Endodontic procedures for retreatment of periapical lesions.
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ABSTRACT:
SUBMITTER: Del Fabbro M
PROVIDER: S-EPMC6461161 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Apical periodontitis is an inflammatory disease of the periradicular tissues caused by the host's immune response to infection of the root canal system. MicroRNAs (miRNAs) have been shown to play an important role in the regulation of inflammation and the immune response; however, their role in the pathogenesis of endodontic periapical disease has not been explored. The purpose of this study was to examine the differential expression of miRNAs in diseased periapical tissues as compared with healthy controls.We first compared miRNA profiles in diseased periapical tissues collected from patients undergoing endodontic surgery with those of healthy pulps by using microarray analyses. The target genes of the differentially expressed miRNAs were identified by using miRWalk and PubMed. Selected miRNAs linked to inflammation and the immune response were then confirmed in a separate cohort of diseased and healthy tissues by using quantitative reverse transcription-polymerase chain reaction. Healthy pulps and periodontal ligaments were used as controls. Data were normalized to the level of SNORD 44, which served as an endogenous control.Of the 381 miRNAs identified by using microarray, 24 miRNAs were down-regulated in diseased periapical tissues compared with controls (n = 13) (P < .003). The down-regulation of 7 miRNAs was confirmed from 9 selected miRNAs by using quantitative real-time polymerase chain reaction (n = 19) (P < .05). Target genes of these miRNAs include key mediators in the immune and inflammatory response such as interleukin-6, matrix metalloproteinase-9, and transforming growth factor-?.These findings offer new insight into the pathogenesis of endodontic disease and have the potential to impact the development of new methods for prevention, diagnosis, and treatment of apical periodontitis.
| S-EPMC4028822 | biostudies-literature
Project description:Introduction: Pharmacotherapy with analgesics and non-steroidal anti-inflammatory drugs has been traditionally used to relief post-operative pain of endodontic treatments. However, due to the side effects reported for these drugs, some efforts have been made to decrease the post-operative pain of the endodontic treatments through laser irradiation. The present study aimed to evaluate the effects of low level laser therapy (LLLT) on the reduction of pain after root canal retreatment. Methods: In this clinical trial, 61 patients requiring endodontic retreatments in posterior teeth were selected. A single visit endodontic retreatment was performed. After biomechanical preparation, low level laser was irradiated to the buccal and lingual mucosa overlying the apices of the target tooth in the experimental group. In the control group patients received placebo laser to eliminate the probable psychological effects of laser. Laser irradiation was done with a single dose of 808 nm wavelength (Whitening Lase II- Laser DMC, Samsung, Korea) with 100 mW power, and dose of 70 J/cm2 for 80 seconds. Pain severity was recorded before, immediately after and 4, 8, 12, 24 and 48 hours after the treatment by visual analogue scale (VAS). The pain scores were statistically analyzed by chi-square test between 2 groups. The effects of different variables on the post-operative pain experience were also studied by means of Logistic regression. Results: Pain scores decreased significantly through time until 48 hours after treatment. No significant differences were observed between the 2 modalities regarding pain scores at any time. According to regression analysis, pain severity scores were lower in the laser-irradiated specimens than control groups (OR = 5.69); however, this difference was not statistically significant. Consumption of analgesics after the treatment had significant effect in decreasing post-operative pain experience (OR = 56) while factors of age, gender, laser irradiation, pre-treatment pain scores and education level did not. Conclusion: Low level laser irradiation had limited effects to decrease pain associated with the endodontic retreatments in the first and second molars; however, more studies are required to assess the effects of different parameters of low level laser in this regard.
