Search

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp. [ABSTRACT FROM AUTHOR]

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Asymptomatic Apical Periodontitis (AAP) is an endoperiodontal disease that involves inflammation and infection of the periapical region of the tooth with no painful symptoms and may be associated with dental trauma. This pathology induces periapical bone resorption and pulp necrosis. This article aims to talk about the diagnosis, etiology, recommended treatment, and necessary monitoring in cases like these. For this purpose, a clinical case of AAP resulting from dental trauma was chosen as methodology. The patient's main complaint included significant trauma to the face resulting from a car accident. After pulp tests and radiographic examinations, the presence of a periapical lesion in dental elements 31 and 42 was diagnosed and the treatment of choice was conventional endodontic therapy. Conservative treatment has a good scientific basis, which includes chemicalmechanical preparation and three-dimensional filling of the root canal. Follow-up should be 6 months to 5 years after treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the oral etiology of patients with odontogenic sinusitis (ODS) and to compare the differences in demographic data, clinical symptoms, extent of sinus involvement, bone penetration of the maxillary sinus floor (MSF) between different etiologies. A retrospective investigation was conducted on 103 patients with ODS recruited from Beijing TongRen Hospital. All enrolled patients underwent sinus CT, nasal endoscopy, and oral examination. A comparison of the patients' clinical symptoms, the extent of involvement of the sinuses, and bone resorption of the MSF according to odontogenic etiologies was conducted. Follow-up was based on symptoms and clinical examination. The most common odontogenic etiologies were endo-periodontal lesions (EPLs, 49.5%), apical periodontitis (AP, 32.0%), and periodontitis (PE, 8.7%). There were statistically significant differences in age (p = 0.002), sex (p = 0.036), inflammation involving the ethmoid sinus (p = 0.037), and bone penetration of the MSF (p < 0.001) between the AP, EPL, and PE groups. There were no significant differences in sinusitis symptoms (p > 0.005) among patients with different odontogenic etiologies. In conclusion, EPL is a neglected oral etiology with a destructive effect on the bone of the MSF, which deserves more attention in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Endo-periodontal lesions are challenging clinical situations where both the supporting tissues and the root canal of the same tooth are infected. In the present study, chlorhexidine (CHX)-loaded calcium hydroxide (CH) pastes were used as intracanal medications (ICMs). They were prepared and tested on pathogens found in both the root canal and the periodontal pocket. Exposure to 0.5% and 1% CHX-loaded ICMs decreased the growth of Porphyromonas gingivalis and was effective in eradicating or inhibiting an Enterococcus faecalis biofilm. CH was injected into the root canal of extracted human teeth immersed in deionized water. CHX-loaded ICMs resulted in the transradicular diffusion of active components outside the tooth through the apex and the lateral dentinal tubules, as shown by the release of CHX (from 3.99 µg/mL to 51.28 µg/mL) and changes in pH (from 6.63 to 8.18) and calcium concentrations (from 2.42 ppm to 14.67 ppm) after 7 days. The 0.5% CHX-loaded ICM was non-toxic and reduced the release of IL-6 by periodontal cells stimulated by P. gingivalis lipopolysaccharides. Results indicate that the root canal may serve as a reservoir for periodontal drug delivery and that CHX-based ICMs can be an adjuvant for the control of infections and inflammation in endo-periodontal lesions. [ABSTRACT FROM AUTHOR]

Introduction: Accessory canals in the furcation area (ACF) can be seen to provide routes of communication joining the dental pulp and periodontal tissue and be considered a cause of endodontic-periodontal disease. However, many points remain unknown concerning the three-dimensional morphology of ACFs as well as their locations and incidences in different types of teeth. The aim of this study was to examine the three-dimensional structure of ACFs using ultra-high-resolution micro-computed tomography (micro-CT), and their incidence on the basis of the existing classification system. Materials and Methods: Ninety-six Japanese mandibular first molars were grouped according to age, with those extracted from individuals <20 years old at the time of extraction classed as "junior" and those from individuals =20 years old at the time of extraction as "senior." Regions of interest were designated for vertical and horizontal observations. Collected specimens were scanned in micro-CT, and three-dimensional reconstruction and morphological analyses were carried out. The morphological classification of ACFs of Yoshida et al. was followed. After classification, the prevalence of teeth with ACFs and the total numbers and percentages of ACFs in each type were calculated. Mann-Whitney U-tests were used for the statistical analysis of numbers of ACFs, with values of P < 0.05 regarded as significant. Results: Ninety-five molars showed at least one accessory canal. Accessory canals were present in 98.0% of junior and 100% of senior individuals. Types 3 and 6 were the most commonly found in the furcation area. Junior showed significantly more accessory canals per tooth than senior (P < 0.05). Conclusions: ACFs were present in the vast majority of specimens of both junior and senior teeth. This result suggested that clinically, affecting endodontic-periodontal disease as well as the presence of ACFs may impact reinfection after infected root canal treatment. [ABSTRACT FROM AUTHOR]

