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AIM: Epigenetic regulation of the key inflammatory genes plays a crucial role in controlling monocyte/macrophage-mediated local and systemic responses to bacterial challenges. However, it has not been addressed in apical periodontitis (AP). We aimed to explore the methylation pattern of the TNF-α gene promoter and its association with the inflammatory phenotype of peripheral blood monocytes from individuals with AP and controls. METHODS: A cross-sectional study was conducted, including otherwise healthy individuals with AP (n = 25) and controls (n = 29). Monocytes were isolated from the volunteer's blood samples using a Ficoll gradient followed by negative immunoselection. RNA and DNA were extracted. The DNA methylation profiles of the TNF-α gene promoter region were analyzed using bisulfite sequencing PCR. The mRNA expression levels of DNA methyltransferases 3a (DNMT3a) and Ten Eleven Translocation enzymes 1(TET1) were assessed by qPCR. A fraction of primary monocytes was also cultured for 24 h, and the supernatant was collected to measure cytokine levels through a Luminex assay. Generalized structural equation models (GSEM) evaluated the association between AP, DNA methylation, and TNF-α protein expression controlled for potential covariates. Models included the effect of the methylation of TNF-α gene promoter as a mediator of the association between AP and TNF-α protein expression levels. RESULTS: Monocytes from AP individuals exhibited a heightened secretion of TNF-α and IL-1ß and hypomethylation of the TNF gene promoter (p < .05). AP diagnosis was associated with the TNF-α gene promoter´s hypomethylated profile and enhanced pro-inflammatory cytokine levels, while lower methylation of the gene promoter region and -163 CpG single site mediated TNF-α overexpression (p < .05). CONCLUSIONS: DNA hypomethylation at the TNF-α gene mediates a proinflammatory phenotype in monocytes from AP patients, supporting a role in the systemic response.

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OBJECTIVES: To assess the existing literature on the use of machine learning (ML) and deep learning (DL) models for diagnosing apical periodontitis (AP) in humans. MATERIALS AND METHODS: A scoping review was conducted following the Arksey and O'Malley framework. The PubMed, SCOPUS, and Web of Science databases were searched, focusing on articles using ML/DL approaches for AP diagnosis. No restrictions were applied. Two independent reviewers screened publications and charted data in predefined Excel tables for analysis. RESULTS: Nineteen publications focused on diagnosing AP by identifying periapical radiolucent lesions (PRLs) in dental radiographs were included. The average sensitivity and specificity for reviewed models were 83% and 90%, respectively. Only three studies explored the direct impact of artificial intelligence (AI) assistance on clinicians' diagnostic performance. Both consistently showed improved sensitivity without compromising specificity. Significant variability in dataset sizes, labeling techniques, and algorithm configurations was noticed. CONCLUSIONS: Findings affirm AI models' effectiveness and transformative potential in diagnosing AP by improving the accurate detection of periapical radiolucencies using dental radiographs. However, the lack of standardized reporting on crucial aspects of methodology and performance metrics prevents establishing a definitive diagnostic approach using AI. Further studies are needed to expand AI applications in AP diagnosis beyond radiographic analysis. CLINICAL RELEVANCE: AI can potentially improve diagnostic accuracy in AP diagnosis by enhancing the sensitivity of PRL detection in dental radiographs without compromising specificity.

