University of Bonn, University of Münster, Private Practice, Steinengraben 67, Basel, 4051, Switzerland.
Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Albert-Schweitzer-Campus 1, building W 30, 48149, Münster, Germany.
Head Face Med. 2023 Jun 7;19(1):22. doi: 10.1186/s13005-023-00366-1.
Patients diagnosed with an autoimmune disease are often systemically medicated with glucocorticoids. Autoimmune pancreatitis (AIP) Type 1 is considered a rare autoimmune disease, which is very well responsive to glucocorticoids and hence can be treated optionally on a long-term basis using low dose of the drug. Apical lesions of root canal-treated teeth can be solved by retreatment of the preexisting root canal obturation or via surgical approaches.
This case report relates to a 76-year-old male patient, whose symptomatic acute apical periodontitis was treated nonsurgically by root canal treatment. However, overtime both roots of tooth 46 were associated with asymptomatic apical lesions. Despite progression of the lesions, due to a painless situation, the patient refrained from proceeding with any further treatment options after explaining the pathological pathway with all its consequences. A few years later the patient was prescribed 2.5 mg glucocorticoid prednisone daily for long-term therapy due to an AIP Type 1. Six years later under strict glucocorticoid therapy the apical lesions healed nearly completely and the patient remained free of symptoms without any further interventions.
These observations suggest that prospective clinical studies are required to further elucidate the potential healing effect of systemic long-term low-dose glucocorticoid medication on lesions of endodontic origin.
患有自身免疫性疾病的患者通常会接受全身性糖皮质激素治疗。1 型自身免疫性胰腺炎（AIP）被认为是一种罕见的自身免疫性疾病，对糖皮质激素非常敏感，因此可以选择长期使用低剂量药物进行治疗。根管治疗后的牙尖病变可以通过重新治疗现有的根管填充或通过手术方法来解决。
本病例报告涉及一位 76 岁男性患者，其症状性急性根尖周炎通过根管治疗进行了非手术治疗。然而，随着时间的推移，46 号牙齿的两个牙根都出现了无症状的根尖病变。尽管病变进展，但由于没有疼痛，患者在了解了所有后果的病理途径后，拒绝接受任何进一步的治疗选择。几年后，该患者因 1 型 AIP 被开处每日 2.5 毫克泼尼松龙的糖皮质激素长期治疗。6 年后，在严格的糖皮质激素治疗下，根尖病变几乎完全愈合，患者无症状，无需进一步干预。
这些观察结果表明，需要进行前瞻性临床研究，以进一步阐明系统长期低剂量糖皮质激素治疗对牙髓来源病变的潜在愈合效果。
