Influence of Diabetes in the Development of Apical Periodontitis: A Critical Literature Review of Human Studies

Aim To investigate the impact of systemic health and tooth‐based factors on the outcome of root canal treatment (RCT). Methodology The target population consisted of all patients receiving RCT at the Helsinki University Clinic in 2008–2011. The inclusion criteria were diagnosable pre‐ and postoperative (minimum 6 months after root filling) radiographs and adequate patient records of RCT available. Teeth extracted for nonendodontic reasons were excluded. Patient documents including digital radiographs of 640 permanent teeth in 504 patients were scrutinized. The radiographs were assessed by two examiners under standardized conditions. The Periapical Index was used to define radiographically ‘healthy’ and ‘healing’ cases as successful. Data included systemic health, technical quality of root fillings, type of restoration and level of alveolar bone loss. Statistical evaluation of differences between groups included chi‐squared tests and Fisher's exact tests. Logistic regression modelling utilizing robust standard errors to allow for clustering within patients was applied to analyse factors related to the outcome of RCT. Results The mean age of patients was 51.5 years (standard deviation (SD) 15.0; range 10–83), and 49% were female. In 41 cases (6%), the patient had diabetes mellitus (DM), in 132 (21%) cardiovascular disease and in 284 (44%) no systemic disease. The follow‐up period was 6–71 months (mean 22.7). In the primary analyses, the success rate of RCT was 73.2% in DM patients and 85.6% in patients with no systemic disease (P = 0.043); other systemic diseases had no impact on success. In the multifactorial analysis, the impact of DM became nonsignificant and RCTs were more likely to succeed in the absence of apical periodontitis (AP; odds ratio (OR) = 4.4; P < 0.001), in teeth with optimal root filling quality (OR = 2.5; P < 0.001), in teeth restored with indirect restorations (OR = 3.7; P = 0.002) and in teeth with none/mild alveolar bone loss (OR = 2.4; P = 0.003). Conclusions DM diminished the success of RCT, especially in teeth with apical periodontitis. However, tooth‐based factors had a more profound impact on the outcome of RCT. This should be considered in clinical decision‐making and in assessment of RCT prognosis.

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“…, , Tibúrcio‐Machado et al . ), although there are some contradictory findings (Sánchez‐Domínguez et al . ).…”

Section: Introductionmentioning

confidence: 99%

Impact of systemic diseases and tooth‐based factors on outcome of root canal treatment

2019

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“…Finally, four systematic reviews were included (Segura‐Egea et al , Aminoshariae et al , Tibúrcio‐Machado et al . , Cabanillas‐Balsera et al ).…”

Section: Resultsmentioning

confidence: 98%

“…The systematic review by Tibúrcio‐Machado et al . () used the STROBE statement for observational studies and basic principles of research for clinical studies.…”

Section: Resultsmentioning

confidence: 99%

“…A meta‐analysis was not performed in two reviews (Aminoshariae et al , Tibúrcio‐Machado et al . ); therefore, two items in the AMSTAR checklist (‘Methods used to combine findings of studies appropriate’ and publication bias) were not applicable and were scored ‘0’. The intra‐ and inter‐examiner reliability scores (VK and SP) for scoring the AMSTAR items of the included studies were 1 and 0.95 ( P < 0.05), respectively, and equate to ‘almost perfect’ agreement.…”

Section: Resultsmentioning

confidence: 99%

“…A total of four systematic reviews were included that addressed the following outcomes: association between diabetes and endodontic outcome (Aminoshariae et al ); apical periodontitis of endodontic origin (Tibúrcio‐Machado et al . ); diabetes and the presence of radiolucent periapical lesions in root filled teeth (Segura‐Egea et al ); and occurrence of extracted root filled teeth (Cabanillas‐Balsera et al ). …”

Section: Discussionmentioning

confidence: 99%

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Association between diabetes and the outcome of root canal treatment in adults: an umbrella review

et al. 2019

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Background Diabetes mellitus is the most common metabolic disorder amongst dental patients. The association between the diabetes and the outcome of root canal treatment is unclear. Aim To conduct an umbrella review to determine whether there is an association between diabetes and the outcome of root canal treatment. Data source The protocol of the review was developed and registered in the PROSPERO database (CRD42019141684). Four electronic databases (PubMed, EBSCHOhost, Cochrane and Scopus databases) were used to perform a literature search until July 2019. Study eligibility criteria, participants and interventions Systematic reviews with or without meta‐analyses published in English assessing any outcomes of root canal treatment comparing diabetic and nondiabetic patients were included. Two reviewers were involved independently in study selection, data extraction and appraising the reviews that were included. Disagreements were resolved with the help of a third reviewer. Study appraisal and synthesis methods The quality of the reviews was assessed using the AMSTAR tool (A measurement tool to assess systematic reviews), with 11 items. Each AMSTAR item was given a score of 1 if the criterion was met, or 0 if the criterion was not met or the information was unclear. Results Four systematic reviews were included. The AMSTAR score for the reviews ranged from 5 to 7, out of a maximum score of 11, and all the systematic reviews were classified as ‘medium’ quality. Limitations Only two systematic reviews included a meta‐analysis. Only systematic reviews published in English were included. Conclusions and implications of key findings Diabetes mellitus is associated with the outcome of root canal treatment and can be considered as a preoperative prognostic factor.

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Endodontic Treatment of Apical Periodontitis

Ørstavik¹

2019

Essential Endodontology

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Influence of Diabetes in the Development of Apical Periodontitis: A Critical Literature Review of Human Studies

Cited by 22 publications

References 32 publications

Impact of systemic diseases and tooth‐based factors on outcome of root canal treatment

Impact of systemic diseases and tooth‐based factors on outcome of root canal treatment

Association between diabetes and the outcome of root canal treatment in adults: an umbrella review

Endodontic Treatment of Apical Periodontitis

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