Endo-periodontal lesions are challenging clinical situations where both the supporting tissues and the root canal of the same tooth are infected. In the present study, chlorhexidine (CHX)-loaded calcium hydroxide (CH) pastes were used as intracanal medications (ICMs). They were prepared and tested on pathogens found in both the root canal and the periodontal pocket. Exposure to 0.5% and 1% CHX-loaded ICMs decreased the growth of Porphyromonas gingivalis and was effective in eradicating or inhibiting an Enterococcus faecalis biofilm. CH was injected into the root canal of extracted human teeth immersed in deionized water. CHX-loaded ICMs resulted in the transradicular diffusion of active components outside the tooth through the apex and the lateral dentinal tubules, as shown by the release of CHX (from 3.99 µg/mL to 51.28 µg/mL) and changes in pH (from 6.63 to 8.18) and calcium concentrations (from 2.42 ppm to 14.67 ppm) after 7 days. The 0.5% CHX-loaded ICM was non-toxic and reduced the release of IL-6 by periodontal cells stimulated by P. gingivalis lipopolysaccharides. Results indicate that the root canal may serve as a reservoir for periodontal drug delivery and that CHX-based ICMs can be an adjuvant for the control of infections and inflammation in endo-periodontal lesions.

Introduction: Endodontic-periodontal diseases frequently pose significant challenges for clinicians in terms of diagnosis, management, and prognosis. Practitioners' knowledge of endo-periodontal lesion (EPL) diagnosis is essential for formulating appropriate treatment plans. This study aimed to evaluate the knowledge of diagnostic and therapeutic approaches to EPLs among dental practitioners in Saudi Arabia., Methods: The study used a cross-sectional survey among Saudi Arabian dental practitioners using a self-administered questionnaire. The statistical methods used included descriptive analysis, Pearson's chi-square test, Fisher's exact test, and binary logistic regression.  Results: The study included 312 respondents, with 95 (30.4%) females and 217 (69.6%) males. The majority were aged 25 to 30 (n = 155, 49.7%). Significant associations were found between participant knowledge and the following variables: age (P < 0.001), organization (P = 0.005), employment (P = 0.001), professional experience (P < 0.001), postgraduate degree (P = 0.002), specialty (P < 0.001), Saudi Commission for Health Specialities (SCHS) rank (P = 0.004), and continuing training (P = 0.043). Additionally, individuals aged 36-40 were 4.3 times more likely to have good knowledge compared to those aged 25-30 (adjusted odds ratio [AOR] = 4.27, P = 0.020), and lecturers were 4.4 times more likely to have good knowledge compared to interns (AOR = 4.40, P = 0.054)., Conclusion: This indicates that the practitioners' overall knowledge was above average and that they possess a fundamental understanding of EPLs. These findings have valuable effects on clinical practice, suggesting that evidence-based guidelines and targeted educational programs can enhance the practitioners' diagnostic accuracy and treatment strategies for EPLs, ultimately improving patient outcomes and clinical efficacy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee of the University of Hail, Saudi Arabia issued approval under reference no. H-2024-024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Algarni et al.)

Understanding the interaction between endodontic and periodontal lesions is of crucial importance to the clinician because of the challenges commonly encountered in the evaluation, diagnosis, treatment and prognosis of these combined diseases. Among the risk factors for the occurrence and development of endo-periodontal lesions are: incorrect endodontic treatment, lack of coronary seal in coronary restorations, occlusal trauma, radicular resorption of infectious or non-infectious nature, peripheral perforations within the endodontic treatment or dental malformations. The treatment and prognosis of endo-periodontal lesions varies depending on the etiology, pathogenesis and the correct recognition of each specific condition.

