmol/L,P＜0.001;butyric acid,2.63(0.47,3.81)mmol/L vs.0.00(0.00,0.24)mmol/L,P＜0.001.There was no significant difference in formic acid,propionic acid and butyric acid concentrations between grade B and grade C periodontitis(P＞0.05).Propionic acid and butyric acid in the deep pocket were significantly higher than in the shallow pocket,while the concentration of formic acid decreased with the increase of PD.Propionic acid(OR=1.51,95％CI:1.29-1.75)and butyric acid(OR=3.72,95％CI:1.93-7.17)were risk factors for periodontitis,while formic acid(OR=0.87,95％CI:0.81-0.93)might be a protective factor for periodontitis.Propionic acid(AUC=0.852,95％CI:0.805-0.900),butyric acid(AUC=0.889,95％CI:0.841-0.937),f(formic acid,AUC=0.844,95％CI:0.793-0.895)demonstrated a good predictive capacity for the risk of periodontitis.Conclusion:The concentration of formic acid decrease in the GCF of periodontitis patients,which is a protective factor for periodontitis,its reciprocal have good predictive capacity.However,propionic acid and butyric acid increase,which are risk factors for periodontitis and have good predictive capacity.The concentration of formic acid,propionic acid,and butyric acid vary with probing depth,but there is no significant difference between grade B and grade C periodontitis.