Segura-Egea Juan J, Cabanillas-Balsera Daniel, Martín-González Jenifer, Cintra Luciano T A
Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain.
Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), São Paulo, Brazil.
Int Endod J. 2023 Mar;56 Suppl 2:219-235. doi: 10.1111/iej.13789. Epub 2022 Jul 8.
The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth.
To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved.
The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models.
Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT.
Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region.
The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non-retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.
根管治疗（RCT）后根尖周病变的愈合并非治疗的治愈作用所致。愈合过程始于炎症，并通过清除诱导免疫反应的免疫原得以解决。然后，根尖周组织自身通过修复或修复与再生相结合的方式进行根尖周病变的愈合，这取决于宿主的修复反应是否正常发挥作用。RCT的最终目标是通过去除细菌抗原和毒素的来源，使慢性炎症组织转变为修复性组织，从而实现伤口愈合。一些全身状况会增加宿主对感染的易感性或损害组织修复反应，导致RCT后炎症过程和根尖周骨吸收持续存在。这可能导致RCT失败，甚至需要拔除患牙。
分析关于全身状况对牙髓病治疗结果可能产生的影响的科学文献，并探讨可能涉及的生物学机制。
在PubMed、SCOPUS和EMBASE数据库中进行检索。确定的纳入标准为报告有关某种全身状况与牙髓病治疗结果关系的数据的原创性科学文章，包括临床研究和在动物模型上进行的研究。
全身因素（年龄、营养、压力、激素、吸烟习惯）以及全身疾病，如糖尿病、心血管疾病、骨质疏松症、HIV感染、炎症性肠病等，均可影响或干扰RCT后根尖周组织的修复。
其中一些全身疾病可改变骨转换和成纤维细胞功能，阻止或延迟根尖周伤口愈合。其他疾病可改变微血管系统，减少根尖周组织的营养和氧气供应。因此，这些全身状况可降低RCT的成功率，并导致根尖周区域伤口愈合不完全（通常形成肉芽肿组织）。
本叙述性综述的结果显示，与吸烟习惯和糖尿病等多种全身状况相关的RCT成功率较低，术后根尖周透射性病变的百分比更高，牙齿未保留（RFT）的比例更高。
