1
|
Hilmi A, Patel S, Mirza K, Galicia JC. Efficacy of imaging techniques for the diagnosis of apical periodontitis: A systematic review. Int Endod J 2023; 56 Suppl 3:326-339. [PMID: 37067066 DOI: 10.1111/iej.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Apical periodontitis (AP) is a chronic inflammatory response of microbial aetiology. Pathological changes associated with AP may not be visible on radiographic images and may linger without causing any symptoms. Clinicians rely mostly on clinical examination and imaging techniques to establish a diagnosis. OBJECTIVES The aim of this review was to answer the following question using the PICO format: In the adult human permanent dentition (P), what is the efficacy of diagnostic imaging of the periapical tissues (I) using histopathology as a reference standard (C) in the diagnosis of apical periodontitis, in terms of diagnostic accuracy (O). METHODS MEDLINE, EMBASE, Scopus and Cochrane Library were searched for English articles published through October 2021. At least two independent reviewers evaluated the study design, imaging modality used, histopathological assessment, outcome measures, results and conclusions for each article. The risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS The initial search strategy identified 544 articles. Seven articles were included for analysis in the final review, all of which involved tissue samples obtained from cadavers. No clinical studies were identified that met the eligibility criteria. A consistently low sensitivity score and negative predictive value were reported for periapical radiography, especially in comparison to CBCT, which scored highly. Both modalities achieved high scores for specificity and positive predictive value. Diagnostic accuracy of CBCT was lower for root-filled teeth in comparison to non-root-filled teeth. DISCUSSION Assessment of the periapical tissues using periapical radiographs was shown to have a low to moderate agreement with the histopathological assessment. CBCT was reported to be more accurate than PR and demonstrated a good agreement with histopathology, especially for non-root-filled teeth. CONCLUSIONS This review identified a need for greater standardization in methodology and reporting, and as the findings are based on cadaver studies, their clinical relevance must be interpreted with caution. REGISTRATION PROSPERO (CRD42021272147).
Collapse
Affiliation(s)
- Ali Hilmi
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - Shanon Patel
- Department of Endodontology, King's College London Dental Institute, London, UK
- Specialist Practice, London, UK
| | - Kazim Mirza
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Johnah C Galicia
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
- Department of Endodontics, Eastman Dental Institute, University College of London, London, UK
- College of Dentistry, Manila Central University, Caloocan City, Philippines
| |
Collapse
|
2
|
Gayatri S, Mathew S, Kumaravadivel K, Thangavel B, Thangaraj DN, Shaji A. Evaluation of Apically Extruded Debris During Retreatment Procedures Using Various File Systems in Teeth With Simulated Apical Root Resorption: An In Vitro Study. Cureus 2023; 15:e40904. [PMID: 37492825 PMCID: PMC10365891 DOI: 10.7759/cureus.40904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/27/2023] Open
Abstract
Aim The aim of this study was to compare the amount of debris produced apically during the removal of root canal obturating material by using various files in extracted teeth with simulated apical root resorption. Materials and methods An in vitro study was conducted in the root canals of 90 extracted mandibular premolar teeth that were prepared with a ProTaper Gold rotary file (Dentsply Maillefer, Ballaigues, Switzerland) and filled with gutta-percha and an AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland) using a cold lateral compaction technique. A total of 45 mandibular premolar teeth were randomly assigned to three control groups (i.e., the ProTaper Universal retreatment file (Dentsply Maillefer), the Reciproc Blue file (VDW, Munich, Germany), and the HyFlex Remover file (Coltene/Whaledent, Altstatten, Switzerland) for the removal of root canal filling material, whereas the remaining 45 teeth were treated as the experimental group and their apical portion was modified to simulate apical root resorption. The teeth of this experimental group were randomly divided into three subgroups according to the same three techniques used with the control groups for the removal of root canal filling materials. The apically extruded debris was collected into pre-weighed borosilicate glass tubes and then dried. The mean weight of the apically extruded debris was assessed using an analytical balance to an accuracy of 10-4 g. Further, the data were analyzed using the Kruskal-Wallis test and Tukey's post hoc test. Results In the simulated apical root resorption groups, all file systems were associated with significantly more debris extrusion than the groups without simulated root resorption (a < 0.05). In both the control groups and experimental groups, the ProTaper Universal retreatment file was associated with the least weight of the apically extruded debris (a < 0.05), followed by the Reciproc Blue file and the HyFlex Remover file. Conclusion The amount of debris extruded apically was significantly greater in the teeth with simulated apical root resorption than in those without it. Further, during the removal of the root canal filling materials, HyFlex Remover was associated with significantly more apically extruded debris in all groups.
