Clinical, radiological and histological diagnoses of periapical periodontitis spreading to the adjacent tooth: A case of endodontic failure

Aims: This article describes the apical infection in endodontically treated tooth 4.5 that spread to adjacent tooth 4.4. Case Report: A 52-year-old woman was referred for the presence of radiolucency extending from tooth 4.5 and mental foramen. Spontaneous symptoms were present. Tooth 4.5 showed poor-quality endodontics. The vitality of tooth 4.4 was negative, even though no mechanical trauma had been reported, nor was caries present. Both teeth were sensitive to percussion. Endodontic re-treatment of 4.5 and endodontic treatment of 4.4 were performed in a single visit. A large amount of endodontic sealer squeezed mesially from the root of tooth 4.5, where a partial horizontal root fracture was hypothesized. 6-, 12-, and 18-month radiographic follow-ups, by both periapical and cone-beam computed tomography (CBCT) analyses, showed incomplete osseous healing. CBCT excluded root fracture on 4.5. Local symptoms were still present. Clinical and radiological conditions led to extractions, and a cystic lesion was enucleated for histopathologic analyses. Histopathologic diagnosis was a periapical cyst. The supposed partial horizontal root fracture of 4.5 was actually a large lateral canal. Although the root canal treatments followed high standards in terms of quality, a persistent chronic infection developed histologically. The cystic lesion was one consistent reason for the unsuccessful healing of 4.5.

Role of viruses in periodontitis:An extensive review of herpesviruses,human immunodeficiency virus,coronavirus-19,papillomavirus and hepatitis viruses

Periodontitis is the inflammation of the supporting structures around the dentition.Several microbial agents,mostly bacteria,have been identified as causative factors for periodontal disease.On the other hand,oral cavity is a rich reservoir for viruses since it contains a wide variety of cell types that can be targeted by viruses.Traditionally,the focus of research about the oral flora has been on bacteria because the most widespread oral diseases,like periodontitis and dental caries,are outcomes of bacterial infection.However,recently and especially after the emergence of coronavirus disease 2019,there is a growing tendency toward including viruses also into the scope of oral microbiome investigations.The global high prevalence of periodontitis and viral infections may point out to a concomitant or synergistic effect between the two.Although the exact nature of the mechanism still is not clearly understood,this could be speculated through the manipulation of the immune system by viruses;hence facilitating the furthermore colonization of the oral tissues by bacteria.This review provides an extensive and detailed update on the role of the most common viruses including herpes family(herpes simplex,varicella-zoster,Epstein-Barr,cytomegalovirus),Human papillomaviruses,Human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 in the initiation,progression and prognosis of periodontitis.

O-linked β-N-acetylglucosamine transferase regulates macrophage polarization in diabetic periodontitis: In vivo and in vitro study

BACKGROUND Periodontitis,when exacerbated by diabetes,is characterized by increased M1 macrophage polarization and decreased M2 polarization.O-linkedβ-N-acetylglucosamine(O-GlcNAcylation),catalyzed by O-GlcNAc transferase(OGT),promotes inflammatory responses in diabetic periodontitis(DP).Additionally,p38 mitogen-activated protein kinase regulates macrophage polarization.However,the interplay between OGT,macrophage polarization,and p38 signaling in the progression of DP remains unexplored.AIM To investigate the effect of OGT on macrophage polarization in DP and its role in mediating O-GlcNAcylation of p38.METHODS For in vivo experiments,mice were divided into four groups:Control,DP model,model+short hairpin(sh)RNAnegative control,and model+sh-OGT.Diabetes was induced by streptozotocin,followed by ligation and lipopolysaccharide(LPS)administration to induce periodontitis.The impact of OGT was assessed by injecting sh-OGT lentivirus.Maxillary bone destruction was evaluated using micro-computed tomography analysis and tartrateresistant acid phosphatase staining,while macrophage polarization was determined through quantitative real-time polymerase chain reaction(qPCR)and immunohistochemistry.For in vitro experiments,RAW264.7 cells were treated with LPS and high glucose(HG)(25 mmol/L D-glucose)to establish a cell model of DP.OGT was inhibited by OGT inhibitor(OSMI4)treatment and knocked down by sh-OGT transfection.M1/M2 polarization was analyzed using qPCR,immunofluorescence,and flow cytometry.Levels of O-GlcNAcylation were measured using immunoprecipitation and western blotting.RESULTS Our results demonstrated that M1 macrophage polarization led to maxillary bone loss in DP mice,associated with elevated O-GlcNAcylation and OGT levels.Knockdown of OGT promoted the shift from M1 to M2 macrophage polarization in both mouse periodontal tissues and LPS+HG-induced RAW264.7 cells.Furthermore,LPS+HG enhanced the O-GlcNAcylation of p38 in RAW264.7 cells.OGT interacted with p38 to promote its O-GlcNAcylation at residues A28,T241,and T347,as well as its phosphorylation at residue Y221.CONCLUSION Inhibition of OGT-mediated p38 O-GlcNAcylation deactivates the p38 pathway by suppressing its self-phosphorylation,thereby promoting M1 to M2 macrophage polarization and mitigating DP.These findings suggested that modulating macrophage polarization through regulation of O-GlcNAcylation may represent a novel therapeutic strategy for treating DP.