| S-EPMC5662501 | biostudies-literature
Project description:The Regenerative Endodontic Procedure (REP) is a biologically based method in which a damaged pulp-dentin complex is replaced by a new vital tissue. This umbrella review aimed to critically assess the available systematic reviews (SRs) on REP. An electronic database search was conducted (PubMed-Medline, CENTRAL, Scielo, Web of Science, and LILACS) until December 2020. Studies were included if they were an SR on REP. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). The primary outcome was the methodological quality in each specific section of REP protocols and outcomes. From 403 entries, 29 SRs were included. Regarding the methodological quality, ten studies were of critically low, three of low, fourteen of moderate, and two were rated as high quality. The quality of evidence produced by the available SRs was not favorable. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of REP.
| S-EPMC7830213 | biostudies-literature
Project description:Periapical periodontitis results from pulpal infection leading to pulpal necrosis and resorption of periapical bone. The current treatment is root canal therapy, which attempts to eliminate infection and necrotic tissue. But, in some cases periapical inflammation doesn't resolve even after treatment. Resolvins belongs to a large family of specialized pro-resolving lipid mediators that actively resolves inflammation signaling via specific receptors. Resolvin D2 (RvD2), a metabolite of docosahexaenoic acid (DHA), was tested as an intracanal medicament in rats in vivo. Mechanism was evaluated in rat primary dental pulp cells (DPCs) in vitro. The results demonstrate that RvD2 reduces inflammatory cell infiltrate, periapical lesion size, and fosters pulp like tissue regeneration and healing of periapical lesion. RvD2 enhanced expression of its receptor, GPR18, dentin matrix acidic phosphoprotein 1 (DMP1) and mineralization in vivo and in vitro. Moreover, RvD2 induces phosphorylation of Stat3 transcription factor in dental pulp cells. We conclude that intracanal treatment with RvD2 resolves inflammation and promoting calcification around root apex and healing of periapical bone lesions. The data suggest that RvD2 induces active resolution of inflammation with pulp-like tissue regeneration after root canal infection and thus maybe suitable for treating periapical lesions.
| S-EPMC6399419 | biostudies-literature
Project description:Background: Many challenges encounter the endodontist, especially when dealing with necrotic teeth with chronic periapical lesions. Postoperative pain may be induced following conventional endodontic therapy and total eradication of the bacteria is almost unachievable even with recently available techniques. In recent years, diode laser usage in the endodontic field has gained acceptance. Thus, this study aimed to investigate the ability of the diode laser (DL) to decrease postoperative pain and achieve root canal sterility. Methods: 56 patients with anterior teeth with chronic periapical lesions in upper anterior teeth were randomly divided into two groups (n = 28). All patients were treated with two visits of conventional root canal treatment with ProTaper Universal. The DL group: root canals were irradiated with 200 µm fiber optic at both visits; the control group (Endo): the DL fiber was placed in root canal with no activation. Bacterial samples were collected from all the cases at each step of the treatment. Pain levels were evaluated using a numerical rating scale preoperatively, and after 6, 12, 24, 48 hours and 7 days. Bacterial count was used to detect both aerobic and anaerobic bacterial load. Results: The qualitative pain scores revealed statistically significant lower pain levels in the DL group compared with the Endo group at all time intervals (P<0.001), except preoperatively where there was no significant difference. There was a statistically significant lower bacterial count for both aerobic and anaerobic bacteria in the DL group compared with the Endo group in both S3 samples (after laser application) and S4 samples (bacterial colonization) (P<0.001). Conclusion: The 980 nm diode laser may be a successful adjunct to conventional endodontic treatment of necrotic cases with chronic periapical lesions in terms of postoperative pain and root canal disinfection. Trail registration: PACTR201511001275414 (date: 23 rd September 2015).
