Minocycline hydrochloride ointment combined with Vitapex paste is effective for middle-aged and elderly patients with combined periodontal-endodontic lesions.

OBJECTIVE: This study was designed to determine the efficacy of minocycline hydrochloride ointment (MHO) combined with Vitapex paste on middle-aged and elderly patients with combined periodontal-endodontic lesions (CPELs) and its effect on the inflammatory factors. METHODS: The data of 88 elderly patients with CPELs treated in the First Affiliated Hospital of Gannan Medical University from March 2020 to March 2022 were analyzed retrospectively. Among them, the patients treated with MHO and iodoform zinc oxide clove oil paste were assigned into the control group (n = 42) and the rest of the patients treated by MHO and Vitapex paste were assigned to the study group (n = 46). The inflammatory factors, periodontal indexes and efficacy were determined and compared between the two groups. The MOS 36-Item Short-Form Health Survey (SF-36) was adopted to evaluate the quality of life (QoL) of patients before and after treatment. Additionally, the adverse reactions of the two groups during treatment were analyzed and compared. The prognosis of the two groups of patients was analysed, and factors impacting their prognosis was analysed through the Logistic regression analysis. RESULTS: Before treatment, the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) were not significantly different between the two groups (all P > 0.05), while after treatment, these levels in both groups decreased significantly, with notably lower levels in the study group than those in the control group (all P < 0.05). Before treatment, the gingival index (GI), plaque index (PLI), probing depth (PD) and bleeding index (BD) of the two groups were similar (all P > 0.05); however, after treatment, the levels of GI, PD, PLI and BI of both groups decreased significantly (all P < 0.05), with more notable decreases in the study group than those in the control group (all P < 0.05). The study group showed a significantly higher overall response rate than the control group (P < 0.05). Before treatment, the SF-36 scores of the two groups were not significantly different (P > 0.05), while after treatment, both groups had significantly increased SF-36 scores, and the score in study group was significantly higher than the control group (P < 0.05). In addition, the incidence of adverse reactions was not notably different between the two groups (P > 0.05). According to univariate analysis, age, dental lesion grade, course of disease, and persistent dull pain were the risk factors affecting the prognosis of patients. According to multivariate analysis, dental lesion grade was the independent risk factor affecting the prognosis. CONCLUSION: MHO combined with Vitapex paste is effective for middle-aged and elderly patients with CPELs, which can effectively inhibit the patients' inflammatory reaction and improve their periodontal condition and QoL, with a low adverse reaction rate, so it is worthy of clinical promotion.

Multi-disciplinary treatment of severe palatal radicular groove of maxillary lateral incisor: A case report and literature review. / 上颌侧切牙重度畸形舌侧沟多学科联合治疗1ä¾‹å¹¶æ–‡çŒ®å¤ä¹ .

Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.

Time-lapse between periodontal regeneration surgery and root canal therapy in sever combined periodontal-endodontic lesions.

Objective: The purpose of this study was to evaluate the time-lapse of periodontal regeneration surgery of combined periodontal-endodontic lesions (PEL) after root canal therapy (RCT) to guide the clinical treatment. Methods: 26 patients (28 teeth) with severe combined PEL were equally divided into 4 groups (n = 7); the control group included patients who underwent periodontal regeneration surgery with no prior RCT and the remaining three experimental groups including patients who received periodontal regeneration surgery post-RCT either immediately or after 3 and 6 months. The probing depth, clinical attachment loss, and periodontal bone density were measured before or after 3, 6, and 12 months post-RCT, respectively. Results: Periodontal regeneration surgery could improve the PD (Probing Depth), CAL (Clinical Attachment Loss), BD (Bone Mineral Density) values irrespective of whether the RCT was performed within 12 months or not. However, obviously improved PD, CAL and BD were observed when surgery was performed post-RCT. The time lapse between RCT and periodontal regeneration surgery had no obvious effects on the periodontal index in 3 months after the surgery. Moreover, these periodontal indexes tend to stabilize in 3 to 6 months after the surgery with no significant differences. Conclusion: Although there were no obvious impacts of time lapse between RCT and periodontal regeneration surgery on the severe PEL, an earlier periodontal surgery might contribute to the healing of periodontal lesions.

Multi-disciplinary treatment of severe palatal radicular groove of maxillary lateral incisor: A case report and literature review / 中南大学学报(医学版)

Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.

Efficacy of root canal therapy combined with basic periodontal therapy and its impact on inflammatory responses in patients with combined periodontal-endodontic lesions.

