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Endodontically treated teeth that receive nonsurgical periodontal treatment are more likely to develop apical periodontitis than periodontally healthy teeth
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
ENDODONTICALLY TREATED TEETH THAT RECEIVE NONSURGICAL PERIODONTAL TREATMENT ARE MORE LIKELY TO DEVELOP APICAL PERIODONTITIS THAN PERIODONTALLY HEALTHY TEETH
Ruiz XF, Duran-Sindreu F, Shemesh H, et al. Development of periapical lesions in endodontically treated teeth with and without periodontal involvement: a retrospective cohort study [published online ahead of print June 9, 2017]. J Endod. http://dx.doi.org/10.1016/ j.joen.2017.03.037. Key words. Endodontics; periodontics; apical periodontitis; chronic periodontitis; risk factors; scaling and root planing; retrospective cohort study. Clinical relevance. Owing to the penetration of bacteria through exposed dentinal tubules, it has been proposed that nonsurgical treatment of chronic periodontitis (NSTCP) is a risk factor for the development of apical periodontitis (AP) in endodontically treated teeth. If this theory is supported by sound evidence, clinicians may approach NSTCP with this potential complication in mind. Study summary. The researchers conducted a retrospective cohort study (RCS) to investigate the association between NSTCP and the development of AP in teeth that had undergone endodontic treatment (ET). They included data collected from the records of 194 patients* who had 1 adequate ET and acceptable coronal restorationy and had been referred for treatment to a university clinic. Using radiographs from the time of referral, the researchers classified each tooth as having periodontal disease (PD)z or not. Using radiographs from at least 2 years later, researchers classified each tooth as having developed AP§ or not. The proportion of teeth that developed AP was 14% among teeth with PD and 3% among teeth without PD. After adjusting for confounders,{ teeth with PD had 5.19
times the odds# of developing AP than teeth without PD. Age, sex, hypertension diagnosis, diabetes, cardiovascular diseases, immunodeficiencies, and smoking were not statistically associated with AP. Strengths and limitations. This RCS had a low risk of bias. Although the researchers used patients’ records to collect data for this study, they had trained and calibrated observers evaluate the radiographs to assess whether the patient had PD and AP. In addition, the researchers made sure that the teeth did not have AP before the NSTCP was administered, that the ET was not at risk of failing, and that there was a sufficiently long period (2 years) for AP to develop as a consequence of the NSTCP before they measured the presence of AP. A potential limitation of this RCS is the differences in age means and proportion of patients with hypertension and diabetes between the groups. Although the researchers showed that there was no association between age and AP and diabetes and AP and seemed to have adjusted the estimate of the association between PD and AP, they did not describe the statistical methods they used and the factors they accounted for, so we have some concerns. The magnitude of the association between PD and AP is large enough, however, to still be important even if these issues were to be addressed. n http://dx.doi.org/10.1016/j.adaj.2017.06.047 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Mean (standard deviation) age, 44 (17) years; 53% female; 13% had hypertension; 26% were smokers; 6% had diabetes. y The researchers defined “adequate endodontic treatment” as root canals sealed with no voids radiographically visible, ending 0 to 2 millimeters short of the apex. They defined “acceptable coronal restoration” as 1 that was intact with no signs of leakage. z The researchers classified teeth as having periodontal disease if the teeth had more than 25% bone loss. All of these teeth had undergone scaling and root planing. § The researchers classified teeth as having apical periodontitis if they exhibited at least any change in bone structure with mineral loss. { The authors did not make clear which variables were considered as confounders for this analysis. # Odds ratio, 5.19; 95% confidence interval, 1.58 to 17.21.
JADA
( )
- -
http://jada.ada.org
-
2017 e1
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
ENDODONTICALLY TREATED TEETH THAT RECEIVE NONSURGICAL PERIODONTAL TREATMENT ARE MORE LIKELY TO DEVELOP APICAL PERIODONTITIS THAN PERIODONTALLY HEALTHY TEETH
Ruiz XF, Duran-Sindreu F, Shemesh H, et al. Development of periapical lesions in endodontically treated teeth with and without periodontal involvement: a retrospective cohort study [published online ahead of print June 9, 2017]. J Endod. http://dx.doi.org/10.1016/ j.joen.2017.03.037. Key words. Endodontics; periodontics; apical periodontitis; chronic periodontitis; risk factors; scaling and root planing; retrospective cohort study. Clinical relevance. Owing to the penetration of bacteria through exposed dentinal tubules, it has been proposed that nonsurgical treatment of chronic periodontitis (NSTCP) is a risk factor for the development of apical periodontitis (AP) in endodontically treated teeth. If this theory is supported by sound evidence, clinicians may approach NSTCP with this potential complication in mind. Study summary. The researchers conducted a retrospective cohort study (RCS) to investigate the association between NSTCP and the development of AP in teeth that had undergone endodontic treatment (ET). They included data collected from the records of 194 patients* who had 1 adequate ET and acceptable coronal restorationy and had been referred for treatment to a university clinic. Using radiographs from the time of referral, the researchers classified each tooth as having periodontal disease (PD)z or not. Using radiographs from at least 2 years later, researchers classified each tooth as having developed AP§ or not. The proportion of teeth that developed AP was 14% among teeth with PD and 3% among teeth without PD. After adjusting for confounders,{ teeth with PD had 5.19
times the odds# of developing AP than teeth without PD. Age, sex, hypertension diagnosis, diabetes, cardiovascular diseases, immunodeficiencies, and smoking were not statistically associated with AP. Strengths and limitations. This RCS had a low risk of bias. Although the researchers used patients’ records to collect data for this study, they had trained and calibrated observers evaluate the radiographs to assess whether the patient had PD and AP. In addition, the researchers made sure that the teeth did not have AP before the NSTCP was administered, that the ET was not at risk of failing, and that there was a sufficiently long period (2 years) for AP to develop as a consequence of the NSTCP before they measured the presence of AP. A potential limitation of this RCS is the differences in age means and proportion of patients with hypertension and diabetes between the groups. Although the researchers showed that there was no association between age and AP and diabetes and AP and seemed to have adjusted the estimate of the association between PD and AP, they did not describe the statistical methods they used and the factors they accounted for, so we have some concerns. The magnitude of the association between PD and AP is large enough, however, to still be important even if these issues were to be addressed. n http://dx.doi.org/10.1016/j.adaj.2017.06.047 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Mean (standard deviation) age, 44 (17) years; 53% female; 13% had hypertension; 26% were smokers; 6% had diabetes. y The researchers defined “adequate endodontic treatment” as root canals sealed with no voids radiographically visible, ending 0 to 2 millimeters short of the apex. They defined “acceptable coronal restoration” as 1 that was intact with no signs of leakage. z The researchers classified teeth as having periodontal disease if the teeth had more than 25% bone loss. All of these teeth had undergone scaling and root planing. § The researchers classified teeth as having apical periodontitis if they exhibited at least any change in bone structure with mineral loss. { The authors did not make clear which variables were considered as confounders for this analysis. # Odds ratio, 5.19; 95% confidence interval, 1.58 to 17.21.
JADA
( )
- -
http://jada.ada.org
-
2017 e1