Impact of systemic health on treatment outcomes in endodontics

Abstract

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.

Mesoporous Calcium-Silicate Nanoparticles Loaded with Prussian Blue Promotes Enterococcus Faecalis Ferroptosis-Like Death by Regulating Bacterial Redox Pathway ROS/GSH

“…2 Root canal therapy is internationally recognized as the first choice at present, but there is still a failure rate of 7% and 14%, secondary root canal treatment had an even lower success rate of 77%. [3][4][5] Enterococcus faecalis (E. faecalis) is the bacteria with the highest detection rate in the cases of failed root canal therapy, and it is also the most important pathogen in the progression of PAP, it has cytolysin, adhesive protein, gelatinase, lipoteichoic acid (LTA) and other virulence factors. 6,7 E. faecalis can form biofilm in the root canal wall, apical triangle, apical divergence and bifurcated root canal.…”

Reduced C‐reactive protein levels after root canal treatment in clinically healthy young apical periodontitis individuals at cardiovascular risk. A prospective study

“…In the present study, we demonstrate a significant reduction of hsCRP and mCRP at 1-and 6 months after RCT in AP individuals with baseline cardiovascular risk, showing a mechanistic link between AP and systemic inflammation. Apical periodontitis and cardiovascular diseases share common risk factors, such as genetic polymorphisms, smoking, and diabetes, increasing susceptibility to chronic inflammation (Segura-Egea et al, 2023). Previously, our research group reported that LGSI markers were significantly higher in AP individuals compared to healthy controls (Garrido et al, 2019).…”

Effects of N‐acetyl‐L‐cysteine against apical periodontitis in rats with adriamycin‐induced cardiomyopathy and nephropathy

“…Conversely, it has been suggested that diabetes, cardiovascular disease, inflammatory diseases, osteoporosis exacerbate AP and prevent or delay its healing. This cycle has been found to be linked to an increase in IL‐β and TNF‐α levels (Cintra et al., 2016, 2017; Segura‐Egea et al., 2023; Sehirli et al., 2019; Zhang et al., 2016). Besides, this accumulating evidence underscores the potential of AP to trigger a systemic immune response, affect distant organs, and influence the overall patient health.…”