F.J. López-Frías

Diabetes mellitus, periapical inflammation and endodontic treatment outcome.

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol. Key words: Apical periodontitis, diabetes mellitus, endodontics, root canal treatment.

Relationship between Smoking and Endodontic Variables in Hypertensive Patients

INTRODUCTION The aim of this study was to investigate the relationship between smoking and the prevalence of apical periodontitis and root canal treatment in hypertensive patients. METHODS In a cross-sectional study, the records of 100 hypertensive patients, 50 smokers and 50 nonsmokers, were examined. Periapical status of all teeth was assessed by using the periapical index score. RESULTS Apical periodontitis in 1 or more teeth was found in 92% of smoker patients and in 44% of nonsmoker subjects (P=.000; odds ratio [OR], 16.8; 95% confidence interval [CI], 4.6-61.3). One or more root-filled teeth were found in 58% and 20% of smoker and nonsmoker subjects, respectively (P < .01; OR, 5.5; 95% CI, 2.3-13.5). Among smoker hypertensive patients, 6% of the teeth had apical periodontitis, whereas in the nonsmoker subjects, 2% of teeth were affected (P < .01; OR, 3.3; 95% CI, 2.0-5.4). The percentage of root-filled teeth in the smoker and nonsmoker groups was 3.6% and 1.2%, respectively (P < .01; OR, 2.9; 95% CI, 1.6-5.5). CONCLUSIONS The prevalence of apical periodontitis and root canal treatment was significantly higher in smoker hypertensive patients compared with nonsmoker subjects.

Clinical measurement of tooth wear: Tooth wear indices

Attrition, erosion, and abrasion result in alterations to the tooth and manifest as tooth wear. Each classification corresponds to a different process with specific clinical features. Classifications made so far have no accurate prevalence data because the indexes do not necessarily measure a specific etiology, or because the study populations can be diverse in age and characteristics. Tooth wears (attrition, erosion and abrasion) is perceived internationally as a growing problem. However, the interpretation and comparison of clinical and epidemiological studies, it is increasingly difficult because of differences in terminology and the large number of indicators/indices that have been developed for the diagnosis, classification and monitoring of the loss of dental hard tissue. These indices have been designed to identify increasing severity and are usually numerical, none have universal acceptance, complicating the evaluation of the true increase in prevalence reported. This article considers the ideal requirements for an erosion index. A literature review is conducted with the aim of analyzing the evolution of the indices used today and discuss whether they meet the clinical needs and research in dentistry. Key words:Tooth wear, tooth wear indices, attrition, erosion, abrasion, abfraction.

Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy

Objective: To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. Method and Materials: A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. Results: The mean pain level during root canal treatment was 2.9 ± 3.0 (median = 2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p > 0.05). Pain during root canal treatment was significantly greater in molar teeth (OR = 10.1; 95% C.I. = 1.6 - 63.5; p = 0.013). Root canal instrumentation and obturation techniques did not affect significantly patient’s pain during root canal treatment (p > 0.05). Conclusion: Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients’ pain during RCT. Key words:Anaesthesia, endodontic pain, pulpitis, root canal instrumentation, root canal obturation, rotary files.

External apical root resorption in maxillary root-filled incisors after orthodontic treatment: A split-mouth design study

Introduction: The purpose of this study was to compare, in a split mouth design, the external apical root resorption (EARR) associated with orthodontic treatment in root-filled maxillary incisors and their contralateral teeth with vital pulps. Methodology: The study sample consisted of 38 patients (14 males and 24 females), who had one root-filled incisor before completion of multiband/bracket orthodontic therapy for at least 1 year. For each patient, digital panoramic radiographs taken before and after orthodontic treatment were used to determine the root resortion and the proportion of external root resorption (PRR), defined as the ratio between the root resorption in the endodontically treated incisor and that in its contralateral incisor with a vital pulp. The student’s t-test, chi-square test and logistic regression analysis were used to determine statistical significance. Results: There was no statistically significant difference (p > 0.05) between EARR in vital teeth (1.1 ± 1.0 mm) and endodontically treated incisors (1.1 ± 0.8 mm). Twenty-six patients (68.4%) showed greater resorption of the endodontically treated incisor than its homolog vital tooth (p > 0.05). The mean and standard deviation of PPR were 1.0 ± 0.2. Multivariate logistic regression suggested that PRR does not correlate with any of the variables analyzed. Conclusions: There was no significant difference in the amount or severity of external root resorption during orthodontic movement between root-filled incisors and their contralateral teeth with vital pulps. Key words:Endodontics, orthodontics, root canal treatment, root resorption.

Patología implanto-endodóncica: concepto, tipos, diagnóstico, tratamiento y prevención

The implant-endodontic pathology is described in the literature as a cause of apical periimplantitis, understood to be an osteolytic lesion that appears in the apical region of the implant during the coronal osteointegration normally. This implant-endodontic pathology researches the relation of endodontic and implants apical lesions leading to infection contiguity between teeth and implants. The first way of contamination is implant-tooth, when the implant placement causes necrosis of the adjacent tooth and subsequent contamination of the implant; the second way is tooth-implant, when there is an exacerbation of latent apical lesion in a tooth, root canal or not, after placing an implant adjacent to it, resulting in apical periimplantitis later. In this work we have summoned the cases of occurring periimplantitis by apical residual infection present in the socket of an extracted tooth with apical periodontal pathology and replaced by an implant. This review aims to make an update of the relationship between periimplantitis and endodontics.