Collapse
Affiliation(s)
- Sasti Gayatri
- Conservative Dentistry and Endodontics, KSR Institute of Dental Science and Research, Tiruchengode, IND
| | - Sebeena Mathew
- Conservative Dentistry and Endodontics, KSR Institute of Dental Science and Research, Tiruchengode, IND
| | - Karthick Kumaravadivel
- Conservative Dentistry and Endodontics, KSR Institute of Dental Science and Research, Tiruchengode, IND
| | - Boopathi Thangavel
- Conservative Dentistry and Endodontics, KSR Institute of Dental Science and Research, Tiruchengode, IND
| | - Deepa N Thangaraj
- Conservative Dentistry and Endodontics, KSR Institute of Dental Science and Research, Tiruchengode, IND
| | - Athira Shaji
- Conservative Dentistry and Endodontics, KSR Institute of Dental Science and Research, Tiruchengode, IND
| |
Collapse
|
3
|
Alsharif SB, Bakhashwain K, Felemban O, Alsharif MB. Endo-Perio Relationship Knowledge, Understanding, and Confidence Among Dentists. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:195-201. [PMID: 36909354 PMCID: PMC9994628 DOI: 10.2147/amep.s401932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Proper knowledge and confidence regarding Endo-Perio relationship plays an important role in correct clinical decisions and management of these conditions. The aim of this study is to assess dentists' knowledge and understanding, in addition, their confidence regarding Endo-Perio relationship, consequently, to investigate the prevalence of misconceptions. METHODS This cross-sectional study, conducted from December 2021 to March 2022, utilized voluntary anonymous questionnaire, distributed among general dentists, graduates of King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia, year of 2021 (n = 151). The questionnaire had two parts, demographic and 13 closed ended scientific questions to assess knowledge and understanding with 4 points Likert scale after each question to assess confidence and misconceptions. Descriptive statistics and Chi-square test at a statistical significance of P-value <0.05 were conducted to analyze the data using SPSS. RESULTS Total of 98 participants completed the questionnaire setting a response rate of (64.9%). Only (21.4%) had sufficient overall knowledge and understanding regarding Endo-Perio relationship with no significant association found between knowledge and gender (p = 0.8). A little more than one-third of our participants (37.83%) were overly confident; false confident, thus, had misconceptions. CONCLUSION Our study revealed that the majority of our participants had deficient knowledge regarding Endo-Perio relationship. Thus, to compensate for this reported deficiency, changing teaching strategies and implementing continuing education courses are suggested. More studies assessing the interaction between knowledge and confidence in different dental topics are needed.
Collapse
Affiliation(s)
- Shahad B Alsharif
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Omnia Felemban
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majd B Alsharif
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Influence of the timing of periodontal intervention on periapical/periodontal repair in endodontic-periodontal lesions: a systematic review. Clin Oral Investig 2023; 27:933-942. [PMID: 36585525 DOI: 10.1007/s00784-022-04849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study is aimed at answering the following question: "Does the timing of periodontal intervention influence the periapical/periodontal repair in endodontic-periodontal lesions?". MATERIAL AND METHODS Six electronic databases were systematically searched for studies published up to April 2022, without restriction of language or year of publication, following the PIOS strategy: (P) adult patients with a diagnosis of endodontic-periodontal lesions, (I) endodontic and periodontal treatment, (O) periapical and periodontal healing, and (S) clinical studies. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2) and non-randomized interventions (ROBINS-I). The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS Three studies (one prospective, one retrospective, and one randomized clinical trial) were included in the present review. Non-randomized studies had a critical and serious risk of bias. The randomized clinical trial had some concerns risk of bias. Non-randomized studies reported that the endodontic intervention should be performed previous to the periodontal intervention. Randomized clinical trial reported improvements when endodontic and periodontal interventions were performed simultaneously. GRADE analysis showed a very low quality of evidence for both randomized and nonrandomized studies. CONCLUSIONS Based on the evidence from the included studies, although it is suggested that the endodontic treatment should be performed prior to periodontal treatment, it is not possible to assure the best treatment sequence for endodontic-periodontal lesions. CLINICAL RELEVANCE Evidences suggests that although the endodontic intervention should be the first therapy of choice, it was not possible to specify the best time to perform the periodontal intervention.
