Smoking and diabetes mellitus have been recognized as significant modifying factors of the evolution of periodontitis, being considered at the moment as descriptive factors in the periodontitis grading system. The purpose of this study was to assess the consequence of smoking, type 2 diabetes, and the combination of these two factors on clinical periodontal parameters, on the levels of gingival crevicular fluid (GCF), and also on ratios of pro-inflammatory and anti-inflammatory cytokines by using a commercially available kit-based multiplex fluorescent immunoassay. The study was carried out on 124 volunteers (control (C) group = 29, diabetes mellitus (DM) group = 32, smoking (S) group = 31, and S + DM group = 32). Total mean bleeding on probing was significantly lower in the S and S + DM groups, compared to that of the other groups (p < 0.05). Total amounts of TGF-β, MIP-1α, IL-6, IL-2, and IL-17 were significantly increased in the periodontally healthy sites of diabetes patients (p < 0.05), compared to those of the controls. Systemically healthy smoking patients had higher values of GM-CSF, TGF-β, IL-4, TNF-α, IL-5, and IL-7, while diabetic smoking patients showed higher values of IL-4, TGF-β, and MIP-1α. In smoking and systemically healthy patients, IL-23, IL-7, and IL-12 showed increased concentrations, while concentrations of TGF-β, MIP-1α, IL-2, IL-7, IL-12, IL-17, IL-21, and IL-23 were higher in smoking DM patients. In conclusion, in our study, diabetes mellitus induced a general pro-inflammatory state, while smoking mainly stimulated immunosuppression in the periodontal tissues of periodontitis subjects.

The study aimed to investigate the effects of endodontic space decontamination using a laser combined with ozonated water in the therapy of complicated pulp gangrene. The subject of this in vivo study was a 12-year-old patient diagnosed with extensive periapical periodontitis on the mandibular right first molar. Biological samples were initially collected to identify the active pathogen—Enterococcus faecalis, then the nonsurgical endodontic treatment was performed in a single visit, according to the active disinfection guidelines of the identified pathogen. Two-month postoperative, clinical and radiological examination revealed a complete healing of the periapical lesion. The correct diagnosis of this endodontic–periodontal pathology, and the unconventional treatment of the complex system of infected root canals, allowed a favorable treatment result without any surgical intervention. This unconventional approach, which combines a laser technique with ozonated water, allows for predictable results in periapical lesion treatment.

The aim of our study was to correlate systemic bone loss by evaluating human Dickkopf-related protein 1 (Dkk-1) biomarker compared to horizontal bone loss as well as the presence and size of periapical lesions assessed by dental X-ray (ortopantomography—OPT) and cone beam computed tomography (CBCT) in patients with cancer in the ears, nose and throat (ENT) region vs. healthy controls. The study included 63 subjects divided into a study group of 33 cancer patients with ENT cancer (larynx/oropharynx/sinuses) and a control group of 30 healthy individuals. Blood samples were collected from both groups to assess Dkk-1 level using a sandwich enzyme immunoassay. The dental radiological examination consisted of a panoramic X-ray and a CBCT in order to appraise the horizontal bone loss, the presence and size of the periapical lesions in 2D vs. 3D images. The panoramic X-ray showed that in the control group, the maximum bone loss reached 13.2 mm, with an average of 4.930 ± 3.258 mm, while in the study group, the maximum horizontal bone loss was 11.3 mm, with an average of 5.191 ± 2.109 mm. The CBCT 3D investigation, when compared to the OPT, showed increased values for horizontal bone loss, both in the control group and in the study group; in the control group, the maximum bone loss reached 14.10 mm, with an average of 5.736 ± 3.471 mm, and in the study group, the maximum value was 12.40 mm, and the average was again slightly higher (6.152 ± 2.519 mm). The mean value for Dkk-1 in cancer patients was 1.209 ± 0.110 ng/mL, significantly lower than the value observed in healthy patients (1.712 ± 0.100 ng/mL). CBCT revealed higher values for the investigated parameters when compared to panoramic X-rays. Taking into account the preliminary nature of our study, we observed a significant correlation between the level of bone loss recorded by the Dkk-1 biomarker and radiological dental examination in patients with ENT cancer when compared to the control group.

