Causes of post treatment apical periodontitis

Endodontic treatment approaches aim to achieve proper treatment and prevention of apical periodontitis to enhance the oral health status and enhance the prognosis of affected teeth. However, many complications can develop secondary to endodontic treatment. The management of post-treatment apical periodontitis might be challenging to clinicians, and the prognosis is usually lower than that of primary apical periodontitis. Therefore, identifying the potential etiology and intervening against them might be ideal for these cases. The present literature review discusses the commonest causes reported in the literature to predispose to the development of post-treatment apical periodontitis. Most of the various investigations in the literature indicate that post-treatment apical periodontitis is usually caused by either extraradicular or intraradicular infections, like primary apical periodontitis. However, it should be noted that some studies also reported that technical or procedural errors might predispose to the pathogenesis of the condition. However, it has been reported that the presence of associated bacterial infection conditions this.

THE EFFECT OF DIFFERENT COMBINATIONS OF CALCIUM HYDROXIDE FOR MANAGEMENT OF POST-OPERATIVE PAIN IN ACUTE APICAL PERIODONTITIS

Objective: To find the effect of different combinations of Calcium Hydroxide for the management of post-operative pain in acute apical periodontitis. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Operative Dentistry Armed Forces Institute of Dentistry, Rawalpindi. from Jun to Nov 2019. Methodology: A total of 282 patients presenting with acute apical periodontitis in their mandibular posterior teeth were selected for this study and were randomly divided into three equal groups with the help of scientific random number table. Group-A patients were given intracanal dressing of Calcium Hydroxide mixed with Chlorhexidine, group-B patients were given intracanal dressing of Calcium Hydroxide mixed with Saline and group-C patients were given intracanal dressing of Calcium Hydroxide mixed with Dexamethasone. Endodontic therapy was initiated after application of rubber dam, following pulpectomy and disinfection with frequent irrigation, canals were prepared and intra-canal dressings were placed according to the allotted group and the cavity was restored till the next appointment. Post-operative pain was recorded at 24 hours, 48 hours and one week using the visual analogue scale. Results: The three intra-canal combinations of Calcium Hydroxide used in the study were found to be equally effective in reducing pain. Overall, the result between the three groups after 24 hours proved to be insignificant (p=0.40), after 48 hours (p=0.84) and 1 week (p=0.45) were also insignificant. Conclusion: Calcium Hydroxide mixed with Saline, Chlorhexidine and Dexamethasone are all effective for pain reduction with dexamethasone being the most effective.

Radiographic Detection of the Relationship Between Tonsilloliths and Dental Plaque-Related Pathologies in a Series of Digital Panoramic Radiographs

Objective: The purpose of this study was to analyse the prevalence of tonsilloliths and to determine radiographically whether there is a relationship between tonsilloliths and dental plaque-related pathologies in a series of digital panoramic radiographs. Materials and Methods: This retrospective study included digital panoramic radiographs of 859 patients admitted for a routine dental examination. The panoramic images were examined for both the presence of tonsilloliths and the number of decayed, missing, restored tooth and apical periodontitis. Periodontal bone loss was also measured in thirds of optimal bone height according to the root length and finally a percentage of bone loss was obtained for each panoramic radiograph evaluated. Results: Tonsilloliths were observed in 141 (16.4%) of all individuals. While there was no significant difference regarding the number of decayed teeth and restored teeth between tonsillolith cases (TT) and cases without tonsillolith (TC), the number of missing teeth and apical periodontitis in TT was significantly higher than TC (p: 0.004, p: 0.030, respectively). There was a significant difference between the groups in terms of the mean percentage of bone loss (p: 0.001; p< 0.05). In addition, cases showing bone loss between one-third and two-thirds of the optimal bone height in the TT group (52.5%) were significantly higher than those in TC (45.5%) (p: 0.035; p< 0.05). Conclusion: The relationship between dental plaque-related pathologies and tonsilloliths, observed in this retrospective study, should be confirmed by Computed Tomography studies and randomized, prospective, clinical trials conducted in a multidisciplinary manner.