Collapse
|
5
|
Cone beam computed tomography assessment of the prevalence and association of pulp calcification with periodontitis. Odontology 2023; 111:248-254. [PMID: 35964264 DOI: 10.1007/s10266-022-00733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 01/12/2023]
Abstract
Periodontitis has a known association with pathological calcification in the cardiovascular system. Considering the close anatomic and circulatory association between dental pulp and the periodontium, this study aimed to evaluate the prevalence of pulp calcification (PC) under different periodontal conditions, as well as the associations of PC with the degree of periodontal damage, via cone beam computed tomography (CBCT) examination. In this study, 55 patients were categorized into three groups according to periodontal condition: group 1 (healthy controls), group 2 (periodontitis stage I-II), and group 3 (periodontitis stage III-IV). PC and radiographic bone loss (RBL) was assessed by CBCT in sagittal, axial, and coronal views, and statistical analyses were conducted. PC was identified in 378 of 1170 teeth (32.3%). The prevalence significantly differed among the three groups (P < 0.001). Group 2 had a 2.43-fold (P < 0.001, 95% confidence interval [CI] 1.64-3.61) higher risk of PC than group 1; and the risk of PC was 3.04-fold (P < 0.001, 95% CI 2.06-4.48) higher in group 3 than group 1. Teeth with more severe RBL exhibited a higher prevalence of PC (P < 0.001). Molar teeth had a higher risk of PC than incisors and premolars. In conclusion, the occurrence of PC is related to the periodontal state, and the prevalence of PC is higher in teeth with periodontitis; tooth type and periodontitis status are important risk factors for PC.
Collapse
|
6
|
'Combined endo-perio lesions' - what is the best treatment? Evid Based Dent 2021; 22:158-159. [PMID: 34916649 DOI: 10.1038/s41432-021-0230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/08/2022]
Abstract
Aims To assess the radiographic and periodontal healing of combined endo-perio lesions in anterior teeth treated with orthograde root canal treatment (RCT), with and without guided tissue regeneration (GTR) and bone grafting.Sample selection A total of 120 individuals attending the Dental University Hospital in Riyadh, Saudi Arabia, diagnosed with true combined endo-perio lesions were selected. Inclusion criteria included being between 25 and 55 years old and having a single-rooted non-vital maxillary anterior tooth with a true combined endo-perio lesion, assessed using a cone beam computed tomography (CBCT) scan. Exclusion criteria included uncontrolled systemic disease, a history of oral cancer or sepsis, recent use of antibiotics, the use of bone metabolism modifying drugs and the presence of fractures, resorption or associated pathological cysts. Power calculations were used to set a minimum sample size of 120 teeth.Design A randomised controlled trial involving four treatment arms: root canal treatment (RCT) with gutta percha (GP) obturation; RCT with mineral trioxide aggregate (MTA) obturation; RCT with GP obturation and guided tissue regeneration (GTR); and RCT with MTA obturation and GTR. Participants were randomly assigned using computer software to each treatment arm via block randomisation.Baseline periodontal measurements (gingival phenotype, keratinised tissue width, pocket depth and clinical attachment level) and a CBCT scan to obtain a CBCT periapical index (CBCTPAI) score were taken at visit one. Visit two involved scaling, root planing and a RCT performed using hand files and a thermoplastic obturation technique for the GP obturation arm (Obtura II, Obtura Spartan, USA) and vertical compaction for the MTA obturation arm (ProRoot White, Dentsply, USA). Visit three (for the GTR and bone-grafting arms), one week later, included regenerative