Asgary Saeed, Aminoshariae Anita, Wesselink Paul R
Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Endodontics, CWRU School of Dental Medicine, Cleveland, OH, USA.
Iran Endod J. 2024;19(3):148-157. doi: 10.22037/iej.v19i3.45605.
Apical periodontitis (AP) is a common inflammatory condition predominantly caused by the response of the immune system to microbial invasion within the root canal system. Contrary to conventional perception, AP may occur in vital teeth with inflamed pulp; adding complexity to diagnosis and treatment. AP, due to its frequent lack of symptoms and reliance on radiographic evaluation for detection, often presents diagnostic challenges. In addition, AP pathogenesis involves complex interactions between microbial virulence and host immune response at the cellular and molecular levels. Comprehensive diagnostic procedures, including patient history, clinical examination, and radiographic evaluation, are essential for early detection and necessary intervention, with the recognition of clinical signs and symptoms underscoring the importance of regular dental evaluations. The current review primarily discusses the radiographic and clinical features of AP in vital and non-vital teeth; introducing a new taxonomic classification to improve diagnostic precision and treatment outcomes. Moreover, it proposes different treatment categories/options for the management of AP, based on pulp status as well as clinical and radiographic findings; emphasizing vital pulp therapy and root canal treatment for vital and non-vital teeth with AP, respectively. Furthermore, the global and regional epidemiology of AP is presented, along with its association with systemic health conditions; ., cardiovascular diseases, diabetes mellitus, and adverse pregnancy outcomes. Moreover, future research directions are advocated to improve the efficacy and predictability of diagnosis and treatments; paving the path for clinicians in early detection, accurate diagnosis, and effective management of AP to enhance oral health outcomes.
根尖周炎（AP）是一种常见的炎症性疾病，主要由免疫系统对根管系统内微生物入侵的反应引起。与传统观念相反，AP可能发生在牙髓发炎的活髓牙中，这增加了诊断和治疗的复杂性。由于AP常常缺乏症状，且依赖影像学评估进行检测，因此经常带来诊断挑战。此外，AP的发病机制涉及微生物毒力与宿主免疫反应在细胞和分子水平上的复杂相互作用。全面的诊断程序，包括患者病史、临床检查和影像学评估，对于早期检测和必要干预至关重要，认识到临床体征和症状凸显了定期牙科评估的重要性。本综述主要讨论活髓牙和死髓牙中AP的影像学和临床特征；引入一种新的分类方法以提高诊断准确性和治疗效果。此外，它根据牙髓状态以及临床和影像学表现，提出了不同的AP治疗类别/选择；分别强调对患有AP的活髓牙进行活髓治疗，对死髓牙进行根管治疗。此外，还介绍了AP的全球和区域流行病学，以及它与全身健康状况的关联，即心血管疾病、糖尿病和不良妊娠结局。此外，提倡未来的研究方向以提高诊断和治疗的疗效及可预测性；为临床医生在早期检测、准确诊断和有效管理AP以改善口腔健康结果铺平道路。