Efektifitas quad-helix dalam perawatan defisiensi transversal maksila pada anakEffectiveness of quad-helix for transverse maxillary deficiency treatment in children

Pendahuluan: Periodontitis apikalis adalah peradangan dan kerusakan jaringan pada daerah apikal jaringan periodonsium. Terjadi akibat pulpa nekrosis mengalami perluasan infeksi dari bakteri saluran akar menuju apeks gigi. Penelitian terdahulu membuktikan bahwa periodontitis apikalis dapat dikaitkan dengan peningkatan kadar interleukin-6. Interleukin-6 adalah salah satu sitokin pro-inflamatori yang mempunyai peran penting dalam respon inflamasi. Tujuan penelitian menganalisis perbedaan kadar interleukin-6 dalam darah vena antara pasien dengan periodontitis apikalis dan pasien tanpa periodontitis apikalis. Metode: Jenis penelitian observasional analitik dengan dua puluh sampel stok darah vena yang terdiri atas 10 sampel darah vena pasien dengan periodontitis apikalis dan 10 sampel darah vena pasien tanpa periodontitis apikalis. Serum darah yang telah dipisahkan dengan metode sentrifugasi dipakai sebagai sampel uji enzyme-linked immunosorbent assay (ELISA) sandwich untuk mengukur kadar IL-6 dengan membaca nilai absorbansi dan kurva standar. Data yang diperoleh dianalisis menggunakan uji Shapiro-Wilk, dilanjutkan dengan uji T tidak berpasangan. Hasil: Kadar IL-6 teridentifikasi pada semua sampel. Sampel darah vena pasien tanpa periodontitis apikalis memiliki kadar IL-6 berkisar antara 4,7-18,74 mg/L, sedangkan kadar IL-6 pada pasien dengan periodontitis apikalis 4,0-90,75 mg/L. Uji T tidak berpasangan menunjukan bahwa terdapat perbedaan yang bermakna (p=0.02). Simpulan: Kadar IL-6 pada darah vena dengan periodontitis apikalis lebih tinggi dibandingkan kadar IL-6 pada tanpa periodontitis apikalis.Kata kunci: periodontitis apikalis; interleukin-6; Enzim-Linked Immunosorbent Assay Sandwich ABSTRACT Introduction: Apical periodontitis is inflammation and tissue damage in the apical area of the periodontium. Occurs due to pulp necrosis experiencing an expansion of infection from root canal bacteria to the apex of the tooth. Previous studies have shown that apical periodontitis can be associated with elevated levels of interleukin-6. Interleukin-6 is a pro-inflammatory cytokine that has a vital role in the inflammatory response. The study aimed to analyze differences in interleukin-6 levels in venous blood between patients with apical periodontitis and patients without apical periodontitis. Methods: This research was an analytic observational study with twenty venous blood samples consisting of 10 venous blood samples from patients with apical periodontitis and ten venous blood samples from patients without apical periodontitis. Blood serum that has been separated by centrifugation method was used as a sandwich enzyme-linked immunosorbent assay (ELISA) test sample to measure IL-6 levels by reading absorbance values and standard curves. The data obtained were analyzed using the Shapiro-Wilk test, followed by an unpaired T-test. Results: IL-6 levels were identified in all samples. Venous blood samples from patients without apical periodontitis had IL-6 levels ranging from 4.7-18.74 mg/L, while IL-6 levels in patients with apical periodontitis were 4.0-90.75 mg/L. The unpaired t-test showed that there was a significant difference (p=0.02). Conclusion: IL-6 levels in venous blood with apical periodontitis were higher than IL-6 levels in those without apical periodontitis.Keywords: apical periodontitis; interleukin-6; Enzyme-Linked Immunosorbent Assay Sandwich

Aging as a Risk Factor on the Immunoexpression of Pro-Inflammatory IL-1β, IL-6 and TNF-α Cytokines in Chronic Apical Periodontitis Lesions

Persistent inflammatory responses in the elderly may act as modifiers on the progression and repair of chronic apical periodontitis lesions (CAPLs). While the involvement of IL-1β, IL-6 and TNF-α in inflammatory responses and, particularly, in CAPL has been documented, their expression in elderly patients needs to be further characterized. Therefore, the purpose of this study was to evaluate and compare the expressions of pro-inflammatory cytokines in CAPL from elderly individuals with young/middle-aged individuals. Thirty CAPL (15 cysts and 15 granulomas) from elderly patients (>60 years) and 30 CAPL (15 cysts and 15 granuloma) from young/middle-aged individuals (20–56 years) were selected. Immunohistochemical reactions were performed against IL-1β, IL-6 and TNF-α. The slides were subdivided into five high-magnification fields and analyzed. The number of positive stains was evaluated for each antibody. There was no significant difference between the cytokines when the cysts and granuloma were compared in the two groups. In the young/middle-aged, only IL-1β showed a difference and was significantly higher in granulomas (p = 0.019). CAPL pro-inflammatory cytokine levels in the elderly were significantly higher than in young/middle-aged individuals (p < 0.05). The pro-inflammatory cytokines IL-1β, IL-6 and TNF-α were significantly higher in CAPL in the elderly compared with the young/middle-aged group. Further elaborate research studies/analyses to elucidate the reasons for and consequences of inflammation in the elderly are recommended.