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Background/Objectives: The aim of this study was to identify and assess the independent risk factors and potential predictors for endo-periodontal lesions (EPLs) in endodontically treated teeth with periapical pathology. Methods: The study group included 90 patients (35 men, 55 women; mean age 47.96 ± 13.495 years) with 126 endodontically treated teeth. Following clinical examinations and radiologic evaluation, 50 patients were diagnosed with endo-periodontal lesions (EPLs) in 64 molars (test group); the control group included 62 endodontically treated teeth without EPLs diagnosed in 40 patients. The independent variables were assessed as risk factors for EPLs. The relationship between patients’ demographic and clinical features and endo-periodontal status was assessed using Chi-squared tests for categorical variables and Student’s t- or Mann–Whitney tests for continuous variables, depending on data distribution. The potential risk factors were characterized by calculating Odds Ratios (ORs) with 95% confidence intervals. The variables included in the multivariate logistic regression model were selected based on their clinical relevance and statistical significance in the univariate analysis. To evaluate the combined effect of the identified risk factors, a binary logistic regression model was constructed using the Enter method. Results: Out of the 126 endodontically treated molars with periapical pathology, 64 teeth (50.8%) were diagnosed with endo-periodontal lesions (EPLs). Patients aged ≥60 years were significantly more represented in the EPL group (32.8%) compared to the control group (12.9%) (p = 0.024). Probing pocket depth ≥ 4 mm was present in 85.9% of teeth with EPLs versus only 30.6% in teeth without EPLs (p < 0.001). Probing pocket depth (PPD) ≥ 4 mm was the strongest predictor (OR = 13.830) and remained significant after adjustment in multivariate analysis (OR = 6.585). PPD ≥ 3.625 mm showed a strong association in univariate analysis (OR = 12.587) and preserved significance in the multivariate model (OR = 6.163). Conclusions: This study highlights age ≥ 60 years and PPD ≥ 4 mm as the most significant independent risk factors for EPLs, emphasizing the need for early periodontal assessment in endodontically treated teeth with periapical pathology. While PPD greater than 3.625 mm is a strong indicator of the presence of EPLs, other factors such as MBL (marginal bone loss) and occlusal considerations appear to have indirect roles in EPL development in endodontically treated teeth with periapical lesions.

Introduction: The aim of this in vitro study was to compare the quality of marginal sealing at the cervical margins of indirect and direct composite resin restorations in mesio-occluso-distal (MOD) cavities. Material and method: MOD preparations were performed on 30 extracted teeth. The mesial cervical margin of each tooth was relocated using a flow composite resin (Enamel Plus HRi Flow, Micerium, Avegno, GE, Italy), then the samples were divided into three groups. In group A, the cavities were directly restored using a nanohybrid composite resin (Miris 2 Coltène Whaledent, Altstaetten, Switzerland) and a universal adhesive (ScotchBond Universal, 3M ESPE, St. Paul, MN, USA) by the etch-and-rinse strategy, for group B, the restoration procedure was similar but the self-etch strategy was used, and the samples in group C were filled using the inlay technique. Each sample was stored for 48 h in a 2% methylene blue solution, then it was cut in a mesio-distal direction using a Struers Secotom 50 device (Cleveland, OH, USA). The marginal sealing and adhesive interface were assessed for each sample at the cervical margin by optical microscopy (OM) and scanning electron microscopy (SEM). One-way ANOVA and Bonferroni post-hoc tests were used with a significance level of 0.05. Results: Significant differences were recorded within groups A and C, between mesial and distal margins (p = 0.02 in group A and p = 0.043 in group C). Conclusions: The marginal sealing is more effective in MOD inlay restoration compared to direct restorations. Relocation of the cervical margin with flow composite resin and the use of different adhesive strategies do not improve the marginal sealing.