periodontal surgery - raising a three-sided buccal flap, removal of granulation tissue, filling the defect with demineralised, freeze-dried bone allograft, coverage with a resorbable collagen membrane and closure with resorbable sutures. Visit two was performed by a single endodontist and visit three, for the GTR and bone grafting arms, was performed by a single periodontist. Previous or future planned treatment was concealed to operators and they were only informed of the treatment to be performed on the day. All teeth received definitive restorations.The follow-up schedule was one, three, six and twelve months post-treatment. CBCT scans were repeated at six and twelve months; clinical periodontal measurements were repeated at three, six and twelve months.Data analysis Descriptive analysis was performed and results were presented as cross-tabulations and a bar chart. Inferential statistics were used; one-way analysis of variance with Tukey's multiple comparison test to compare the mean value of measurements between treatment arms at follow-up visits and Kruskal-Wallis test to compare mean CBCTPAI scores between arms at follow-up visits. The p-value was set at ≤0.05.Results Baseline comparison showed no statistically significant differences between treatment arms. No participants were lost to follow up. At 12 months, GTR showed improved healing, with 98% of cases showing CBCTPAI scores better than 1, compared to 100% cases scoring 1 + D or worse without GTR. Statistically significant differences were found between treatment arms with respect to CBCTPAI score and pocket depth at 12 months.Conclusions GTR may improve radiographically-assessed healing of combined endo-perio lesions. MTA obturation may play a role in the management of combined endo-perio lesions. Study limitations do not allow for more definitive conclusions.
Collapse
|
7
|
Gomes BPFA, Berber VB, Marinho ACS, Louzada LM, Arruda-Vasconcelos R, Passini MRZ, Lopes EM, Pecorari VGA, Chen T, Paster BJ. Chemomechanical preparation influences the microbial community and the levels of LPS, LTA and cytokines in combined endodontic-periodontal lesions: A clinical study. J Periodontal Res 2021; 57:341-356. [PMID: 34910826 DOI: 10.1111/jre.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study was conducted to compare the microbiomes, the levels of lipopolysaccharides (LPS), lipoteichoic acid (LTA), and cytokines (interleukin [IL]-1β and tumor necrosis factor-alpha [TNF-α]), before and after chemomechanical preparation (CMP) of the root canals (RC) and their associated periodontal pockets (PP) in teeth with combined EPL. MATERIALS Samples were taken from 10 RC and PP, before and after CMP. The microbiomes (next-generation sequencing, V3-V4 hypervariable region of the 16S rRNA gene), microbiome diversity (bioinformatics analyses), LPS (limulus amebocyte lysate), LTA, IL-1β, and TNF-α (ELISA) were evaluated. A statistical analysis was performed with significance level set at 5%. RESULTS The most abundant phyla in both sites were Firmicutes and Proteobacteria. Comparative studies of bacterial genera species revealed that some increased and others decreased after CMP at both sites. A 3% reduction in Gram-negative bacteria (RC) and a 4% increase in Gram-positive bacteria (PP) were detected. LPS levels were 4.4 times higher in PP than in the RC. LTA was detected in all samples investigated. Higher levels of IL-1β and TNF-α were detected in both sites at baseline. After CMP, LPS, LTA, IL-1β and TNF-α were reduced in both sites. CONCLUSION The microbial community in the RC and PP in teeth with combined EPL indicated a similarity between both sites. CMP effectively reduced the microbial load and the LPS levels from teeth with EPL, and consequently diminished the cytokine levels. The reduction in LTA levels in the RC and PP proved challenging.