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AIM: Apical periodontitis (AP) is the chronic inflammation of the periradicular tissues in response to root canal infection. Whilst AP has been linked with systemic inflammation and noncommunicable diseases, its potential association with nonalcoholic fatty liver disease (NAFLD) is unknown. We aimed to evaluate the serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels as surrogate markers of hepatic injury, and the systemic inflammatory burden in otherwise healthy individuals with and without AP diagnosis. METHODOLOGY: Cross-sectional study. Individuals with AP (n = 30) and healthy controls (n = 29) were recruited. The number, mean diameter (mm) and periapical index of the apical lesions of endodontic origin (ALEO) were assessed. ALT and AST levels (pg/mL) were measured through enzyme-linked immunosorbent assays. The serum levels of TNF-α, IL-4, IL-9, IL-10, IL-17A and IL-22 were evaluated by Multiplex assay. Inferential analysis was performed using t-test or Mann-Whitney tests according to data distribution and linear regression models. Data were analysed with StataV16 (p < .05). RESULTS: ALT and AST levels were significantly higher in individuals with AP compared to controls (p < .05). Serum inflammatory biomarkers showed no significant differences between the study groups. Bivariate and multivariate analyses confirmed that AP diagnosis was independently associated with ALT and AST elevations (p < .05). Additionally, the number of ALEO positively influenced AST levels (p = .002). IL-22 on the other hand, was associated with reduced ALT levels (p = .043). CONCLUSION: AP is associated with higher serum hepatic transaminases ALT and AST, potentially contributing to NAFLD physiopathology in young adults.

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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.

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. CONCLUSÕES: Houve uma associagdo entre as alteragóes sinusais e aslesoes apicais.

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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.

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AIM: To determine the systemic inflammatory burden, including hsCRP and its monomeric forms, in patients with apical lesions of endodontic origin treated with root canal treatment (RCT). METHODOLOGY: Prospective pre-/post-study. Apical periodontitis (AP) individuals aged 16-40 were included (N = 29). Individuals received RCT and were followed at 1 and 6 months. Fasting blood samples were obtained. Apical lesions of endodontic origin (ALEO) diameter (mm), and periapical index (PAI), were recorded. The serum concentrations of total hsCRP were determined by turbidimetry. Tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, IL-1ß, and soluble (s) E-selectin were assessed by Multiplex assay. Additionally, mCRP forms were determined in the serum of AP patients with a baseline moderate to high cardiovascular risk based on hsCRP stratification (hsCRP ≥1 mg/L) by immunowestern blot (n = 15). Also, CRP isoforms were explored in ALEOs from AP individuals (n = 4). Data were analysed with StataV16. RESULTS: Periapical index and ALEO sizes were reduced at both follow-up visits after RCT (p < .05). Serum levels of TNF-α, IL-6, IL-10, IL-1ß, and sE-selectin did not show significant differences. CRP was borderline reduced at 1 month (p = .04); however, in AP individuals at cardiovascular risk (hsCRP ≥ 1 mg/L), hsCRP and its monomeric isoform significantly decreased at 1 and 6 months (p < .05). CONCLUSIONS: High-sensitivity CRP and mCRP are reduced after RCT in AP individuals at cardiovascular risk.

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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.

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

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OBJECTIVES: Assess the efficacy of biomechanical preparation using a reciprocating system followed by final irrigation protocols, then intracanal medication, on reducing endotoxins and cultivable bacteria of infected teeth in irradiated patients. MATERIALS AND METHODS: Twenty-two infected single-rooted canals in patients submitted to head and neck radiotherapy were prepared by reciprocating motion and 2.5% NaOCl. Patients were randomly divided into two groups of 11 patients before the final irrigation protocol: apical positive pressure (APP) or passive ultrasonic activation (PUA). Both groups were treated in two sessions, using Ca(OH)2 as intracanal medication for 14 days. Root canal content sampling was performed after canal access (S1), after biomechanical preparation plus the irrigation protocol (S2), and after intracanal medication (S3). Chromogenic limulus amoebocyte lysate assay measured endotoxin levels (EU/mL), and bacterial load was determined by culture techniques (CFU/mL). RESULTS: Treatment protocols reduced bacterial counts after S2 in both groups (p = 0.01). S3 differed from S1 (p = 0.01), but not from S2 (p = 0.4). Endotoxin levels were reduced in both groups after S2 (P = 0.03) and were lower in S3 than in S2, with significant differences in the APP group (p = 0.03). CONCLUSIONS: Biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth, followed by the irrigation protocol (APP or PUA), demonstrated efficacy in reducing endodontic contaminants. Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. CLINICAL RELEVANCE: This clinical study demonstrated that endodontic treatment in irradiated patients is efficacious at reducing bacterial load and endotoxin levels.