Efficacy of recombinant human osteoprotegerin combined with tinidazole in the treatment of periodontitis mice and its correlation with serum RANKL and MCP-1 levels

Objective: To investigate the effect of recombinant human osteoprotegerin combined with tinidazole on mice with periodontitis and the effect on serum RANKL and MCP-1 levels. Methods: 80 SPF-cleaned mice were randomly divided into 4 groups, 20 each, model group, tinidazole group and recombinant human osteoprotegerin group were modeled by Kimura et al., and tinidazole group received tinidazole. After intragastric administration, the recombinant human osteoprotegerin group was injected with recombinant human osteoprotegerin in the periodontal pocket according to the tinidazole group. The periodontal changes of the four groups of mice were observed and recorded, and the gingival rating was performed. Epithelial tissue morphology was observed by hematoxylin-eosin (HE) staining. Serum levels of IL-4, IL-6, RANKL and MCP-1 were measured by enzyme-linked immunosorbent assay. Results:After the intervention, the model group developed severe inflammatory reactions, including redness, hemorrhage, and deep periodontal pockets. The teeth were significantly loosened. The mice in the tinidazole group and the recombinant human osteoprotegerin group recovered substantially, and the gingival rating of the recombinant human osteoprotegerin group was better than that. The tinidazole group and the model group (P<0.05). The results of HE staining showed that the model group had edema, vasodilation and a large amount of inflammatory infiltration. The epithelial structure of the mice in the tinidazole group and the recombinant human osteoprotegerin group was intact and arranged closely and orderly. After intervention, the IL-4 in the tinidazole group and the recombinant human osteoprotegerin group was significantly higher than the model group and IL-6 was significantly lower than the model group (P<0.05), and the recombinant human osteoprotegerin group IL-4 was significantly higher after the intervention. IL-6 was significantly lower in the tinidazole group than in the tinidazole group (P<0.05). After the intervention, the tinidazole group and the recombinant human osteoprotegerin group were significantly reduced, and the recombinant human osteoprotegerin group RAKNL and MCP-1 were significantly lower than the model group (P>0.05). Conclusion: Recombinant human osteoprotegerin combined with tinidazole has a better therapeutic effect on gums and teeth in mice with periodontitis, and can lower the levels of RAKNL and MCP-1 in serum, inhibit bone resorption and protect teeth.

1,8-桉叶油素干预大鼠实验性牙周炎模型的炎症反应

背景:研究表明,天然植物精油提取物1,8-桉叶油素具有抗炎、抗氧化、抗菌、抗肿瘤等多种药理作用,在多种疾病中表现出抗炎作用。目的:探讨1,8-桉叶油素对大鼠实验性牙周炎模型炎症反应的影响。方法:按照完全随机数字表法将30只SD大鼠随机分为正常对照组、牙周炎对照组和1,8-桉叶油素组,每组10只。牙周炎对照组和1,8-桉叶油素组利用正畸钢丝结扎法构建实验性牙周炎模型。造模8周后,正常对照组和牙周炎对照组大鼠颊、腭侧牙周袋内均注射生理盐水,1,8-桉叶油素组大鼠颊、腭侧牙周袋内注射1,8-桉叶油素溶液,2次/d,连续给药4周。给药结束后,进行牙周临床指标检测、牙周组织学评估、血清炎症因子水平检测及牙龈组织中炎症因子m RNA与蛋白表达检测。结果与结论:①与正常对照组比较,牙周炎对照组大鼠牙龈出血指数、牙周探诊深度增加(P<0.05),血清中白细胞介素1β、肿瘤坏死因子α、白细胞介素6水平升高(P<0.05),血清中白细胞介素10水平降低(P<0.05),牙龈组织中白细胞介素1β、肿瘤坏死因子α、白细胞介素6mRNA与蛋白表达均升高(P<0.05),牙龈组织中白细胞介素10 mRNA与蛋白表达均降低(P<0.05);苏木精-伊红染色结果显示,牙周炎对照组大鼠牙周组织炎症明显。②与牙周炎对照组比较,1,8-桉叶油素组大鼠牙龈出血指数、牙周探诊深度减少(P<0.05),血清中白细胞介素1β、肿瘤坏死因子α、白细胞介素6水平降低(P<0.05),血清中白细胞介素10水平升高(P<0.05),牙龈组织中白细胞介素1β、肿瘤坏死因子α、白细胞介素6 mRNA与蛋白表达均降低(P<0.05),牙龈组织中白细胞介素10 mRNA与蛋白表达均升高(P<0.05);苏木精-伊红染色结果显示,1,8-桉叶油素组大鼠牙周组织炎症明显减轻。结果表明,1,8-桉叶油素治疗可减轻大鼠实验性牙周炎模型的炎症反应。

