Endodontic medicine: interrelationships among apical periodontitis, systemic disorders, and tissue responses of dental materials

Abstract: Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors—systemic diseases, endodontic infection, and endodontic dental materials—and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing.

Tissue characterization following revascularization of immature dog teeth using different disinfection pastes

Abstract Revascularization of immature teeth with necrotic pulps traditionally involves the use of triple antibiotic paste, which may sometimes lead to undesirable complications. The objective of this study was to assess tissue repair in immature dog teeth with apical periodontitis subjected to revascularization, comparing two different pastes used for root canal disinfection. Apical periodontitis was induced in 30 dog premolars. Teeth were randomly divided into three experimental groups: root canals filled with triple antibiotic paste (n = 10); root canals filled with 1% propolis paste (n = 10); and no medication (n = 10). An additional group (n = 10, no intervention) was used as control. After 7 months, the jaws were histologically evaluated for the following variables: newly formed mineralized tissue (present/absent); vital tissue in the canal space (absent/periodontal ligament-like/pulp-like); apical extension of root (present/absent); and severity of inflammatory process (absent/mild/moderate/severe). There were no statistically significant differences among the experimental groups in new mineralized tissue formation and apical root development. The formation of vital tissue in the canal space, in turn, was statistically different between the triple paste and propolis groups: vital tissues were present in all revascularized teeth disinfected with propolis paste (100%), compared to 71% of those disinfected with the triple paste. Severity of inflammatory process was different between the triple paste and no medication groups. The new tissues formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. Propolis may have some advantages over the triple paste for the revascularization of immature teeth.

Análise comparativa dos níveis de proteína C-reativa altamente sensível entre indivíduos portadores e não portadores de lesão periapical crônica / Comparative analysis of C-reactive protein in patients with and without chronic apical periodontitis

As doenças bucais inflamatórias crônicas, como a doença periodontal, estão relacionadas com a etiopatogênese das doenças arteriais coronarianas, causando danos endoteliais e facilitando a formação das placas ateromatosas. As doenças inflamatórias do periápice, assim como a doença periodontal, são doenças bacterianas que ativam a produção localizada de citocinas e outros mediadores próinflamatórios, como a proteína C-reativa (PCR). Essa proteína tem sido utilizada como um marcador sistêmico da inflamação, infecção e da lesão celular. Suas concentrações podem detectar doenças ocultas no organismo e monitorar a resposta ao tratamento de certos processos inflamatórios e infecciosos. O objetivo desse trabalho foi avaliar se as lesões periapicais crônicas podem ativar a resposta inflamatória, gerando repercussões sistêmicas e determinar se o método da PCR altamente sensível (PCR-as) por imunoturbidimetria pode ser utilizado para o diagnóstico e monitoramento do tratamento endodôntico destas lesões. Assim, comparou-se os níveis plasmáticos da PCR entre 13 indivíduos portadores e 13 indivíduos não portadores de lesão periapical crônica. Foram comparados também os níveis da PCR dos indivíduos portadores de lesão periapical crônica antes e após o tratamento do dente em questão. Não foi possível observar diferenças estatisticamente significantes entre os valores da PCR dos pacientes portadores de lesão periapical crônica antes e após os tratamentos (p=0,9203 com o teste t para amostras emparelhadas e p=0,94427 com o teste Wilcoxon), nem mesmo quando comparou-se os pacientes com lesão periapical crônica com os pacientes controles (p=0,1012 com o teste t para amostras independentes e p=0,1585 com o teste Mann Whitney). Pode-se concluir, com base na metodologia adotada, que as lesões periapicais crônicas não são capazes de induzir uma resposta inflamatória de repercussão sistêmica e o método da PCR-as por imunoturbidimetria não pode ser utilizado para o diagnóstico...

Inflammatory effects from periodontal disease can cause oral bacterial by products to enter the bloodstream. These effects may cause blood clots that contribute to a coronary heart disease risk factor. Chronic apical periodontitis are also bacterial diseases that stimulate the production of cytokines and other cell-mediated inflammatory factors such as C-reactive protein (CRP). CRP is one of the acute phase proteins that increase during systemic inflammation. Its been suggested that testing CRP levels in the blood may be an additional way to assess cardiovascular disease risk. The aim of this study was to evaluate if chronic apical periodontitis can ativate inflammatory response leading to systemic effects and to determine if a highly sensitive CRP (hs-CRP) assay is available to diagnose and track the endodontic treatment of these lesions. Plasma levels of hs-CRP were compared in blood of 13 individuals with chronic apical periodontitis and 13 healthy controls. CRP levels were also compared in the individuals with chronic apical periodontitis before and after treatment of the tooth. There was no statistical association among CRP levels of individual with or without chronic apical periodontitis (p=0,1012 for t test and p=0,1585 for Mann Whitney test). There was no statistical association among CRP levels of individual with chronic apical periodontitis before and after dental treatments (p=0,9203 for t test and p=0,94427 for Wilcoxon test). In conclusion, these results suggest that chronic apical periodontitis can not ativate inflammatory response leading to systemic effects and even a highly sensitive CRP (hs-CRP) assay is not available to diagnose and track the endodontic treatment of these lesions.