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El uso de tomografía computarizada Cone Beam (CBCT) puede favorecer el diagnóstico temprano de periodontitis apical e influir en su pronóstico y tratamiento; sin embargo, no existe una estandarización entre los índices que determinan la presencia de lesiones periapicales en esta técnica radiológica. Es por tal motivo que, el objetivo de este estudio fue evaluar lesiones periapicales utilizando tres índices sobre CBCT. La población de estudio estuvo conformada por todas las CBCT realizadas en un centro radiológico peruano durante un año, se realizó un muestreo no probabilístico y se evaluaron 36 tomografías Cone Beam con los índices CBCT-PAI, COPI y CBCT-ERI; los datos recolectados fueron analizados estadísticamente y se determinó que el índice CBCT-PAI identificó 91,7 % lesiones periapicales; el índice COPI, 72,2 % y el índice CBCT-ERI, 88,9 %. Asimismo, se aplicó la prueba x2 de Pearson y se determinó un valor de p=0,05. Por lo tanto, se concluyó que el diagnóstico de lesiones periapicales sobre tomografía computarizada Cone Beam puede presentar resultados similares cuando se evalúa con cualquiera de los índices CBCT-PAI, COPI o CBCT-ERI.

The use of Cone Beam Computed Tomography (CBCT) can favor the early diagnosis of apical periodontitis and influence its prognosis and treatment; however, there is no standardization among the indexes that determine the presence of periapical lesions in this radiological technique. For this reason, the aim of this study was to evaluate periapical lesions using three indices on CBCT. The study population consisted of all the CBCT scans performed in a Peruvian radiological center for one year, a non-probabilistic sampling was performed and 36 Cone Beam tomography's were evaluated with the CBCT-PAI, COPI and CBCT-ERI indexes; the data collected were analyzed statistically and it was determined that the CBCT-PAI index identified 91.7 % periapical lesions; the COPI index, 72.2 % and the CBCT-ERI index, 88.9 %. Likewise, Pearson's x2 test was applied and a value of p=0.05 was determined. Therefore, it was concluded that the diagnosis of periapical lesions on Cone Beam computed tomography can present similar results when evaluated with any of the CBCT-PAI, COPI or CBCT-ERI indexes.

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OBJECTIVE: To evaluate the effects of cigarette smoke inhalation on the immune-inflammatory profile of experimental apical periodontitis in rats. METHODOLOGY: In total, 32 male Wistar rats were divided into four groups (n = 8): AP-induced apical periodontitis; S-cigarette smoke inhalation; APS-induced AP and cigarette smoke inhalation; and C (control)-neither AP nor cigarette smoke inhalation. To induce cigarette smoke inhalation, the animals were kept in a chamber filled with tobacco smoke for 8 min thrice a day for 50 days. AP was induced 20 days after inhalation initiation by exposing their coronary pulp to their oral environment for 30 days. After animals were euthanized, their right hemimaxillae were removed for histopathological, semi-quantitative and immunohistochemical (F4/80, CD206 and iNOS) analyses. RESULTS: Quantitative data showed a moderate number of inflammatory infiltrates in AP and an intense number in APS (p < .05). Comparing F4/80+ cells showed no statistically significant differences among groups, but we found more CD206+ cells in AP than in C and S (p > .05). INOS+ immunostaining showed a significant increase in AP and APS, when compared with C and S (p < .05). APS had more iNOS+ cells than AP (p < .05). CONCLUSION: Cigarette smoke inhalation worsened AP, leading to a predominantly pro- inflammatory profile in our experimental model.

