Outcome of non‐surgical root canal treatment related to periodontitis and chronic disease medication among adults in age group of 60 years or more

A literature review of local and systemic considerations for endodontic treatments in older adults

OBJECTIVES

The aim of this literature review was to summarise the clinical important findings on the endodontic treatment outcome in older patients (≥60 years old) with pulpal/periapical disease considering local and systemic factors from a body of knowledge that is heterogeneous in methods or disciplines.

BACKGROUND

Due to the increasing number of older patients in the endodontic practice, and the current trend for tooth preservation, the need for clinicians to have a better understanding of age-related implications that may influence the required endodontic treatment in older adults to retain their natural dentition is indispensable.

METHODS

PubMed/Medline and Embase was searched by a medical librarian using specific terms based on inclusion/exclusion criteria. The reference list was hand-seached for additional relevant publications between 2005-2020. A combination of these terms was performed uing Boolean operators and MeSH terms.

RESULTS

Of the 1577 publications identified manually and electronically, 25 were included to be fully reviewed by the examiners. The data was derived from three systematic reviews, one systematic and meta-analysis, three case series, four prospective and 14 retrospective cohorts. Overall, there was heterogeneity in reporting as well as limitations in most studies.

CONCLUSIONS

The outcome of endodontic treatment (ET) either nonsurgical or surgical or combination of these is not affected by older age. ET can be the treatment of choice in older patients wiht pulpal/periapical disease. There is no evidence that older age per se affects the outcome of any type of endodontic treatment.

Endodontic Outcome of Root Canal Treatment Using Different Obturation Techniques: A Clinical Study

OBJECTIVE

To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables.

METHODS

This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected.

RESULTS

The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome.

CONCLUSIONS

The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.

Outcome of root canal treatment of teeth with chronic apical periodontitis treated with foraminal enlargement and 2% chlorhexidine gel: a retrospective cohort study

INTRODUCTION

This retrospective cohort study aimed to estimate the success rate (SR) of primary root canal treatment on teeth with a diagnosis of pulp necrosis (PN) and asymptomatic apical periodontitis (AAP) when using 2% chlorhexidine gel as an auxiliary chemical substance (ACS) and foraminal enlargement instrumentation technique.

METHODS

This study evaluated 178 patients with 206 teeth submitted to primary root canal treatment performed by graduate residents in endodontics. The inclusion criteria were patients who underwent treatment over a period of 1 to 7 years on teeth with a diagnosis of PN and AAP. The SR was evaluated clinically and radiographically and categorized considering strict' (complete resolution of periradicular lesion) or 'loose' (reduction in the size of existing periradicular lesion) criteria. Cases of clinical and/or radiographical absence of repair were classified as a failure. Two calibrated examiners independently assessed treatment outcomes using the ImageJ software.

RESULTS

The SR were 81.1% (95% CI: 75.7% - 86.4%) and 87.4% (95% CI: 82.8% - 91.9%) when considering the 'strict' or 'loose' criteria, respectively. Females had a higher SR when strict criteria were applied. Also, the SR was significantly reduced when there was an increase in the patient's age.

CONCLUSION

Within the limitations of this study, it was found that teeth with a diagnosis of PN and AAP and treated associating the use of 2% chlorhexidine gel and foraminal enlargement achieved substantial SR. Gender and age were prognostic factors that played a significant role in the SR. Future randomized controlled trials should further investigate the effects of foraminal enlargement and 2% chlorhexidine gel as an ACS.

Impact of systemic health on treatment outcomes in endodontics

BACKGROUND

The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth.

OBJECTIVE

To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved.

METHODS

The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models.

RESULTS

Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT.

DISCUSSION

Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region.

CONCLUSIONS

The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non-retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.

Comparison of dental pulp periodontal therapy and conventional simple periodontal therapy as treatment modalities for severe periodontitis

BACKGROUND

Severe periodontitis is a major oral health concern today as it can lead to loss of teeth. Conventional periodontal therapy has numerous pitfalls as it does not address the pulp-periodontal complex in its entirety.

AIM

To investigate the effect of dental pulp periodontal therapy on the levels of interleukin-1β (IL-1β) and IL-10 in gingival crevicular fluid (GCF) in patients with severe periodontitis.

METHODS

Eighty-six patients with severe periodontitis were randomly divided into a research group (n = 43) and a control group (n = 43). The control group was treated with simple periodontal therapy, and the research group was treated with dental pulp periodontal therapy. The total effective rates of the treatments; periodontal status before and after treatment through the measurement of the periodontal pocket probing depth (PPD), gingival sulcus bleeding index (SBI), mobility (MD), and plaque index (PLI); the levels of inflammatory factors IL-1β and IL-10 in the GCF; and the incidence of complications were calculated for both groups and compared using the Student’s t test and the χ² test.

RESULTS

The total effective rate of treatment in the study group (93.02%) was higher than that in the control group (76.74%; P < 0.05). While before treatment, there was no significant difference in the PLI, MD, SBI, or PPD between the two groups, the post-treatment values of PLI, MD, SBI, and PPD (4.71 ± 0.16 mm, 0.61 ± 0.09 mm, 0.96 ± 0.17 mm, and 0.76 ± 0.26 mm, respectively) were significantly lower (P < 0.05) in the research group than in the control group (5.35 ± 0.24 mm, 0.93 ± 0.15 mm, 1.35 ± 0.30 mm, and 1.04 ± 0.41 mm, respectively). There was no significant difference in the level of IL-1β or IL-10 in the GCF before treatment between the two groups; after treatment, the IL-1β level in the research group (139.04 ± 15.54 pg/mL) was significantly lower than that in the control group (156.35 ± 18.10 pg/mL), and the level of IL-10 in the research group (7.98 ± 1.01 ug/L) was higher than that in the control group (5.56 ± 0.96 ug/L) (P < 0.05). The incidence of complications in the study group (4.65%) was significantly lower than that of the control group (18.60%; P < 0.05).

CONCLUSION

Endodontic therapy and periodontal treatment for patients with severe periodontitis can effectively reduce the levels of inflammatory factors in the GCF and the inflammatory reaction. In addition, it can improve the periodontal condition and the overall treatment effect, reduce the risk of complications, and ensure the safety of treatment.