To improve the quality and effectiveness of medical care for patients with inflammatory periodontal diseases, it is necessary to search for new approaches in both diagnosis and treatment. The aim of our study is to determine the effect of the diode laser on the pathogenic microflora of periodontal pockets and root canals in patients with endo-periodontal lesions (EPL). We carried out a comparative assessment of the bacterial contents of the root canals and periodontal pockets by polymerase chain reaction (PCR) before and after treatment with a diode laser (Doctor Smile Simpler, wavelength 980 nm) for 54 patients with EPL. The control group consisted of 56 patients who were treated according to the generally accepted method, including professional oral hygiene, endodontic treatment, and curettage of periodontal pockets. Evaluation criteria were a qualitative assessment of the content of periodontopathogens in the root canal and periodontal pocket before and after and treatment. As a result of our study, we found a statistically significant (p

Objectives: There is little evidence about the effect of different treatment protocols for grade 3 endo-periodontal lesions without root damage in patients with periodontitis according to the new classification of periodontal disease. The aim of this study is to evaluate the impact of endodontic treatment on the achievement of periodontal healing. Materials and methods: Teeth with the initial diagnosis endo-periodontal lesion without root damage grade 3, treated with a standardized endodontic treatment protocol, were included in this study. A retrospective analysis was performed to assess the impact on periodontal healing by evaluating probing pocket depth (PPD), clinical attachment gain (CAL), and periapical index score (PAI). Results: Nineteen teeth and 13 patients were included. A mean reduction of 3.19 ± 3.41 mm in PPD was recorded. The mean CAL gain was 2.33± 3.75 mm. Five teeth (45.4%) showed an improvement of PAI and were classified as treatment success. Conclusions: The results failed to show a highly predictable treatment outcome for endo-periodontal lesion grade 3 without root damage in patients with periodontitis. However, endodontic therapy alone resulted in treatment success for some of the teeth, which would otherwise have had a poor prognosis. Clinical relevance: Endo-periodontal lesions can often be challenging for dentists in daily clinical practice. To date, there is not much evidence for practitioners to rely on. Therefore, this study aims to strengthen the evidence for the management and treatment of endo-periodontal lesions. Although the outcome is not highly predictable yet, teeth with the initial diagnosis endo-periodontal lesion without root damage grade 3 can benefit from an endodontic treatment. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To critically evaluate the existing literature on acute lesions occurring in the periodontium (periodontal abscesses [PA], necrotizing periodontal diseases [NPD], and endo‐periodontal lesions [EPL]) to determine the weight of evidence for the existence of specific clinical conditions that may be grouped together according to common features. The ultimate goal is to support an objective classification system. Importance: Although PA, NPD, and EPL occur with relatively low frequency, these lesions are of clinical relevance, because they require immediate management and might severely compromise the prognosis of the tooth. Findings: In general, the evidence available to define these three conditions was considered limited. PA and EPL are normally associated with deep periodontal pockets, bleeding on probing, suppuration, and almost invariably, with pain. EPL are also associated with endodontic pathology. NPDs have three typical features: pain, bleeding, and ulceration of the gingival interdental papilla. The available data suggested that the prognosis of PA and EPL are worse in periodontitis than in nonperiodontitis patients. Lesions associated with root damage, such as fractures and perforations, had the worst prognosis. NPD progression, extent and severity mainly depended on host‐related factors predisposing to these diseases. Conclusions: PA should be classified according to the etiological factors involved, with the most frequent being those occurring in pre‐existing periodontal pockets. NPD are clearly associated with the host immune response, which should be considered in the classification system for these lesions. EPLs should be classified according to signs and symptoms that have direct impact on their prognosis and treatment, such as presence or absence of fractures and perforations, and presence or absence of periodontitis. [ABSTRACT FROM AUTHOR]