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Abstract Interleukins 6 and 17 act in bone resorption in the presence of infections of endodontic origin for host defense. Genetic polymorphisms may be associated with increased bone loss, represented by areas of large periapical lesions. This study aimed to verify the frequency of interleukin 6 and 17 gene polymorphism in patients with asymptomatic apical periodontitis or chronic apical abscess and to verify the existence of correlations between periapical lesion area with age, gender, and presence of the polymorphism, in the studied population, in the state of Pernambuco. A population consisting of thirty diagnosed individuals was included. The area of the lesions was measured in mm². Genomic DNA was extracted and genotyping was performed by Polymerase Chain Reaction Restriction Fragment Length Polymorphism for interleukin 6 (rs 1800795) and interleukin 17 (rs 2275913). Fisher's exact, chi-square, and odds ratio tests were used. A logistic regression analysis was also performed using sex, age, and the presence of polymorphism as covariates, in addition to linear regression to test the relationship between age and lesion area. All tests used a significance level of 0.05% (p ≤0.05%). There was no statistical significance in the occurrence of large areas of periapical lesions correlated with age, sex, and diagnosis, nor in the distribution of alleles in the polymorphism of interleukins 6 and 17 in the studied groups. The frequency of homozygous and heterozygous polymorphism was high. The polymorphism of these interleukins is not correlated with the increase in the areas of asymptomatic periapical inflammatory lesions.

Resumo As interleucinas 6 e 17 atuam na reabsorção óssea na presença de infecções de oriegem endodôntica para defesa do hospedeiro. Polimorfismos genéticos podem estar associados ao aumento da perda óssea, representada por áreas de lesões periapicais grandes. O objetivo deste estudo foi verificar a frequência do polimorfismo dos genes interleucina 6 e 17 em pacientes com periodontite apical assintomática ou abscesso apical crônico e verificar a existência de correlações entre área de lesão periapical com idade, sexo e presença do polimorfismo, na população estudada, no estado de Pernambuco. Foi incluída uma população constituída por trinta indivíduos diagnosticados. A áreas da lesões foram medidas em mm². O DNA genômico foi extraído e a genotipagem realizada por Polimorfismo de Comprimento de Fragmento de Restrição de Reação em Cadeia da Polimerase para interleucina 6 (rs 1800795) e interleucina 17 (rs 2275913). Os testes exato de Fisher, qui-quadrado e odds ratio foram utilizados. Uma análise de regressão logística também foi realizada usando sexo, idade e presença de polimorfismo como covariável, além de regressão linear para testar a relação da idade e área da lesão. Todos os testes utilizaram um nível de significância de 0,05% (p ≤0.05%). Não houve significância estatística na ocorrência das áreas grandes de lesões periapicais correlacionadas com idade, sexo e diagnóstico nem nas distribuições de alelos no polimorfismo das interleucinas 6 e 17 nos grupos estudados. A frequência de polimorfismo homozigoto e heterozigoto foi alta. O polimorfismo dessas interleucinas não está correlacionado ao aumento das áreas das lesões inflamatórias periapicais assintomáticas.

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This study aimed to investigate if apical periodontitis in different periods changes systemic levels of the antioxidant and pro-oxidant parameters in Wistar rats. Twenty-four rats were randomly allocated into healthy animals, apical periodontitis at 14 days (AP14) and apical periodontitis at 28 days (AP28). The first mandibular molars were accessed in the AP groups, and the pulp chamber was exposed to the oral environment, inducing the apical lesion. After 14 and 28 days, the animals were anesthetized, euthanized, and hemimandibles were collected for micro-computed tomography (micro-CT) analysis to measure lesion volume, bone volume (BV), percent of bone to total tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and trabecular space (Tb.Sp). A histological examination of the remaining bone was also performed. Finally, blood samples were collected for oxidative biochemistry analysis, investigating glutathione (GSH), Trolox equivalent antioxidant capacity (TEAC), and lipid peroxidation (TBARS). The lesion volume was greater at 28 than at 14 days, as shown by micro-CT. AP14 and AP28 had decreased BV and Tb.Th, but only AP28 showed a reduction in BV/TV. Tb.N and Tb. Sp were increased in apical periodontitis at 28 days. In the histopathological analysis, AP14 had focal regions of moderate mononuclear inflammatory infiltrate, and AP28 had an intense inflammatory infiltrate with bacterial colonies. In the biochemical evaluation, GSH, TEAC, and TBARS were increased after 14 days. However, GSH returned to control levels, TEAC was similar to AP14, and TBARS increased significantly after 28 days. Therefore, the oxidative biochemistry response was modulated according to the progression of periapical damage. After 14 days, the organism could still react to the injury. However, at 28 days, the antioxidant response decreased, associated with an increase in TBARS.