Collapse
Affiliation(s)
- Brenda P F A Gomes
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Vanessa B Berber
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Ariane C S Marinho
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Lidiane M Louzada
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Rodrigo Arruda-Vasconcelos
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Maicon R Z Passini
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Erica M Lopes
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Vanessa G A Pecorari
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, Brazil.,BioStatistics, Universidade Paulista - UNIP, São Paulo, Brazil
| | - Tsute Chen
- Department of Molecular Genetics, The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Bruce J Paster
- Microbiology Department, The Forsyth Institute, Cambridge, Massachusetts, USA
| |
Collapse
|
8
|
Kumar G, Tewari S, Tagg J, Chikindas ML, Popov IV, Tiwari SK. Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review. Probiotics Antimicrob Proteins 2021; 13:299-314. [PMID: 33580864 DOI: 10.1007/s12602-021-09750-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 01/09/2023]
Abstract
Apical periodontitis (AP) is a biofilm-associated disease initiated by the invasion of dental pulp by microorganisms from the oral cavity. Eradication of intracanal microbial infection is an important goal of endodontic treatment, and this is typically accomplished by mechanical instrumentation and application of sodium hypochlorite and chlorhexidine. However, these agents are tissue-irritating at higher concentrations and cytotoxic. Certain probiotics have been found effective in controlling marginal periodontitis, as evidenced by reduction of pathogenic bacterial loads, gains in clinical attachment levels, and reduced bleeding on probing. In vitro studies have shown inhibitory activity of some probiotics against endodontic pathogens. Similarly, in vivo studies in rats have demonstrated a positive immuno-modulatory role of probiotics in AP, as manifested by decreased levels of proinflammatory markers and increased levels of anti-inflammatory markers. A role for probiotics in effecting a reduction of bone resorption has also been reported. This review provides an outline of current research into the probiotic management of AP, with a focus on understanding the mechanisms of their direct antagonistic activity against target pathogens and of their beneficial modulation of the immune system.
Collapse
Affiliation(s)
- Gaurav Kumar
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Sanjay Tewari
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - John Tagg
- BLIS Technologies Ltd, Dunedin, New Zealand
| | - Michael Leonidas Chikindas
- Health Promoting Naturals Laboratory, School of Environmental and Biological Sciences, Rutgers State University, 65 Dudley Road, New Brunswick, NJ, 08901, USA.,Center for Agrobiotechnology, Don State Technical University, Gagarin Square 1, Rostov-on-Don, 344002, Russia.,I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Str., 19c1, Moscow, 119146, Russia
| | - Igor V Popov
- Center for Agrobiotechnology, Don State Technical University, Gagarin Square 1, Rostov-on-Don, 344002, Russia
| | | |
Collapse
|
9
|
Makeeva MK, Daurova FY, Byakova SF, Turkina AY. Treatment of an Endo-Perio Lesion with Ozone Gas in a Patient with Aggressive Periodontitis: A Clinical Case Report and Literature Review. Clin Cosmet Investig Dent 2020; 12:447-464. [PMID: 33149696 PMCID: PMC7604462 DOI: 10.2147/ccide.s267933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/16/2020] [Indexed: 01/29/2023] Open
Abstract
The pulp and periodontium have obvious relationships that have been described in many studies. Pulp infections may affect periodontal tissues and vice versa. Teeth with endo-perio lesions have a worse prognosis than isolated endodontic or periodontal lesions. Elimination of endodontic and periodontal infections is essential for successful treatment, so co-operation between endodontists and periodontists is necessary. In this clinical case, a 44-year-old male presented with primary periodontal disease with secondary endodontic involvement in his lower right canine because of aggressive periodontitis. There was 10 mm of clinical attachment loss and 8 mm periodontal pocket mesial from the tooth and bone radiolucency periapical and lateral from the root. Periodontal therapy was followed by endodontic treatment. Periodontal therapy included root scaling and planing, treatment of the periodontal pocket with ozone gas, systemic antibiotics, oral hygiene instructions, and chlorhexidine rinsing. Endodontic therapy included root canal instrumentation with rotary endodontic files, irrigation, root canal treatment with ozone gas, and obturation with lateral compaction. Radiographs at a 6-month follow-up appointment showed complete healing of the periapical lesion and alveolar bone lateral to the root. Using an interdisciplinary approach to treat endo-perio lesions provides favorable clinical outcomes. Ozone therapy is beneficial for the successful treatment of endo-perio lesions with narrow periodontal pockets in patients with aggressive periodontitis and poor prognosis.