Does a biological link exist between periodontitis and rheumatoid arthritis?

Periodontitis or Periodontal disease(PD) and Rheumatoid arthritis(RA) are two the most common chronic inflammatory diseases. Periodontitis is a biofilm associated destructive inflammatory disease of the periodontium caused by specific microorganisms. Rheumatoid arthritis is an autoimmune condition and is identified by elevated serum autoantibody titre directed against citrullinated peptides or rheumatoid factor. Periodontitis may involve some elements of autoimmunity. Recent studies have established that PD and RA show a common pathway and could be closely associated through a common dysregulation and dysfunction in inflammatory mechanism. The enzyme peptidyl arginine deiminase(PAD), expressed by Porphyromonas gingivalis(P. gingivalis) is responsible for the enzymatic deimination of arginine residuals to citrulline resulting in protein citrullination and its increased accumulation in RA.Citrullination by PAD may act as a putative biologic link between PD and RA. Association of Human leukocytic antigen-DR4 antigen has been established both with RA and PD. Several interleukins and inflammatory mediators(ILs) and Nuclear factor kappa beta ligand are linked to these common chronic inflammatory diseases. Antibodies directed against heat shock protein(hsp 70 ab) of P. gingivalis, P. melanogenicus and P. intermedia are raised in PD as well as RA. Both the conditions share many pathological and immunological similarities. Bacterial infection, genetic susceptibility, altered immune reaction and inflammatory mediators considered responsible for RA are also associated with PD. So it is plausible that a biological link may exist between PD and RA. Therapies aimed at modifying the expression and effect of inflammatory mediators and effector molecules such as matrix metalloproteinases, proinflammatory cytokines and autoantibodies of structural proteins may probably reduce the severity of both RA and PD.

人类巨细胞病毒、EB病毒和单纯疱疹病毒1型与慢性牙周炎的相关性研究

目的 研究人类巨细胞病毒( HCMV)、Epstein- Barr病毒( EBV)和单纯疱疹病毒1型( HSV- 1)与慢性牙周炎的相关性。方法 收集6 2例慢性牙周炎患者(男性2 7例,女性35例;平均年龄5 3岁)的牙周炎部位,轻度龈炎部位的龈下菌斑,提取DNA后使用巢式PCR检测HCMV、EBV和HSV- 1,比较分析它们在同一患者不同部位的检出率。结果 牙周炎部位的HCMV检出率为38.7% ,EBV的检出率为5 8.0 % ,HSV- 1的检出率为30 .6 % ,2种以上病毒合并感染的检出率为4 0 .3% ;轻度龈炎部位的HCMV检出率为12 .9% ,EBV为19.4 % ,HSV- 1为9.7% ,2种以上病毒合并感染的检出率为8.0 %。这3种病毒及其合并感染在牙周炎部位的检出率均高于轻度龈炎部位,差异有统计学意义( P<0 .0 5 )。结论 提示HCMV、EBV、HSV- 1与慢性牙周炎有相关性。

富血小板血浆对牙周韧带成纤维细胞在牙骨质表面附着及增殖的影响

目的探讨应用富血小板血浆(PRP)对人牙周韧带成纤维细胞(PDLFs)在健康牙和牙周病患牙牙骨质表面附着和增殖情况的影响。方法采用组织块法培养人牙周膜成纤维细胞,取第四代细胞用于实验。分别制备健康牙和牙周病患牙牙骨质块置于96孔板,附着实验在接种细胞后加入含10%PRP和不含PRP的培养液,4小时后MTT法检测附着细胞数量;增殖实验在接种细胞常规培养24小时,而后加入不含血清的培养液培养48小时,更换为含10%PRP和不含PRP的培养液,24小时后MTT法检测细胞数量;并以扫描电镜观察细胞在牙骨质表面的情况。结果附着实验中10%PRP组附着细胞数量较不含PRP组明显增多;增殖实验中10%PRP组和不含PRP组细胞数量无明显差异。结论10%PRP可促进人PDLFs在健康牙和牙周病患牙牙骨质块上的附着,但对细胞在牙骨质块上的增殖无明显影响。