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INTRODUCTION: Bisphosphonates are antiresorptive drugs used worldwide to treat systemic bone pathologies. This study aimed to assess the impact of zoledronic acid on the progression of induced apical periodontitis and the expression of cytokines interleukin (IL)-1ß, IL-10, IL-6, and tumor necrosis factor alpha (TNF-α) in a mouse model. METHODS: Sixteen female isogenic BALB/c mice 6 weeks of age were distributed into 2 groups: mice with induced apical periodontitis (the AP group, n = 8) and mice with induced apical periodontitis treated with zoledronic acid (the AP-ZA group, n = 8). The AP-ZA group received a dose of 125 µg/kg zoledronic acid diluted in sterile saline solution administered intraperitoneally once a week for 4 weeks before pulp exposure, whereas the AP group received only saline solution. Pulp exposures were performed on the maxillary first molars for the induction of apical periodontitis, and mice were euthanized after 7 and 21 days. The jaws were collected; scanned using micro-computed tomographic imaging; and processed for polymerase chain reaction analysis of IL-1ß, IL-10, IL-6, and TNF-α. The Student t test was performed for parametric data, and Mann-Whitney U tests were used for nonparametric data. The level of significance was set at 5%. RESULTS: Micro-computed tomographic imaging revealed higher bone resorption in the AP group compared with the AP-ZA group at both time points (P < .05). Real-time polymerase chain reaction demonstrated higher TNF-α expression in the AP group at both time points and higher IL-6 and IL-1ß expression in the AP group at the 7- and 21-day time points, respectively, compared with the AP-ZA group (P < .05). No differences were observed regarding IL-10 expression between the groups. CONCLUSIONS: Zoledronic acid had significant anti-inflammatory and antiresorptive effects on apical periodontitis in mice.

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Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

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OBJECTIVES: To evaluate the prevalence and morphological characteristics of DI using CBCT. METHODS: A literature search was performed in PubMed, Embase, Scopus, and Web of Science. Inclusion criteria were randomized clinical trials, cross-sectional studies, and prospective and retrospective cohort studies evaluating the morphological characteristics of DI in anterior teeth using CBCT. Three reviewer authors independently screened the studies, applied the eligibility criteria, assessed the risk of bias, and extracted until September (2022). The risk of bias was evaluated using the Joanna Briggs Institute criteria. Meta-analyses of proportions were used for estimate the prevalence DI according to factors at participant and tooth levels. RESULTS: Six studies were included in the meta-analysis. Among 7373 individuals, a prevalence of 7.45 % of DI was observed (n = 258; τ2 = 0.0096; CI of 4.51-11.3; p < 0.05), with no significant influence of sex. Regarding laterality, unilateral DI showed higher mean prevalence (4.30 %; CI of 2.03-7.33). Among the 382 anterior teeth with DI (0.72 %), the most affected tooth was the upper lateral incisor (5.12 %; n = 329; CI of 2.35-8.86; p < 0.001), type I was the most prevalent (0.59 %; CI of 0.24-1.08) and the presence of open apex and periradicular pathology ranged from 4.3 % to 22.72 % and 3.5-77.92 %, respectively. CONCLUSIONS: The prevalence of individuals with dens invaginatus was 7.45 %, the most affect tooth was the upper lateral incisor with a prevalence of 5.12 % unilaterally and type I was the most prevalent morphology.

