Endodontic Management of Endo-Perio Lesions

An endo-perio lesion is one of the more common tooth-related problems. An association between the presence of apical and marginal periodontitis is known in the literature and has been observed in 5.7% of individuals aged 40–45 years old. The purpose of the present article is to present three case reports describing the successful retreatment of endo-perio lesions. In each of these cases, we used a biologically active bioceramic root canal sealer, GuttaFlow Bioseal, which is a bioactive root canal filling material composed of gutta percha, polydimethylsiloxane, platinum catalyzer, zirconium dioxide, and bioglass. All cases were followed up clinically and radiographically for a period of at least 11 months.

The Role of the Immune Response in Chronic Marginal and Apical Periodontitis

The immune response is a complex, dynamic and strongly individual biologic network that plays an essential role in the pathogenesis of chronic apical and marginal periodontitis. Recent research in the field of periodontology has indicated that the major determinant of susceptibility to disease is the nature of the immunoinflammatory response as marginal periodontal tissue damage is thought to be primarily mediated by the host reaction. Whether the same rules apply for the development of apical periodontitis, however, remains largely unexplored. This review aims to draw parallels between the pathogenesis of chronic periodontitis of endodontic and marginal origin, outline the evidence for the destructive role of immune response in chronic marginal periodontitis and raise questions about its role in chronic apical periodontitis. It would be worthy to further explore the impact of the immune system on the characteristics and progress of these diseases and transfer some of the scientific models from the field of periodontology to the field of endodontics. Research in this area could lead to a more comprehensive understanding of the dynamics of apical and marginal periodontitis and lay the foundation of new personalized treatment strategies. 

Saliva and Serum Immune Responses in Apical Periodontitis

Apical periodontitis is an inflammatory reaction at the apex of an infected tooth. Its microbiota resembles that of marginal periodontitis and may induce local and systemic antibodies binding to bacteria- and host-derived epitopes. Our aim was to investigate the features of the adaptive immune response in apical periodontitis. The present Parogene cohort (n = 453) comprises patients with cardiac symptoms. Clinical and radiographic oral examination was performed to diagnose apical and marginal periodontitis. A three-category endodontic lesion score was designed. Antibodies binding to the bacteria- and host-derived epitopes were determined from saliva and serum, and bacterial compositions were examined from saliva and subgingival samples. The significant ORs (95% CI) for the highest endodontic scores were observed for saliva IgA and IgG to bacterial antigens (2.90 (1.01–8.33) and 4.91 (2.48–9.71)/log10 unit), saliva cross-reacting IgG (2.10 (1.48–2.97)), serum IgG to bacterial antigens (4.66 (1.22–10.1)), and Gram-negative subgingival species (1.98 (1.16–3.37)). In a subgroup without marginal periodontitis, only saliva IgG against bacterial antigens associated with untreated apical periodontitis (4.77 (1.05–21.7)). Apical periodontitis associates with versatile adaptive immune responses against both bacterial- and host-derived epitopes independently of marginal periodontitis. Saliva immunoglobulins could be useful biomarkers of oral infections including apical periodontitis—a putative risk factor for systemic diseases.

Inflamatory Chemistry and Organic Surgery in the Maxilar Compression

The morphology and physiology of odonto-periodontal units, muscles, temporomandibular joints, maxillary bones, ligaments are in a constant balance, even if all these components are subject to continuous transformation. Affecting a systemic element will attract imbalances to other levels, and the therapeutic solution will require knowledge and understanding of the ensemble. A complete dental exam must allow identification of all factors responsible or likely to cause imbalance in the stomatognat system. The maxillary compression is an abnormality characterized by a transversal developmental deficiency in the upper jaw and / or the mandibular, showing morpho-functional changes that denote a complex disruption in the development of the dento-maxillary apparatus. The common modification of all the fractured cases is the insufficient development in a transversal sense, dental arcades (mono - or bimaxilar), along with facial and maxillary bone changes, disturbances of inter - maxillary or occlusion blocking, functional deficits and disturbances. The strictly mandibular compression situation is very rare and addresses cases by affecting growth at the condylian level. The study includes 27 cases with jaw compression and benefited from orthognat surgery in the Maxillofacial Surgery Clinic between 2015 - 2018. If untreated, the abnormality determines the appearance of many cavities especially in the front teeth, difficulty in performing dental hygiene will lead to chronic marginal periodontitis, the occurrence of abnormal contact between teeth with joint pain, decreased chewing field. The jaw compression is revealed by multiple facial and oral signs, as well as by functional changes. Orthognatic surgery is the only effective treatment for many patients in jaw compression.