Copyright of dentalTarget is the property of dentalTarget and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Didilescu AC, Rusu D, Anghel A, Nica L, Iliescu A, Greabu M, Bancescu G, Stratul SI. Investigation of six selected bacterial species in endo-periodontal lesions. International Endodontic Journal, 45, 282-293, 2012. Abstract Aim To investigate and determine possible associations of six tested bacteria belonging to 'orange' and 'green' complexes, in endo-periodontal lesions: Parvimonas micra, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens and Capnocytophaga sputigena. Methodology Forty-six patients presenting with different types of endo-periodontal lesions were investigated. Clinical examinations, periapical radiographs and microbiological sampling from the canal system (endo) and periodontal pockets (perio) were performed. Qualitative and semiquantitative evaluation of bacteria was performed by polymerase chain reaction (PCR) and DNA-DNA hybridization (micro-IDent plus; Hain Lifescience, Germany). Results Extremely high bacterial loads in endodontic samples were recorded for P. micra, F. nucleatum and C. sputigena, while periodontal samples were often colonized by the same species, plus C. rectus. Significant association was recorded between F. nucleatum-endo and P. micra-endo ( P = 0.03, Fisher's exact test). There was marginal evidence of associations between: (i) C. sputigena-endo and C. sputigena-perio ( P = 0.06, Fisher's exact test); (ii) P. micra-endo and P. micra-perio ( P = 0.05, Fisher's exact test). Sensitivity to percussion was associated with an increased chance of cases with P. micra-endo ( P = 0.03, Pearson chi-square test). Conclusion The findings suggest that F. nucleatum, P. micra and C. sputigena may play a role in the pathogenesis of endo-periodontal lesions. [ABSTRACT FROM AUTHOR]

The present study aimed to analyze local and regional changes in regards to odontogenic sinusitis in subjects with endo-periodontal lesions and diabetes mellitus and to investigate the effect on the level of glycemic control (glycated hemoglobin) that could be generated by adjunctive therapy with subantimicrobial doses of doxycycline. This study was performed on 51 subjects with diabetes who were divided into two therapeutic groups: 31 patients with diabetes (the study group) who underwent conventional endo-periodontal therapy and subantimicrobial doses of doxycycline and 20 patients with diabetes who followed only conventional endo-periodontal therapy (the control group). Patients underwent endodontic and periodontal clinical examination, with retro-dental-alveolar radiographs and CBCT examinations. For each patient, glycated hemoglobin A1c (HbA1c) was determined. This evaluation was performed at the beginning of the study, as well as 3, 6 and 12 months after baseline. A significant percentage of patients, both in the study group and in the control group, showed radiological signs of odontogenic sinusitis, totaling 29 patients (56.86%). Periodontal parameters revealed lower levels in patients who underwent the regimen which consisted of subantimicrobial doses of doxycycline; these results were maintained over the study period. Moreover, we demonstrated significantly reduced glycated hemoglobin levels throughout the study (12 months) in the doxycycline-treated group. This fact has far-reaching effects in the sphere of loco-regional complications as well, and the risk of odontogenic sinusitis can be significantly reduced. [ABSTRACT FROM AUTHOR]

Objective: To critically evaluate the existing literature on acute lesions occurring in the periodontium (periodontal abscesses [PA], necrotizing periodontal diseases [NPD], and endo-periodontal lesions [EPL]) to determine the weight of evidence for the existence of specific clinical conditions that may be grouped together according to common features. The ultimate goal is to support an objective classification system., Importance: Although PA, NPD, and EPL occur with relatively low frequency, these lesions are of clinical relevance, because they require immediate management and might severely compromise the prognosis of the tooth., Findings: In general, the evidence available to define these three conditions was considered limited. PA and EPL are normally associated with deep periodontal pockets, bleeding on probing, suppuration, and almost invariably, with pain. EPL are also associated with endodontic pathology. NPDs have three typical features: pain, bleeding, and ulceration of the gingival interdental papilla. The available data suggested that the prognosis of PA and EPL are worse in periodontitis than in nonperiodontitis patients. Lesions associated with root damage, such as fractures and perforations, had the worst prognosis. NPD progression, extent and severity mainly depended on host-related factors predisposing to these diseases., Conclusions: PA should be classified according to the etiological factors involved, with the most frequent being those occurring in pre-existing periodontal pockets. NPD are clearly associated with the host immune response, which should be considered in the classification system for these lesions. EPLs should be classified according to signs and symptoms that have direct impact on their prognosis and treatment, such as presence or absence of fractures and perforations, and presence or absence of periodontitis., (© 2018 American Academy of Periodontology and European Federation of Periodontology.)