| S-EPMC6659763 | biostudies-literature
Project description:Dental caries, one of the most prevalent infectious diseases worldwide, affects approximately 80% of children and the majority of adults. Dental caries may result in endodontic disease, leading to dental pulp necrosis, periapical inflammation and bone resorption, severe pain, and tooth loss. Periapical inflammation may also increase inflammation in other parts of the body. Although many studies have attempted to develop therapies for this disease, there is still an urgent need for effective treatments. In this study, we applied a novel gene therapeutic approach using recombinant adeno-associated virus (AAV)-mediated RNAi knockdown of Cathepsin K (Ctsk) gene expression, to target osteoclasts and periapical bone resorption in a mouse model. We found that AAV-sh-Cathepsin K (AAV-sh-Ctsk) impaired osteoclast function in vivo and furthermore reduced bacterial infection-stimulated bone resorption by 88%. Reduced periapical lesion size was accompanied by decreases in mononuclear leukocyte infiltration and inflammatory cytokine expression. Our study shows that AAV-RNAi silencing of Cathepsin K in periapical tissues can significantly reduce endodontic disease development, bone destruction, and inflammation in the periapical lesion. This is the first demonstration that AAV-mediated RNAi knockdown gene therapy may significantly reduce the severity of endodontic disease.
| S-EPMC3545691 | biostudies-literature
Project description:INTRODUCTION:The aim of this study was to compare the antibacterial efficacy of diode laser 810nm and photodynamic therapy (PDT) in reducing bacterial microflora in endodontic retreatment of teeth with periradicular lesion. METHODS:In this in vivo clinical trial, 20 patients who needed endodontic retreatment were selected. After conventional chemo mechanical preparation of root canals, microbiological samples were taken with sterile paper point (PP), held in thioglycollate broth, and then were transferred to the microbiological lab. In the first group, PDT with methylene blue (MB) and diode laser (810 nm, 0.2 W, 40 seconds) was performed and in the second group diode laser (810 nm, 1.2 W, 30 seconds) was irradiated. Then second samples were taken from all canals. RESULTS:CFU/ml amounts showed statistically significant reduction in both groups (P < 0.001). CFU/ml amounts were compared between the two groups and there was no statistical difference. CONCLUSION:PDT and diode laser 810 nm irradiation are effective methods for root canal disinfection. PDT is a suitable alternative for diode laser 810 nm irradiation, because of lower thermal risk on root dentin.
| S-EPMC4909011 | biostudies-literature
Project description:It has been proposed that individual genetic predisposition may contribute to a persistent apical periodontitis condition. Matrix metalloproteinases (MMPs) are associated with levels of inflammation and are involved in caries, pulpal, and periapical tissue destruction. MMPs also play a major role in bone resorption. In this study, we hypothesized that polymorphisms in MMP genes and their regulators may contribute to an individual's increased susceptibility to apical tissue destruction in response to deep carious lesions.Sixteen hundred radiographic records obtained through the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository were screened for subjects with deep carious lesions in dentin with or without periapical lesions (? 3 mm). DNA samples of 268 patients were sorted into 2 groups: 158 cases with deep carious lesions but no periapical lesions (controls) and 110 cases with periapical lesions and deep carious lesions (cases). Sixteen SNP markers in MMP2, MMP3, MMP9, MMP13, MMP14, and TIMP2, were selected for genotyping. Genotypes were generated by endpoint analysis in a real-time polymerase chain reaction instrument. Analyses were performed comparing cases and controls. Allele and genotypic frequencies and haplotype analysis were calculated using the PLINK program.An association was found for MMP3 rs639752 (P = .03) and rs679620 (P = .004) genotypes in individuals with periapical lesions. We also observed altered transmission of MMP2 marker haplotypes (P = .000004) in these individuals.Variations in MMP2 and MMP3 are associated with periapical lesion formation in individuals with untreated deep carious lesions. Future studies could help predict host susceptibility to developing periapical lesions.