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Introducción: La prevalencia de periodontitis apical en dientes con tratamiento endodóntico oscila entre el 35 y el 60%, se ha encontrado una fuerte asociación con respecto al grado de inflamación sistémica generada por la periodontitis apical, como por ejemplo altos niveles de citoquinas proinflamatorias, proteína C reactiva e interleuquina 6; estudios refieren que un tratamiento endodóntico adecuado puede reducir los niveles de proteína C reactiva en individuos sanos y con periodontitis apical. Objetivo: Evaluar la frecuencia de periodontitis apical en una población adulta colombiana seleccionada y su correlación con la calidad del tratamiento endodóntico. Materiales y métodos: Estudio observacional analítico de corte transversal, se determinó la frecuencia de periodontitis apical en 318 CBCT (Tomografía Computarizada de Haz Cónico), de pacientes de una subpoblación de Bucaramanga y Medellín y evaluó la asociación de la calidad del tratamiento endodóntico con el estado periapical. Resultados: Sólo el 37,66% de los dientes evaluados fueron considerados sanos; el 44,81% se clasificaron como tratamiento endodóntico adecuado. La calidad del tratamiento endodóntico influyó significativamente en la condición del periodonto apical. Conclusiones: Los tratamientos evaluados presentaron alta frecuencia de periodontitis apical, la cual se asoció en buena parte a la alta frecuencia de tratamientos endodónticos inadecuados.

Introduction: The prevalence of apical periodontitis in teeth with endodontic treatment ranges between 35% and 60%, and a strong association has been found with respect to high levels of systemic inflammation markers (pro-inflammatory cytokines, protein C-reactive and interleukin 6) caused by apical periodontitis. Studies have shown that an adequate endodontic treatment can reduce C-reactive protein levels in healthy individuals and those with apical periodontitis. Objective: To evaluate the frequency of apical periodontitis in a selected Colombian adult population and its correlation with the quality of endodontic treatment. Materials and methods: Observational, analytical, cross-sectional study. The frequency of apical periodontitis was determined in 318 CBCTs of patients from Bucaramanga and Medellin, and the association between quality of endodontic treatment and periapical status was analyzed. Results: Only 37.66% of the observed teeth were considered healthy, whereas 44.81% were classified as teeth with appropriate endodontic treatment. Quality of endodontic treatment significantly affected the condition of the apical periodontium. Conclusions: The analyzed treatments had a high apical periodontitis frequency, which was associated with a high frequency of inadequate endodontic treatments.

Introdução: A prevalência de periodontite apical em dentes com tratamento endodôntico varia entre 35 e 60 %, uma forte associação foi encontrada com relação ao grau de inflamação sistêmica gerada pela periodontite apical, como altos níveis de citocinas pró-inflamatórias, proteína C reativa e interleucina 6; estudos relatam que o tratamento endodôntico adequado pode reduzir os níveis de proteína C-reativa em indivíduos saudáveis ​​e naqueles com periodontite apical. Objetivo: Avaliar a frequência da periodontite apical em uma população adulta colombiana selecionada e sua correlação com a qualidade do tratamento endodôntico. Materiais e métodos: Estudo transversal analítico observacional; a frequência de periodontite apical foi determinada em 318 CBCT de pacientes de uma subpopulação de Bucaramanga e Medellín, foi avaliada a associação da qualidade do tratamento endodôntico com o estado periapical. Resultados: Apenas 37,66% dos dentes avaliados foram considerados saudáveis, 44,81% dos dentes foram classificados como tratamento endodôntico adequado. A qualidade do tratamento endodôntico influenciou significativamente a condição do periodonto apical. Conclusões: Os tratamentos avaliados apresentaram alta frequência de periodontite apical, que foi amplamente associada à alta frequência de tratamentos endodônticos inadequados.