Endodoncia preventiva: Protección pulpar mediante la técnica de eliminación de la caries en etapas (stepwise excavation)

espanolEl tratamiento de la caries dentinaria profunda en dientes permanentes se ha venido realizando, generalmente, mediante la remocion completa y en una sola sesion de la dentina cariada, incluyendo la dentina blanda desmineralizada, sin tener en cuenta el potencial regenerador de la pulpa dental. Una complicacion frecuentemente ligada a esta actitud es la exposicion pulpar intraoperatoria que, en muchos casos, termina en tratamiento de conductos. Varios estudios han demostrado que la eliminacion de la caries dentinaria profunda por etapas, en dos visitas con varios meses de diferencia, protege a la pulpa, disminuyendo la frecuencia de exposiciones pulpares, a la vez que permite la formacion de dentina terciaria, con la consiguiente disminucion del porcentaje de casos que requieren tratamiento endodoncico. En este articulo se analiza el estado del conocimiento y la evidencia cientifica sobre este tema. EnglishThe treatment of deep dentine carious lesions in permanent teeth has included, generally, complete removal of affected dentin in a single session, including soft demineralized dentin, regardless of the regenerative potential of dental pulp. One complication often linked to this attitude is the pulp exposure, in many cases ending in root canal treatment. Several studies have shown that the elimination of deep dentine caries in stages, in two visits to several months apart, protects the pulp, reducing the frequency of pulp exposures, while allowing the development of tertiary dentin, with the consequent decrease in the percentage of cases requiring endodontic treatment. This article discusses the state of knowledge and scientific evidence on this topic.

Anomalías y displasias dentarias de origen genético-hereditario

espanolLas alteraciones del desarrollo embriologico de la denticion provocan anomalias y displasias dentarias. Los factores etiopatogenicos implicados en las alteraciones del desarrollo dentario son basicamente dos: geneticos y ambientales. Segun la fase del desarrollo en que afecten al organo del esmalte y a los tejidos dentarios, apareceran diferentes anomalias y/o displasias dentales. El control genetico del desarrollo dentario se lleva a cabo mediante dos procesos: a) control de la histogenesis del esmalte y la dentina, y b) la especificacion del tipo, tamano y posicion de cada diente. La mutacion de los genes implicados en la amelogenesis (AMELX, ENAM, MMP20 y KLK4) o en la dentinogenesis (DSPP) produce alteraciones del desarrollo dentario aisladas o no sindromicas. Por el contrario, las mutaciones de los genes reguladores morfogeneticos involucrados en la determinacion de la posicion y el desarrollo precoz de los organos dentarios (genes homeobox), ademas de alterar la morfodiferenciacion dentaria, tienen efectos pleiotropicos y afectan a otros organos, provocando sindromes hereditarios en los que uno de sus rasgos es la alteracion dentaria. En este articulo se revisan las principales anomalias y displasias dentarias de causa genetico-hereditaria. EnglishAlterations of the embryologic development of the dentition cause dental anomalies and dysplasias. The causing factors involved in the disturbances of tooth development are basicallytwo: genetic and environmental factors. Depending on the phase of tooth development when the factors act, they will appear different dental anomalies and dysplasias. Genetic control of tooth development is carried out through two processes: a) control of amelogenesis and dentinogenesis,and b) the specification of the type, size and position of each tooth. Mutation of genes involved in amelogenesis (AMELX, ENAM, MMP20 and KLK4) and dentinogenesis (DSPP) produces non-syndromicalterations of tooth development.On the contrary, mutations in morphogenetic regulatory genes involved in determining the position and the early development of the teeth (homeobox genes), not only alter teeth morphodifferentiation, but also have pleiotropic effects affecting other organs, causing hereditary syndromes in which one of its features is the presence of dental abnormalities. Dental anomalies and dysplasias of genetic origin are reviewed in this article.

Asociación entre la diabetes mellitus y las infecciones crónicas orales de origen endodóncico

La evidencia cientifica disponible en la actualidad aporta abundantes datos a favor de la existencia de una relacion entre la diabetes mellitus (DM) y dos infecciones cronicas orales de muy alta prevalencia, la enfermedad periodontal (EP) y la periodontitis apical cronica. Ambas infecciones cronicas orales comparten dos caracteristicas importantes: 1) una microbiota anaerobia Gram negativa comun y 2) en ambas aumentan los niveles locales de mediadores inflamatorios, pudiendo repercutir sobre los niveles sistemicos. La interrelacion DM -infecciones cronicas orales se produciria a traves del eje inflamacion-estres oxidativo. La DM se asocia a formas agresivas de enfermedad periodontal y a una mayor prevalencia de lesiones periapicales, a un mayor tamano de las lesiones, a una mayor probabilidad de infecciones periapicales asintomaticas y a un peor pronostico para los dientes tratados endodoncicamente. Por otra parte, la periodontitis apical cronica podria contribuir al descontrol metabolico del paciente diabetico.