Endodontics has gained emphasis in the scientific community in recent years due to the increase in clinical and in animal models studies focused on endodontic medicine, which aims to evaluate the interrelationship between systemic and periapical tissues pathological conditions. These studies have shown that systemic changes can boost the pathogenesis of endodontic infection, favoring its development and progression. A contrary relationship is reported in numerous studies that affirm the potential of endodontic infection to trigger systemic damage and may lead to the worsening of pre-existing pathologies. Recently, the potential of filling materials to develop systemic changes such as neurological alterations had been evaluated, also showing that systemic diseases can negatively influence tissue responses to filling materials after endodontic treatment. Despite advances in endodontic medicine studies, there are still gaps in knowledge on the mechanisms of interactions between apical periodontitis (AP) and systemic diseases and much research to be done. In this sense, this critical narrative literature review aimed to show the evolution of studies in endodontic medicine to help the endodontist to know the role of systemic diseases in the pathogenesis of AP and the possible interference in the repair of periapical tissues after endodontic treatment, as well as to evidence the systemic complications that can be triggered or aggravated in the presence of endodontic infection.

Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have been reported to exert important roles in the inflammatory response (Vardar et al., 2004). The major ω-3 PUFAs are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both being able of competitively inhibiting the production of arachidonic acid metabolites via the cyclooxygenase and lipoxygenase pathways, thus reducing the pro-inflammatory arachidonic mediators (Calder, 2006). DHA has demonstrated anti-inflammatory effects by interference with interleukin-1 signaling pathways leading to cyclooxygenase-2 induction in endothelial cells (Massaro et al., 2006). In addition, EPA lowers the level of arachidonic acid available for metabolism and competes against arachidonic acid for metabolism to form metabolites of leukotrienes and prostaglandins, decreasing the inflammatory response (Mukaro et al., 2008).As a consequence of possessing anti-inflammatory properties, ω-3 PUFAs has been accepted as an adjunct therapy in the treatment

Aim Natural substances such as omega‐3 have been used in the medical field due to their numerous properties and, in particular, modulating effect on the systemic and local inflammatory processes. Thus, this study evaluated the influence of omega‐3 supplementation on the subcutaneous tissue response of endodontic sealers in Wistar Rats. Methodology Polyethylene tubes were implanted in the subcutaneous tissue of 48 animals (one empty for control and three filled with Sealapex, AH Plus or Endofill). The animals were treated with omega‐3 (TO) or water (TW). Treatments started 15 days before implantation until euthanasia. After 5, 15 and 30 days (n = 8), animals were euthanized and polyethylene tubes and surrounding tissue were removed and processed for histological analysis. The inflammatory reaction was analysed by Haematoxylin and Eosin stain and immunolabelling for IL‐6 and TNF‐α. The collagen maturity was analysed by picrosirius red stain and calcium deposition by von Kossa stain and polarized light. Results were statistically analysed (p < .05). Results Amongst TW sealer groups, Endofill evoked a more intense inflammatory infiltrate compared with AH Plus and control in the 30‐day period (p = .009). However, in TO sealer groups, there was no difference amongst the sealers and control in all periods (p > .05). Comparing each sealer as a function of the supplementation with water or omega‐3, there are differences for Endofill (p = .001) and Sealapex (p = .005) in the 30‐day period, presenting lower inflammatory infiltrate in the animals treated with omega‐3. A higher percentage of immature fibres was observed at 15 and 30 days in the TO group, compared with the TW group (p < .05). The deposition of calcium particles was observed only by Sealapex in all periods, despite the supplementation procedure. Conclusions Omega‐3 supplementation influence the tissue reactions of endodontic sealers, modulating inflammation, the immunolabelling of IL‐6 and TNF‐α, the repair process and it does not interfere with calcium deposition.

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Fundamento: O tratamento endodôntico tem como principal objetivo eliminar os microrganismos e seus produtos tóxicos, permitindo o reestabelecimento das defesas do organismo e consequentemente, o reparo dos tecidos periapicais. No entanto, inúmeros fatores podem afetar o reparo periapical, como os materiais obturadores empregados, a presença de microrganismos, fatores sistêmicos e mais recente, as infecções virais têm sido associadas ao agravamento das lesões periapicais. Objetivo: Discutir a relação das principais infecções virais com as manifestações da periodontite apical e como estas infecções podem influenciar no reparo dos tecidos periapicais. Conclusão: A literatura não estabelece uma relação causa-efeito entre a presença de vírus nos tecidos periapicais e o aumento da patogenicidade da periodontite apical. No entanto, mais estudos devem ser realizados para afirmar o potencial viral nos tecidos periapicais, uma vez que a literatura mostra uma resposta imunológica na periodontite apical desencadeada por vírus na fase lítica, semelhante a observada a outros patógenos, sendo capaz de exacerbar a resposta inflamatória, aumentar a reabsorção óssea e ainda interferir no reparo dos tecidos periapicais.