Exposure to Hyaluronan and Radon-Containing Water during the Treatment of Periodontal Pockets

Hyaluronic acid (HA) preparations have emerged as pivotal components in contemporary dentistry, gaining widespread recognition for their multifaceted roles in various biological functions. Extensive literature underscores the significance of HA in maintaining tissue water balance, fostering cell proliferation, promoting rapid cell migration, influencing cell differentiation during organism development, and facilitating tissue regeneration. Notably, HA’s interactions with cell surface receptors contribute to the viscosity of synovial fluid, activate the immune system, and enhance cartilage elasticity. Beyond these established functions, HA has also been investigated for its potential involvement in determining and studying the hormetic effects of radon water, adding a novel dimension to its applications in dental research. A thorough exploration of existing studies reveals a nuanced understanding of how HA interventions impact the outcomes of dental procedures. The comprehensive scope of these investigations allows for a more accurate assessment of the potential effectiveness of specific interventions and provides valuable insights into post-procedural prognoses for individual patients. This synthesis of literature serves as the foundation for elucidating the intricate interplay between HA, radon exposure, and their relevance in modern dental practices.

Unraveling brain aging through the lens of oral microbiota

The oral cavity is a complex physiological community encompassing a wide range of microorganisms.Dysbiosis of oral microbiota can lead to various oral infectious diseases,such as periodontitis and tooth decay,and even affect systemic health,including brain aging and neurodegenerative diseases.Recent studies have highlighted how oral microbes might be involved in brain aging and neurodegeneration,indicating potential avenues for intervention strategies.In this review,we summarize clinical evidence demonstrating a link between oral microbes/oral infectious diseases and brain aging/neurodegenerative diseases,and dissect potential mechanisms by which oral microbes contribute to brain aging and neurodegeneration.We also highlight advances in therapeutic development grounded in the realm of oral microbes,with the goal of advancing brain health and promoting healthy aging.

Expression of PCNA in oral gingival epithelium of aggressive and, chronic periodontitis—A pilot study

Periodontal disease leads to loss of tissue homeostasis of tooth supporting structures. The mechanism of fibrous tissue degradation by various enzymes in chronic periodontitis and aggressive periodontitis was well documented but there is paucity of information regarding epithelial response. The aim of the present study was to evaluation of epithelial cell proliferation in Chronic Periodontitis, Aggressive Periodontitis and normal patients using Proliferating Cell Nuclear Antigen (PCNA). The study consists of 30 individuals who attended the Periodontia clinic of Vishnu Dental College. They were divided equally into 3 groups: chronic periodontitis (10) aggressive periodontitis (10) and normal individuals requiring gingival excision for crown lengthening (10). Excised gingival tissues were routinely processed and subjected to Immuno-histochemical evaluation using Proliferating Cell Nuclear Antigen (PCNA). The mean proliferation index was almost equal in Aggressive periodontitis patients (36.55) and normal individuals (37.02) but it was high in Aggressive Periodontitis patients when compared to chronic periodontitis group (18.86). Observations of this study indicate the possibility of subclinical inflammation in clinically normal gingiva and difference in the types of microorganism associated with chronic periodontitis and aggressive periodontitis.

奥硝唑用于感染根管消毒的细菌学研究

目的 观察和探讨新型抗厌氧菌药物奥硝唑消毒感染根管的抗菌效果。方法 选择感染根管患牙98颗,常规根管预备后,随机分为试验组(奥硝唑组)和对照组(甲醛甲酚组)各4 9颗。分别在根管预备前、预备后及封药后进行根管内细菌标本采样、培养、分离与鉴定,测定根管内细菌变化及检出情况,并观察封药后临床症状和体征的变化。结果 2组封药后,根管内细菌数量及检出率均较封药前明显降低( P<0 .0 5 ) ,根管内细菌数量及检出率比较,差异无显著性( P>0 .0 5 ) ,奥硝唑的近期临床疗效优于甲醛甲酚。结论 奥硝唑是一种较安全。

