Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre of Oral Clinical & Translational Sciences, Guy's Dental Hospital, King's College London, London, UK.
Department of Restorative Dentistry, Division of Endodontics, Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
Int Endod J. 2022 Sep;55(9):923-937. doi: 10.1111/iej.13786. Epub 2022 Jun 27.
The aim of the study was to measure serum levels of molecular markers of inflammation in patients undergoing non-surgical root canal retreatment (Re-RCT) and periapical surgery (PS) for the treatment of apical periodontitis and to establish if such levels are influenced by the size of apical radiolucencies at baseline and by the treatment outcome.
A total of 115 participants were recruited (n = 50 Controls, n = 35 Re-RCT, n = 30 PS). Preoperative periapical radiographs and cone beam CT (CBCT) scans of teeth were taken. Blood was collected from treatment groups at baseline, 3-, 6-, and 12-month post-treatment and from controls at baseline and 12 months. Serum levels of IL-1β, IL-6, IL-8, TNF-α, Pentraxin 3, ICAM-1, VCAM-1, hs-CRP, FGF-23, MMP-2, MMP-8, MMP-9, C3 and ADMA were analysed using multiplex immunoassay and enzyme-linked immunosorbent assay. Different time points within the same group were compared using Wilcoxon signed-rank test, and differences between groups were analysed using the Mann-Whitney test. Non-linear association between different factors was assessed using Spearman's correlation.
Preoperative serum levels of FGF-23, IL-1β, hs-CRP and ADMA were significantly higher in the diseased groups compared with controls (p < .001; p = .008; p < .001; p = .013, respectively). The preoperative size of the radiolucency was associated with increased levels of FGF-23, IL-1β and IL-6. At 3-months following treatment, IL-1β, IL-8, hs-CRP, C3, MMP-2 and MMP-9 levels increased compared with baseline in treatment groups. IL-1β and IL-8 further increased at 6 months, whereas FGF-23, hs-CRP, C3, MMP2 and MMP-9 decreased. One-year post-treatment, FGF-23, pentraxin-3 and ADMA were significantly reduced below baseline levels. At the 1-year review, CBCT revealed that 25.9% of treated cases completely healed, while 63% were healing, and 11.1% failed. Treatment outcome was found to be influenced by preoperative levels of ADMA and IL-8 levels at 6 months.
Both symptomatic and asymptomatic apical periodontitis (AP) can contribute to increased levels of molecular markers of inflammation. A further transient inflammatory markers rise after root canal retreatment and apical surgery were demonstrated. Successful endodontic treatment and periapical surgery result in a long-term reduction in inflammatory marker levels.
本研究旨在测量行非手术根管再治疗（Re-RCT）和根尖手术（PS）治疗根尖周炎患者的血清炎症分子标志物水平，并确定这些水平是否受基线根尖放射透影区大小和治疗结果的影响。
共招募 115 名参与者（n=50 例对照组，n=35 例 Re-RCT 组，n=30 例 PS 组）。术前拍摄根尖射线片和锥形束 CT（CBCT）扫描。治疗组在基线、治疗后 3、6 和 12 个月以及对照组在基线和 12 个月时采集血液。采用多重免疫分析法和酶联免疫吸附试验分析血清中白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）、Pentraxin 3、细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、高敏 C 反应蛋白（hs-CRP）、成纤维细胞生长因子-23（FGF-23）、基质金属蛋白酶-2（MMP-2）、基质金属蛋白酶-8（MMP-8）、基质金属蛋白酶-9（MMP-9）、C3 和不对称二甲基精氨酸（ADMA）的水平。采用 Wilcoxon 符号秩检验比较同一组内不同时间点的差异，采用 Mann-Whitney 检验比较组间差异。采用 Spearman 相关分析评估不同因素之间的非线性关系。
与对照组相比，患病组术前血清 FGF-23、IL-1β、hs-CRP 和 ADMA 水平显著升高（p<0.001;p=0.008;p<0.001;p=0.013，分别）。术前放射透影区大小与 FGF-23、IL-1β 和 IL-6 水平升高有关。治疗后 3 个月，与基线相比，治疗组的 IL-1β、IL-8、hs-CRP、C3、MMP-2 和 MMP-9 水平升高。6 个月时 IL-1β 和 IL-8 进一步升高，而 FGF-23、hs-CRP、C3、MMP2 和 MMP-9 则下降。治疗后 1 年，FGF-23、Pentraxin-3 和 ADMA 明显低于基线水平。1 年复查时，CBCT 显示 25.9%的治疗病例完全愈合，63%的病例在愈合，11.1%的病例失败。术前 ADMA 和 6 个月时 IL-8 水平与治疗结果有关。
有症状和无症状的根尖周炎（AP）均可导致炎症分子标志物水平升高。本研究进一步证明根管再治疗和根尖手术后会出现短暂的炎症标志物升高。成功的根管治疗和根尖周手术可长期降低炎症标志物水平。
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