PALATO GINGIVAL GROOVE;

Introduction: The palatogingival groove (PGG) is an anomaly which considered as a developmental defect. In 1908, this anomaly was first of all described by Black. According to him this palatogingival groove starts just beneath the cingulum and travels towards the apex from cementoenamel junction. Palatogingival groove presents variation in depth and length along the root. Objectives: To determine frequency of palatogingival groove in maxillary lateral incisors, as early diagnosis can prevent the development of caries and periodontitis. Study Design: Cross sectional study Setting: 500 adult patients were examined (1000 maxillary lateral incisors) which includes both genders aged 20-45 years, recruited from Operative Department, Ibn-e-Sina Hospital Multan. Period: Six months from Jan to June 2017. Material & Method: In patients oral cavity both right and left side were inspected and the groove extension was assorted into, coronal grooves (coronal to cement enamel junction), and apical grooves (extended to the root, beyond the cement enamel junction). Results: The PGG prevalence rate in the population has been reported to be between 2.8% and 8.5%. Conclusion: The frequency of palatogingival groove was 9%. Bilateralism of the PGGs was calculated and was found to be 62.2%. 30% caries was present in all cases. Palatogingival groove can cause marginal periodontitis, pulpal necrosis and apical periodontitis. Early diagnosis can prevent the development of caries and periodontitis.

An in-vitro antimicrobial effect of 405 nm laser diode combined with chlorophylls of Alfalfa (Medicago sativa L.) on Enterococcus faecalis

Background: Enterococcus faecalis (E. faecalis) is a bacterium commonly detected in the root canals of teeth with post-treatment apical periodontitis or advanced marginal periodontitis. It has the ability to live in an extreme environment and survive as an organism with its virulence factor possibly contributing to the pathogenesis of post-treatment apical and marginal periodontitis. Photodynamic therapy (PDT) is an urgently required alternative method of improving therapy effectiveness. Photodynamic therapy combined with conventional endodontic treatment decreases the number of antibioticresistant bacteria and biofilms. Chlorophyll is one of the photosensitizers added to enhance the absorption of light in photodynamic therapy. Purpose: The purpose of this study was to determine the antimicrobial effect of the combination of photodynamic laser therapy and Alfalfa chlorophyll in E. faecalis. Methods: In vitro study using E. faecalis distributed between negative control (C-) and positive control (C+), treatment groups using various energy doses of a 405 nm diode laser (2.5, 5, 7.5, 10, 12.5, 15, 17.5, 20 J/cm2) with (G1) and without alfalfa chlorophyll as organic photosensitizer (G2). The suspension was inoculated on Tryptocase Soy Agar (TSA) and incubated at 37° C for 24 hours. The number of colonyforming units per milliliter (CFU/ml) was determined. The results were analyzed by ANOVA with p value ≤0.05. Results: A 405 nm irradiating laser with or without a photosensitizer can decrease E. faecalis viability percentage through the administering of various energy doses. The highest decrease (42%) was obtained in the group without a photosensitizer using 20 J/cm2, while 10 J/cm2 in the group with a photosensitizer proved the most effective dose (25%). Conclusion: The results of this study showed a decrease in the viability of E. faecalis exposed to a 405 nm (40 mW) laser. An irradiating process using a 405 nm laser without a photosensitizer (Alfalfa chlorophyll) resulted in the highest percentage decrease (42%) in E. faecalis bacterial viability.