Postgraduate Program in Dentistry, Department of Endodontics, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Curitiba, Paraná, Brazil.
PLoS One. 2024 Feb 15;19(2):e0297020. doi: 10.1371/journal.pone.0297020. eCollection 2024.
Systemic diseases affecting the immune system can influence the body's response time to endodontic treatment, potentially necessitating a longer duration for the complete resolution of existing infections when compared to healthy controls. This systematic review aims to evaluate the association between the presence of chronic diseases and periapical status after endodontic treatment through a systematic and comprehensive assessment of existing literature on this topic. The search strategy covered seven electronic databases and grey literature, encompassing articles published until October 2023. Two reviewers independently assessed potentially eligible studies based on the following criteria: Included were studies involving populations exposed to pre-existing chronic diseases who underwent endodontic treatment in permanent teeth. These studies evaluated periapical health status, making comparisons with healthy individuals. There were no language or publication date restrictions. Additionally, two reviewers independently extracted data regarding the characteristics of the included studies. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. Meta-analysis was conducted using random effects models. The certainty of evidence was assessed using the GRADE tool. Twenty-three studies were included in the synthesis. Patients with diabetes were found to have about half the odds of having periapical health compared to non-diabetic patients (OR = 0.46; 95% CI = 0.30-0.70%; I2 = 58%) in teeth that underwent endodontic treatment. On the other hand, other systemic diseases like HIV, cardiovascular disease, and rheumatoid arthritis did not demonstrate significant differences concerning the outcome. In conclusion, diabetic patients showed a lower likelihood of maintaining periapical health. Conversely, patients with HIV, cardiovascular disease, and rheumatoid arthritis did not exhibit significant differences, although the existing evidence is still considered limited. It is crucial to manage these patients in a multidisciplinary manner to provide appropriate care for this population.
系统性疾病会影响免疫系统，从而影响身体对根管治疗的反应时间。与健康对照组相比，这些疾病可能需要更长的时间才能完全消除现有的感染。本系统评价旨在通过对该主题现有文献的系统和全面评估，评估慢性疾病的存在与根管治疗后根尖周状态之间的关联。该检索策略涵盖了七个电子数据库和灰色文献，包括截至 2023 年 10 月发表的文章。两名审查员根据以下标准独立评估潜在合格的研究：纳入研究涉及患有先前存在的慢性疾病的人群，这些人在恒牙中接受了根管治疗。这些研究评估了根尖周健康状况，并与健康个体进行了比较。无语言或出版日期限制。此外，两名审查员独立提取了纳入研究特征的数据。使用 Joanna Briggs 研究所关键评估清单评估偏倚风险。使用随机效应模型进行荟萃分析。使用 GRADE 工具评估证据确定性。共有 23 项研究纳入了综合分析。接受根管治疗的糖尿病患者与非糖尿病患者相比，根尖周健康的可能性约为后者的一半（OR = 0.46；95%CI = 0.30-0.70%；I2 = 58%）。另一方面，其他系统性疾病，如 HIV、心血管疾病和类风湿性关节炎，在该结果方面并未显示出显著差异。总之，糖尿病患者保持根尖周健康的可能性较低。相比之下，HIV、心血管疾病和类风湿性关节炎患者并未表现出显著差异，尽管现有证据仍被认为有限。以多学科方式管理这些患者至关重要，以为该人群提供适当的护理。