Collapse
Affiliation(s)
- Maria K Makeeva
- Conservative Dentistry Department, People's Friendship University of Russia (RUDN University), Moscow, Russia.,Therapeutic Dentistry Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Fatima Yu Daurova
- Conservative Dentistry Department, People's Friendship University of Russia (RUDN University), Moscow, Russia
| | - Svetlana F Byakova
- Therapeutic Dentistry Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anna Yu Turkina
- Therapeutic Dentistry Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| |
Collapse
|
10
|
Alshawwa H, Wang JF, Liu M, Sun SF. Successful management of a tooth with endodontic-periodontal lesion: A case report. World J Clin Cases 2020; 8:5049-5056. [PMID: 33195681 PMCID: PMC7642532 DOI: 10.12998/wjcc.v8.i20.5049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/01/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endodontic-periodontal lesion is a commonly encountered dental condition. However, the prognosis of the condition varies from good to poor. Some cases are associated with a poor prognosis that requires tooth extraction. This report presents a case of an endodontic-periodontal lesion in a tooth that was successfully treated by root canal treatment.
CASE SUMMARY A 51-year-old female patient with no medical history complained about persistent pain and discomfort in her left mandibular first molar. Clinical examination showed the left mandibular first molar with poor restoration. It was also associated with underlying necrotic pulp and periodontal involvement. Radiographic examination revealed visible bone defects in the apical and periodontal areas. Based on the findings, the patient was diagnosed with a primary endodontic lesion. A root canal treatment for the endodontic lesion was performed. The patient received a coronal all-ceramic endocrown restoration. A follow-up was arranged to check the prognosis. At the 3 mo follow-up, the clinical and radiography evaluations showed complete disappearance of signs and symptoms and an increase in the radiopacity of the root area.
CONCLUSION Despite the poor prognosis associated with many endodontic lesions, this case report highlights that a good prognosis is still possible for an endodontic lesion with apical and periodontal bone loss. In this case, it was achieved via successful root canal treatment without the need for periodontal or surgical intervention.
Collapse
Affiliation(s)
- Hamed Alshawwa
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Jia-Feng Wang
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Min Liu
- Department of Periodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Shu-Fen Sun
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
11
|
Successful Management of Teeth with Different Types of Endodontic-Periodontal Lesions. Case Rep Dent 2018; 2018:7084245. [PMID: 30002934 PMCID: PMC5996454 DOI: 10.1155/2018/7084245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/17/2018] [Accepted: 05/06/2018] [Indexed: 01/08/2023] Open
Abstract
Endodontic-periodontal diseases often present great challenges to the clinician in their diagnosis, management, and prognosis. Understanding the disease process through cause-and-effect relationships between the pulp and supporting periodontal tissues with the aid of rational classifications leads to successful treatment outcomes. In this report, we present several treatment modalities in patients with different endodontic-periodontal lesions. A modification to the new endodontic-periodontic classification, Al-Fouzan's classification, was also added. The first case was classified as retrograde periodontal disease (i.e., primary endodontic lesion with drainage through the periodontal ligament). The second case was diagnosed as an iatrogenic periodontal lesion caused by root perforation. The third case was diagnosed as an iatrogenic periodontal lesion caused by tooth trauma due to orthodontic treatment. The first two cases were managed with a nonsurgical approach, whereas the third case was managed with nonsurgical and surgical approaches. All patients showed complete healing of soft and hard tissue lesions. A thorough understanding of the disease history and the patient's signs and symptoms, complete examination with full investigation, and the use of a systematic step-by-step approach in the management of such challenging endodontic-periodontal lesions with regular recall visits were very useful and successful.
