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      Periapical healing outcome following non-surgical endodontic intervention among diabetic patients: A systematic review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions

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          Abstract

          Background

          Periapical diseases are common dental conditions that require non-surgical endodontic intervention (NEI) for successful treatment. However, the impact of diabetes mellitus (DM) on the periapical healing (PH) outcome in diabetic patients remains somewhat unclear. This review aimed to evaluate the PH outcome following endodontic intervention among DM-afflicted individuals.

          Methods

          A comprehensive search was conducted across multiple electronic databases to identify relevant studies. Specifically, a set of selection criteria was applied to select studies that assessed PH outcomes in individuals with DM who underwent different treatment protocols. Data extraction and quality assessment were performed following predetermined protocols. The risk of bias (RoB) 2 assessment tool evaluated the quality of the included studies.

          Results

          A total of 11 studies met the inclusion criteria and were included in the investigation. Four studies showed a higher incidence of apical periodontitis in diabetic individuals compared to controls, and five studies reported reduced healing and success rates in this group. Overall, nine studies have shown that DM has a negative impact on periapical outcomes. This suggests that DM is an important factor in the prognosis of endodontic intervention. The assessment tools used were PAI, PR, SC, and FD analysis. RoB-2 assessed the included studies as having a moderate RoB.

          Conclusion

          This review provides compelling evidence that DM patients experienced a noticeable negative impact on PH outcomes compared to the control population. These findings highlight the importance of considering the diabetic status of patients when assessing the prognosis of periapical diseases and planning interventions for NEI. Further research is needed to validate these results and explore potential mechanisms underlying the observed associations.

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          Most cited references36

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          IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045

          J.D. da Rocha Fernandes, Y. Huang, J.E. Shaw … (2018)
          Since the year 2000, IDF has been measuring the prevalence of diabetes nationally, regionally and globally.
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            A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival : Outcome of non-surgical root canal treatment

            Y-L Ng, V. Mann, K Gulabivala (2011)
            To investigate the probability of and factors influencing tooth survival following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. This prospective study involved annual follow-up of 2 (100%) to 4 years (50%) of 1°RCTx (759 teeth, 572 patients) and 2°RCTx (858 teeth, 642 patients) carried out by Endodontic postgraduate students. Pre-, intra- and post-operative data were collected prospectively from consented patients. Information about extraction of the root filled tooth was sought from the patient, the referring dentist or derived from the patient's records and included the timing and reasons for extraction. Tooth survival was estimated and prognostic factors were investigated using Cox regression. Clustering effects within patients were adjusted in all models using robust standard error. The 4-year cumulative tooth survival following 1°RCTx [95.4% (93.6%, 96.8%)] or 2°RCTx [95.3% (93.6%, 96.5%)] was similar. Thirteen prognostic factors were identified. Significant patient factors included history of diabetes and systemic steroid therapy. Significant pre-operative factors included narrow but deep periodontal probing depth; pain; discharging sinus; and iatrogenic perforation (for 2°RCTx cases only). Significant intra-operative factors included iatrogenic perforation; patency at apical terminus; and extrusion of root fillings. Significant post-operative restorative factors included presence of cast restoration versus temporary restoration; presence of cast post and core; proximal contacts with both mesial and distal adjacent teeth; and terminal location of the tooth. The presence of pre-operative pain had a profound effect on tooth loss within the first 22 months after treatment [hazard ratio (HR) = 3.1; P = 0.001] with a lesser effect beyond 22 months (HR = 2.4; P = 0.01). Patency at the apical terminus reduced tooth loss (HR = 0.3; P < 0.01) within the first 22 months after treatment but had no significant effect on tooth survival beyond 22 months. Extrusion of gutta-percha root filling did not have any effect on tooth survival (HR = 1.1; P = 0.2) within the first 22 months but significantly increased the hazard of tooth loss beyond 22 months (HR = 3.0; P = 0.003). The 4-year tooth survival following primary or secondary root canal treatment was 95%, with thirteen prognostic factors common to both. © 2011 International Endodontic Journal.
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              Periapical and endodontic status of type 2 diabetic patients in Catalonia, Spain: a cross-sectional study.

              José López-López, Enric Jané-Salas, Albert Estrugo-Devesa … (2011)
              The aim of this study was to investigate radiographically the prevalence of apical periodontitis (AP) and endodontic treatment in a sample of adult type II diabetic patients and control subjects. In a cross-sectional study, the radiographic records of 50 adult patients reporting a history of well-controlled type 2 diabetes mellitus (DM) (study group) and 50 age- and sex-matched subjects who reported no history of DM (control group) were examined. Periapical status of all teeth was assessed using the periapical index score. The average number of teeth per patient in the diabetic and control groups was 21.9 and 24.6 teeth, respectively (P = .012). AP in one or more teeth was found in 37 diabetic patients (74%) and in 21 control subjects (42%) (odds ratio = 3.9, P = .002). One or more root-filled teeth were found in 35 (70%) and 25 (50%) of diabetic and control subjects, respectively (odds ratio = 2.3, P = .043). Among diabetic patients with root-filled teeth, 16 (46%) had AP affecting at least one treated tooth. Among controls with root-filled teeth, 6 (24%) had AP affecting at least one treated tooth (P > .05). Adjusting for teeth number, multivariate logistic regression analysis showed that periapical status (odds ratio = 3.3, P = .0071) and the number of root-filled teeth (odds ratio = 1.7; P = .0035) were significantly associated with diabetic status. The results showed that in adult patients, type 2 DM is significantly associated with an increased prevalence of AP and endodontic treatment. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Butta Viswanath
                Harsh Priyank
                Sahana Shivakumar
                Akshayraj Langaliya
                Aravind D Kumbhar
                Ashima Jakhar
                Gabriele Cervino
                Giuseppe Minervini
                Journal
                Journal ID (nlm-ta): Saudi Dent J
                Journal ID (iso-abbrev): Saudi Dent J
                Title: The Saudi Dental Journal
                Publisher: Elsevier
                ISSN (Print): 1013-9052
                ISSN (Electronic): 1658-3558
                Publication date PMC-release: 05 October 2023
                Publication date (Print): January 2024
                Publication date (Electronic): 05 October 2023
                Volume: 36
                Issue: 1
                Pages: 52-59
                Affiliations
                [a ]Department of Conservative, Endodontics and Aesthetic Dentistry, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi
                [b ]Public Health Dentistry, Peoples College of Dental Sciences and Research Centre, Peoples University, Bhopal
                [c ]Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
                [d ]Department of Dentistry, Chief Dental Surgeon and I/c Superintendent Community Health Center, Kotarvada, Gujarat, India
                [e ]Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai
                [f ]School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, 1, 98125 Messina, Italy
                [g ]Saveetha Dental College & Hospitals Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai - 600 077, India
                [h ]Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
                Author notes
                Article
                Publisher Item ID: S1013-9052(23)00188-8
                DOI: 10.1016/j.sdentj.2023.10.002
                PMC ID: 10874800
                SO-VID: b966bee1-13a8-485a-bceb-54166e3929a4
                Copyright © © 2023 THE AUTHORS. Published by Elsevier B.V. on behalf of King Saud University.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 24 July 2023
                Date revision received : 28 September 2023
                Date accepted : 2 October 2023
                Categories
                Subject: REVIEW ARTICLE

                Keywords: periapical healing,diabetes mellitus,non-surgical endodontic intervention,endodontic success,root canal
                Data availability:
                Keywords: periapical healing, diabetes mellitus, non-surgical endodontic intervention, endodontic success, root canal

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