OBJECTIVE: To investigate the effect of root canal and basic periodontal therapies on the efficacy and inflammatory response in patients with pulpal-periodontal disease. METHODS: Clinical data of 103 patients with combined periodontal-endodontic lesions were retrospectively analyzed. The patients were divided into a control group (n=50, treated with conventional root canal therapy) and an observation group (n=53, treated with root canal and basic periodontal therapies). The clinical efficacy after treatment, as well as the probing pocket depth (PD), periodontal indices, inflammatory factors release, and pain level (visual analogue scale) before and after treatment were compared between the two groups. The status of diseased teeth and adverse reactions after treatment were recorded. RESULTS: After 1 month of treatment, the observation group had lower incidences of loosening of teeth, periodontitis and total adverse reactions, as well as higher tooth retention rate and effective rate as compared with the control group (all P<0.05). The PD, BI, PLI, GI and serum levels of interleukin-6 (IL-6) and interleukin-1ß (IL-1ß) all decreased in both groups after 1 month of treatment, and the decreases were more in the observation group than those in the control group (all P<0.05). Compared with before treatment, scores of visual analogue scale decreased in both groups 48 hours after the drug was sealed and 1 month after treatment, and the decreases were more in the observation group than those in the control group (all P<0.05). CONCLUSION: Root canal and basic periodontal therapies can significantly reduce the pain, control the progression of oral inflammation, improve periodontal health and increase the retention rate of affected teeth in patients with combined periodontal-endodontic lesions, showing safety and efficacy.

High levels of HIF-1ɑ in hypoxic dental pulps associated with teeth with severe periodontitis.

In this study we investigated the expression of HIF-1ɑ in dental pulps of the teeth with severe periodontitis. The expression of HIF-1ɑ in dental pulps of the teeth with severe periodontitis was detected by immunohistochemistry, immunofluorescence and real-time PCR. Bone marrow macrophages (BMMs) were cultured under hypoxia in vitro. HIF-1ɑ, osteoclast-specific factors (NFATc1, CTSK and c-fos) and RANKL-induced osteoclastogenesis were evaluated by immunofluorescence, TRAP staining and western blotting. High levels of HIF-1ɑ protein were detected in dental pulps of teeth with severe periodontitis, whereas few positive HIF-1ɑ expressions were detected in healthy dental pulps. Hypoxia occurred in the dental pulps in response to heavy periodontitis. Many HIF-1ɑ-positive infiltratory inflammatory cells were observed around blood vessels. Tooth internal resorption was found in some teeth with severe periodontitis. The HIF-1ɑ levels were upregulated in BMMs under hypoxia, which also promoted osteoclast formation and resorption by NFATc1, CTSK and c-fos. Teeth with severe periodontitis show hypoxic dental pulps and increased potential of osteoclastic differentiation.

Papillary reconstruction and guided tissue regeneration for combined periodontal-endodontic lesions caused by palatogingival groove and additional root: a case report.

We described a combined periodontal-endodontic lesion, which was caused by a palatogingival groove and an additional root. An interdisciplinary approach involving endodontic therapy, mineral trioxide aggregate (MTA) filling, root resection, guided tissue regeneration, and papillary reconstruction was used for the case. The tooth presents morphologically and functionally normal except tooth discoloration caused by MTA.

Bacterial analysis of combined periodontal-endodontic lesions using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) / 中华微生物学和免疫学杂志

Objective To compare the bacterial community profiles present in periodontium and root canals of the same tooth diagnosed as combined periodontal-endodontic lesions by using denaturing gradient gel electrophoresis (DGGE).Methods Samples were collected from 13 extracted teeth with advanced periodontitis,endodontic samples from root tip 1/3 root canal,and periodontal samples from the corresponding neighboring periodontium.Genomic DNA was collected for the following universal bacterial primersPCR.The PCR products were then loaded on the DGGE gels to gain separate bands.The typical DGGE bands were excised,PCR-cloned and sequenced.Results The number of bands,which was indicative of the number of bacterial species,was compared intra-group (periodontal and pulpal specimen from the same tooth).The difference was statistically significant (P＜0.01),but there was no positive correlation between them.The similarity (Dice Coefficient) between them was 13.1％-62.5％.Taxa identified through BLAST (≥98％ identity) were Campylobacter,Fusobacterium,Neisseria,et al in the periodontium,and Mogibacterium,Corynebacterium,Actinomyces,et al in the root canals.Conclusion Common bacteria existed between them,but not all of the periodontal bacteria would appear in neighboring root canal; and the bacteria in the root canal are not completely from neighboring periodontal tissue.The original bacteria in the root canals may resuscitate and enrich the bacterial community.In combined periodontal-endodontic lesions (periodontal source),it is probable that new species existed to be confirmed either in the periodontium or in the root canal.