The impact of apical periodontitis, non-surgical root canal retreatment and periapical surgery on serum inflammatory biomarkers.

The aim of the study was to measure serum levels of molecular markers of inflammation in patients undergoing non-surgical root canal retreatment (Re-RCT) and periapical surgery (PS) for the treatment of apical periodontitis and to establish if such levels are influenced by the size of apical radiolucencies at baseline and by the treatment outcome. A total of 115 participants were recruited (n = 50 Controls, n = 35 Re-RCT, n = 30 PS). Preoperative periapical radiographs and cone beam CT (CBCT) scans of teeth were taken. Blood was collected from treatment groups at baseline, 3-, 6-, and 12-month post-treatment and from controls at baseline and 12 months. Serum levels of IL-1β, IL-6, IL-8, TNF-α, Pentraxin 3, ICAM-1, VCAM-1, hs-CRP, FGF-23, MMP-2, MMP-8, MMP-9, C3 and ADMA were analysed using multiplex immunoassay and enzyme-linked immunosorbent assay. Different time points within the same group were compared using Wilcoxon signed-rank test, and differences between groups were analysed using the Mann-Whitney test. Non-linear association between different factors was assessed using Spearman's correlation. Preoperative serum levels of FGF-23, IL-1β, hs-CRP and ADMA were significantly higher in the diseased groups compared with controls (p < .001; p = .008; p < .001; p = .013, respectively). The preoperative size of the radiolucency was associated with increased levels of FGF-23, IL-1β and IL-6. At 3-months following treatment, IL-1β, IL-8, hs-CRP, C3, MMP-2 and MMP-9 levels increased compared with baseline in treatment groups. IL-1β and IL-8 further increased at 6 months, whereas FGF-23, hs-CRP, C3, MMP2 and MMP-9 decreased. One-year post-treatment, FGF-23, pentraxin-3 and ADMA were significantly reduced below baseline levels. At the 1-year review, CBCT revealed that 25.9% of treated cases completely healed, while 63% were healing, and 11.1% failed. Treatment outcome was found to be influenced by preoperative levels of ADMA and IL-8 levels at 6 months. Both symptomatic and asymptomatic apical periodontitis (AP) can contribute to increased levels of molecular markers of inflammation. A further transient inflammatory markers rise after root canal retreatment and apical surgery were demonstrated. Successful endodontic treatment and periapical surgery result in a long-term reduction in inflammatory marker levels.

Bakhsh A ，Moyes D ，Proctor G ，Mannocci F ，Niazi SA ... -  《-》

Successful endodontic treatment reduces serum levels of cardiovascular disease risk biomarkers-high-sensitivity C-reactive protein, asymmetric dimethylarginine, and matrix metalloprotease-2.

To investigate serum biomarkers of inflammation 2 years following non-surgical root canal re-treatment (Re-RCT) and peri-apical surgery (PS). The results were correlated with signs and symptoms, treatment outcome, metabolic syndrome factors, infection with severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 (COVID-19) infection and COVID-19 vaccination. Subjects from our previous study were recalled for 2 years post-treatment follow-up. Changes to the patient's history (medical, dental, social) were noted. Periapical health of the treated teeth was examined both clinically and radiographically. Blood pressure, fasting HbA1C and low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides and total cholesterol (TC) levels were measured. Serum inflammatory marker levels were assayed using a Bio-Rad Bio-Plex 200 analyser and values at different time points within the same group were compared using a Wilcoxon signed-rank test and differences between groups with a Mann-Whitney test. Linear associations were tested using Pearson's correlations. The recall percentage at 2 years was 56.9% (n = 37), with a 100% radiographic success rate using periapical radiographs. In total, 21 cases (56.8%) were completely healed, and 16 cases (43.2%) were healing. Higher matrix metalloprotease 2 (MMP2) levels were present in the healing group compared to the healed group. Serum levels of high-sensitivity C-reactive protein (hs-CRP), asymmetric dimethylarginine (ADMA) and MMP-2 were significantly reduced (p ≤ .001) whereas other biomarkers showed significant increases at 2 year compared to pre-operative levels, while FGF-23 and ICAM-1 were not significantly increased. HbA1C (p = .015), TC (p = .003), LDL (p = .003) and HDL (p = .003) reduced significantly at 2 years post-treatment compared to their preoperative levels. COVID infection showed a significant association with MMP-9 (p = .048). hs-CRP, ADMA and MMP-2 can be regarded as prognostic biomarkers of successful Re-RCT and PS as they reduced at 2 year recall in cases which showed evidence of clinical and radiographic success. The successful treatment of chronic apical periodontitis is correlated with improvements in metabolic syndrome indicators, better glycemic control, and reduction at 2 year of some systemic inflammatory markers which are related to risks of cardiovascular disease events.

Al-Abdulla N ，Bakhsh A ，Mannocci F ，Proctor G ，Moyes D ，Niazi SA ... -  《-》

Endodontic procedures for retreatment of periapical lesions.

Del Fabbro M ，Corbella S ，Sequeira-Byron P ，Tsesis I ，Rosen E ，Lolato A ，Taschieri S ... -  《-》

Four-year Outcome of Nonsurgical Root Canal Retreatment Using Cone-beam Computed Tomography: A Prospective Cohort Study.

The purpose of this prospective study was to investigate the 4-year outcome and prognostic factors of nonsurgical root canal retreatment determined by measuring the volumetric change of periapical radiolucencies on cone-beam computed tomographic (CBCT) scans. Ninety-seven endodontically treated teeth from 80 patients diagnosed as apical periodontitis and indicated for root canal retreatment were included. Retreatment was performed by 7 endodontic specialists using a standardized treatment protocol. The teeth were reexamined clinically and radiographically 48-67 months after retreatment. The volume of preoperative and postoperative periapical radiolucencies on CBCT images was independently measured by 2 examiners. Radiographic outcome is presented in 4 categories: absence, reduction, enlargement, or unchanged. Reduction or enlargement was determined when the volumetric change of radiolucency was 20% or more. Multivariate logistic regression was performed for predictor analysis. Sixty-two teeth (63.9%) from 50 patients returned for follow-up. Fifty-eight teeth were included in the prognostic analysis, all of which were symptom free. The 4 remaining teeth that had been extracted because of fracture were excluded. The total volume of periapical radiolucencies at 4 years postoperatively decreased by 94.6% compared with that preoperatively (P < .001), with an average reduction of 83.4% (95% confidence interval, 69.2%-97.5%). The periapical radiolucencies were determined as absence in 44 teeth (75.9%), reduction in 10 teeth (17.2%), unchanged in 1 tooth (1.7%), and enlargement in 3 teeth (5.2%). Tooth type was identified as an outcome predictor (P < .05). The 4-year outcome of endodontic retreatment is predictable, with a significant volumetric reduction in periapical radiolucencies.

Zhang MM ，Fang GF ，Chen XT ，Liang YH ... -  《-》

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

Garrido M ，Bordagaray MJ ，Schweitzer C ，Lucero-Mora J ，Reyes M ，Pellegrini E ，Hernández-Ríos P ，Fernández A ，Hernández M ... -  《-》