Collapse
|
12
|
Rotstein I. Interaction between endodontics and periodontics. Periodontol 2000 2017; 74:11-39. [DOI: 10.1111/prd.12188] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 02/06/2023]
|
13
|
Rodriguez FR, Paganoni N, Eickholz P, Weiger R, Walter C. Presence of root canal treatment has no influence on periodontal bone loss. Clin Oral Investig 2017; 21:2741-2748. [PMID: 28213764 DOI: 10.1007/s00784-017-2076-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/07/2017] [Indexed: 01/24/2023]
Abstract
AIM The aim of this study was to compare the interproximal bone level at root canal-filled teeth and non-root canal-filled teeth. MATERIALS AND METHODS The records of patients from the department were consecutively screened from January 2009 to October 2011. The distance between the coronal reference point to the alveolar bone crest (AC) was assessed at the mesial and distal aspects of root canal-filled teeth (RCF+) and their contralateral non-root canal-filled teeth (RCF-) on periapical radiographs. Generalised linear mixed-effects models were applied. RESULTS The sample consisted of 128 pairs of teeth comprising data from 72 patients. The results for AC revealed a median distance of 3.2 mm for RCF+ and 3.4 mm for RCF- (p = 0.61). Using the maximal distance on either the distal or the mesial tooth surface, a median distance of 3.6 mm was detected for RCF+ and 3.8 mm for RCF-, respectively (p = 0.42). Even after taking several tooth- and subject-specific variables into account, the differences between AC on RCF+ and RCF- were statistically not significant (p > 0.05). CONCLUSION The interproximal bone loss did not differ statistically significant between root canal-filled teeth and non-root canal-filled teeth. CLINICAL RELEVANCE Existence of appropriately done root canal fillings in periodontitis patients has no effect on the prognosis of periodontal disease.
Collapse
Affiliation(s)
- Fabiola-Regina Rodriguez
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
| | - Nadine Paganoni
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
- Volkszahnklinik Basel, University Centre for Dental Medicine, Basel, Switzerland
| | - Peter Eickholz
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, 60596, Frankfurt, Germany
| | - Roland Weiger
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
| | - Clemens Walter
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland.
| |
Collapse
|
14
|
Schmidt JC, Walter C, Amato M, Weiger R. Treatment of periodontal-endodontic lesions - a systematic review. J Clin Periodontol 2014; 41:779-90. [DOI: 10.1111/jcpe.12265] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Julia C. Schmidt
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - Mauro Amato
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| |
Collapse
|
15
|
A new classification of endodontic-periodontal lesions. Int J Dent 2014; 2014:919173. [PMID: 24829580 PMCID: PMC4009301 DOI: 10.1155/2014/919173] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/12/2014] [Indexed: 11/18/2022] Open
Abstract
The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. Differentiating between a periodontal and an endodontic problem can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may cause the periodontal involvement and vice versa. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult, but it is of vital importance to make a correct diagnosis for providing the appropriate treatment. This paper aims to discuss a modified clinical classification to be considered for accurately diagnosing and treating endo-perio lesion.
Collapse
|
16
|
Li H, Guan R, Sun J, Hou B. Bacteria community study of combined periodontal-endodontic lesions using denaturing gradient gel electrophoresis and sequencing analysis. J Periodontol 2014; 85:1442-9. [PMID: 24579762 DOI: 10.1902/jop.2014.130572] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The entire microbial population and predominant microflora of root canals (RCs) and adjacent periodontal pockets (PPs) from teeth with combined periodontal-endodontic lesions were determined and compared. METHODS Pooled RC and PP samples were collected from the molars of 20 patients diagnosed with combined periodontal-endodontic lesions. DNA was extracted for polymerase chain reaction-based denaturing gradient gel electrophoresis (PCR-DGGE), cloning, and sequence analysis. A coefficient of similarity (Cs) was used to determine the similarity of the bacterial profiles from RCs and PPs. RESULTS Significantly fewer bands were produced by PCR-DGGE from RCs (5.9 ± 1.7) than from PPs (8.0 ± 1.8) (P <0.001). The average Cs of the RC and PP samples was 93.81% ± 10.26%. Overall, 60 genera/species were identified by sequencing. Of these, the predominant genera in RCs were Porphyromonas sp. (13.9%), Filifactor sp. (12.5%), and Parvimonas sp. (11.1%), similar to the genera obtained from PP samples. In total, 43 genera/species were common to the RC and PP samples. The most prevalent bacteria in both the RC and PP samples were (in descending order) Filifactor alocis, Parvimonas micra, Porphyromonas gingivalis, and Tannerella forsythia. CONCLUSIONS The high similarity in the sets of organisms present in both RC and PP samples in this study suggests that the pocket could be a source of RC infection. The data also demonstrate that combined periodontal-endodontic lesions consist of a diverse and complex microbial community.