RESUMO

The purpose of this study is to assess the laser effect in root canal disinfection and periapical healing of endodontically treated teeth from patients with asymptomatic apical periodontitis. This study was performed as a randomized clinical trial. Thirty patients were selected according to the inclusion/exclusion criteria. Fifteen patients received the root canal retreatment (RCR) combined with 980-nm diode laser irradiation (LI). The canals were irrigated with saline solution and gently dried with paper points, keeping the dentin partially moist. The irradiation was performed using a 320-µm-diameter fiber in helicoidal movements (pulsed mode, power output of 1.5 W, 100 Hz for 20 s). The other 15 patients received the RCR with placebo irradiation (PI). Microbiological samples were taken in three periods: S1, after the filling material removal (baseline); S2, after laser or placebo irradiation (LI or PI); and S3, after the RCR followed by laser or placebo. The samples were submitted to the total microbial and E. faecalis counting. The periapical radiographic healing was analyzed after 3, 6, 9, and 12 months. Microbiological data (CFU/mg) were analyzed by ANOVA and Tukey's test (P < 0.05), and the repair by Mann-Whitney test (P < 0.05). In S2, the laser provided 42.44% microbial reduction and 53.14% of E. faecalis, different from the placebo that had no reduction, and 4.85% for Enterococcus (P < 0.05). In S3, the bacterial counts decreased without differences between groups. No differences in healing were found at 3 months. However, diode laser facilitated the repair from 3- to 12-month follow-up (P < 0.05) and had 45% more healed cases than placebo. Diode laser provided an antimicrobial effect before the biomechanical preparation but was not synergistic in RCR. It improved the periapical healing during follow-up.

RESUMO

Osteoclasts play a key role in the regulation of bone mass and are highly active metabolically. Here we show that a metabolic reprogramming toward the hexosamine biosynthetic pathway (HBP) is required not only for osteoclast differentiation but also to determine the bone resorption mode during physiological and pathological bone remodeling. We found that pharmacological inhibition of O-GlcNAc transferase (OGT) significantly reduced protein O-GlcNAcylation and osteoclast differentiation. Accordingly, genetic deletion of OGT also inhibited osteoclast formation and downregulated critical markers related to osteoclasts differentiation and function (NFATc1, αvintegrin, cathepsin K). Indeed, cells treated with OSMI-1, an OGT inhibitor, also reduced nuclear translocation of NFATc1. Furthermore, the addition of exogenous N-acetylglucosamine (GlcNAc) strongly increased osteoclast formation and demineralization ability. Strikingly, our data show for the first time that O-GlcNAcylation facilitates an aggressive trench resorption mode in human cells. The incubation of osteoclasts with exogenous GlcNAc increases the percentage of erosion by trench while having no effect on pit resorption mode. Through time-lapse recording, we documented that osteoclasts making trenches moving across the bone surface are sensitive to GlcNAcylation. Finally, osteoclast-specific Ogt-deficient mice show increased bone density and reduced inflammation-induced bone loss during apical periodontitis model. We show that osteoclast-specific Ogt-deficient mice are less susceptible to develop bacterial-induced periapical lesion. Consistent with this, Ogt-deleted mice showed a decreased number of tartrate-resistant acid phosphatase-positive cells lining the apical periodontitis site. In summary, here we describe a hitherto undiscovered role of the HBP/O-GlcNAcylation axis tuning resorption mode and dictating bone resorption outcome.

RESUMO

The microscopical diagnosis of radicular cyst (RC) is straightforward; nonetheless, in some cases with unusual histopathological features, strict clinicopathological correlation is necessary to achieve the correct diagnosis. We report a case of a 5-year-old girl was referred presenting extensive carious lesion in the tooth #55, associated with vestibular sinus tract. Medical history revealed allergic asthma diagnosis. After clinical and imagi-nological exams, the deciduous tooth was extracted. Microscopically, the soft tissue lesion attached to the root showed typical RC features; however, in the cystic capsule, lymphoid follicles and vascular networks (lined by epithelioid endothelial cells) surrounded by nu-merous eosinophils, were observed. Immunohistochemistry, through CD3, CD20, CD34 and alpha-smooth muscle actin antibodies, highlighted these findings. Moreover, CD1a and CD207 were negative. To the best of our knowledge, this is the first report of RC showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features. (AU)