| S-EPMC3331995 | biostudies-literature
Project description:INTRODUCTION/BACKGROUND:The choice between endoscopic injection (EI) and ureteroneocystotomy (UNC) for surgical correction of vesicoureteral reflux (VUR) is controversial. OBJECTIVE:To compare postoperative outcomes of EI vs UNC. STUDY DESIGN:This study reviewed linked inpatient (SID), ambulatory surgery (SASD), and emergency department (SEDD) data from five states in the United States (2007-10) to identify pediatric patients with primary VUR undergoing EI or UNC as an initial surgical intervention. Unplanned readmissions, additional procedures, and emergency room (ER) visits were extracted. Statistical analysis was performed using multivariate logistic regression using generalized estimating equation (GEE) to adjust for hospital-level clustering. RESULTS:The study identified 2556 UNC and 1997 EI procedures. Compared with patients undergoing EI, those who underwent UNC were more likely to be younger (4.6 vs 6.0 years, P < 0.001), male (30 vs 20%, P < 0.001), and publicly insured (34 vs 29%, P < 0.001). As shown in Summary Figure, compared with EI, UNC patients had lower rates of additional anti-reflux procedures within 12 months (25 (1.0) vs 121 (6.1%), P < 0.001), but a higher rate of 30-day and 90-day readmissions and ER visits. On multivariate analysis, patients treated by UNC remained at higher odds of being readmitted (OR = 4.45; 2.69 in 30 days; 90 days, P < 0.001) and to have postoperative ER visits (OR = 3.33; 2.26 in 30 days; 90 days, P < 0.001); however, EI had significantly higher odds of repeat anti-reflux procedures in the subsequent year (OR = 7.12, P < 0.001). DISCUSSIONS:Endoscopic injection constituted nearly half of initial anti-reflux procedures in children. However, patients treated with UNC had significantly lower odds of requiring re-treatment in the first year relative to those treated with EI. By contrast, patients treated with UNC had more than twice the odds of being readmitted or visiting an ER postoperatively. Although the available data were amongst the largest and most well validated, the major limitation was the retrospective nature of the administrative database. The practice setting may not be generalizable to states not included in the analysis. CONCLUSIONS:Postoperative readmissions and ER visits were uncommon after any surgical intervention for VUR, but were more common among children undergoing UNC. The EI patients had a more than seven-fold increased risk of surgical re-treatment within 1 year.
| S-EPMC5632086 | biostudies-literature
Project description:IntroductionThis study was conducted to evaluate the microbiomes of endodontic-periodontal lesions before and after chemomechanical preparation (CMP).MethodsClinical samples were taken from 15 root canals (RCs) with necrotic pulp tissues and from their associated periodontal pockets (PPs) (n = 15) of teeth with endodontic-periodontal lesions before and after CMP. The Human Oral Microbe Identification using Next Generation Sequencing (NGS) protocol and viable culture were used to analyze samples from RCs and PPs. The Mann-Whitney U test and Benjamini-Hochberg corrections were performed to correlate the clinical and radiographic findings with microbial findings (P < .05).ResultsBacteria were detected in 100% of the samples in both sites (15/15) using NGS. Firmicutes was the most predominant phylum in both sites using both methods. The most frequently detected species in the RCs before and after CMP using NGS were Enterococcus faecalis, Parvimonas micra, Mogibacterium timidum, Filifactor alocis, and Fretibacterium fastidiosum. The species most frequently detected in the PPs before and after CMP using NGS were P. micra, E. faecalis, Streptococcus constellatus, Eubacterium brachy, Tannerella forsythia, and F. alocis. Associations were found between periapical lesions ≤ 2 mm and Desulfobulbus sp oral taxon 041 and with periodontal pockets ≥ 6 mm and Dialister invisius and Peptostreptococcus stomatis (all P < .05, found in the RCs before CMP).ConclusionsIt is concluded that the microbial community present in combined endodontic-periodontal lesions is complex and more diverse than previously reported. It is important to note that bacteria do survive in some root canals after CMP. Finally, the similarity between the microbiota of both sites, before and after CMP, suggests there may be a pathway of infection between the pulp and periodontium.
| S-EPMC7061340 | biostudies-literature