Collapse
Affiliation(s)
- Hong Li
- Department of Endodontics, School of Stomatology, Capital Medical University, Beijing, China
| | | | | | | |
Collapse
|
17
|
Lim JH, Lee JH, Shin SJ. Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups. Restor Dent Endod 2014; 39:56-62. [PMID: 24516831 PMCID: PMC3916507 DOI: 10.5395/rde.2014.39.1.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/22/2013] [Indexed: 12/04/2022] Open
Abstract
A tooth with primary endodontic disease that demonstrates a periodontal defect might be extracted because of misdiagnosis as severe periodontal disease or a vertical root fracture. The aim of this case report was to demonstrate the long-term survival of endodontically treated teeth, which had been initially considered unsavable. With meticulous evaluation including the patient's dental history, clinical and radiographic examinations, teeth with primary endodontic lesions could be differentiated and saved after proper root canal treatment. Pain history, vitality test, and radiographic examinations, as well as a general periodontal condition check with periodontal probing on an affected tooth, might be the key methods to differentiate endodontic pathosis from that of periodontal disease.
Collapse
Affiliation(s)
- Jae-Hyung Lim
- Department of Oral and Maxillofacial Surgery, Korea University Ansan Medical Hospital, Ansan, Korea
| | - Ji-Hyun Lee
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, CA, USA
| | - Su-Jung Shin
- Department of Conservative Dentistry, Yonsei University College of Dentistry, Seoul, Korea
| |
Collapse
|
18
|
Caviedes-Bucheli J, Azuero-Holguin MM, Correa-Ortiz JA, Aguilar-Mora MV, Pedroza-Flores JD, Ulate E, Lombana N, Munoz HR. Effect of Experimentally Induced Occlusal Trauma on Substance P Expression in Human Dental Pulp and Periodontal Ligament. J Endod 2011; 37:627-30. [DOI: 10.1016/j.joen.2011.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 01/31/2011] [Accepted: 02/03/2011] [Indexed: 01/08/2023]
|
19
|
Possibilities of endodontic therapy of endodonic-periodontal lesions. SRP ARK CELOK LEK 2009; 137:351-6. [DOI: 10.2298/sarh0908351n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Intoduction. Endoperiodontal lesions are frequent in clinical practice and may require complex therapy. It is very important to determine differential diagnosis and the origin of the lesion, because the treatment plan is based on aetiology and stadium of the development of the lesion. Objective. The aim of this clinical study was to analyze the efficacy of endodontic treatment in different types of endodontic- periodontal lesions. Methods. Thirty patients and 42 teeth with diagnosed endoperiodontal lesions were included in the study and divided in two groups. Vital pulp therapy was applied to 18 vital teeth where the diagnosis was perio-endodontic lesions. The therapy of infected canal system was applied to 24 teeth with endodontic- periodontal or combined lesions. Standard endodontic procedure consisted of cleaning and shaping of the root canal system and between sessions filling with calcium-hydroxide paste. Obturation was made by lateral compact of the guttapercha and Apexit paste. Efficiency was evaluated clinically and radiographically three, six and twelve months later. Results. Radiographic and clinical follow-up showed a significant radiographic improvement and absence of subjective symptoms in a very high percentage of the treated vital and avital teeth. The results of this study showed that in the observation period of 12 months endodontic therapy was successful in 88.89% of vital teeth, and in the group of avital teeth the percentage was 91.67%. Conclusion. Endodontic treatment of the endoperiodontal lesions was sufficient and it was the basic condition to achieve a complete healing of endodontic-periodontal lesions. Such therapy ensures significant improvement or even complete healing of both types of lesions, of endodontic and periodontal origin.
Collapse
|