TGF和bFGF对牙周膜细胞ALP活性及Fn合成的影响

目的探讨转化生长因子α,β(TGFα,β)和碱性成纤维细胞生长因子(bFGF)对人牙周膜(PDL)细胞碱性磷酸酶(ALP)活性及纤维结合蛋白(Fn)合成的影响。方法体外培养人PDL细胞,与一定浓度的TGFα,β或bFGF作用后,用ELISA法检测Fn含量,用酶动力学方法检测ALP活性。结果TGFα使PDL细胞合成Fn的水平(0.937±0.036)比对照组(0.687±0.023)增加了136.4%(P<0.05),TGFβ使Fn的水平(2.885±0.052)明显提高(P<0.001),bFGF组(0.738±0.041)则没有明显影响(P>0.05)。与对照组(2.431±0.051)相比,TGFβ(1.748±0.042)可抑制PDL细胞的ALP活性(P<0.05),bFGF(1.138±0.046)显著抑制PDL细胞的ALP活性(P<0.01),TGFα(0.331±0.022)的抑制作用更强(P<0.01)。结论TGFα,β和bFGF可能通过调节PDL细胞的ALP活性和合成Fn的水平,发挥PDL细胞在牙周组织的再生中的作用。

纯钛表面牙周韧带细胞牙骨质附着蛋白的表达

目的 以牙骨质附着蛋白为分化指标,分析牙周韧带细胞在纯钛表面的分化趋势,并探讨诱导矿化对牙周韧带细胞牙骨质附着蛋白表达的影响。方法 第三代牙周韧带细胞在商用纯钛表面接种后,分别进行常规培养和矿化液诱导矿化培养,通过免疫荧光原位检测牙骨质附着蛋白的表达,并比较诱导矿化对牙骨质附着蛋白表达的影响。结果 牙周韧带细胞在纯钛表面初期呈条纹状生长,常规培养和诱导矿化培养条件下均能表达牙骨质附着蛋白,诱导矿化对牙骨质蛋白的表达无明显影响。结论 在常规培养条件和诱导矿化培养条件下,纯钛表面生长的牙周韧带细胞能高度表达牙骨质附着蛋白,提示纯钛表面体外培养的牙周韧带细胞具有形成牙骨质的分化趋势,从而可为种植体周构建牙周韧带结构提供在种植体侧的锚着点。

A Comparable Study of Combinational Regenerative Therapies Comprising Enamel Matrix Derivative plus Deproteinized Bovine Bone Mineral with or without Collagen Membrane in Periodontitis Patients with Intrabony Defects

Aim: The aim of the present study was to examine the effectiveness of collagen membrane (CM) in regenerative therapy with deproteinized bovine bone mineral (DBBM) and enamel matrix derivative (EMD) for periodontal intrabony defects. Methods: Eighteen periodontal intrabony defects of nine chronic periodontitis patients were evaluated. Two defects per patient with probing pocket depth (PPD) ≥ 6 mm were assigned to two different types of treatments: EMD + DBBM + CM or EMD + DBBM. Clinical parameters including Gingival Index (GI), PPD, clinical attachment level (CAL), gingival recession (GR), bleeding on probing (BOP), tooth mobility (MOB), and the filled bone volume/rate (FBV/FBR), which was measured by cone beam computed tomography, were compared at baseline and 12 months post-treatment. Differences between groups were determined by the chisquare test, McNemar’s test, and Wilcoxon signed-rank test. Results: Clinically, PPD, CAL, and FBR significantly improved in both groups (p Conclusion: Periodontal regenerative therapies comprising EMD and DBBM with and without CM resulted in positive clinical outcomes. The use of CM may result in better outcomes in MOB decrease;however, long-term prognosis must be further studied.

Applications of stem cells in orthodontics and dentofacial orthopedics:Current trends and future perspectives

A simple overview of daily orthodontic practice involves use of brackets, wires and elastomeric modules. However, investigating the underlying effect of orthodontic forces shows various molecular and cellular changes. Also, orthodontics is in close relation with dentofacial orthopedics which involves bone regeneration. In this review current and future applications of stem cells(SCs) in orthodontics and dentofacial orthopedics have been discussed. For craniofacial anomalies, SCs have been applied to regenerate hard tissue(such as treatment of alveolar cleft) and soft tissue(such as treatment of hemifacial macrosomia). Several attempts have been done to reconstruct impaired temporomandibular joint. Also, SCs with or without bone scaffolds and growth factors have been used to regenerate bone following distraction osteogenesis of mandibular bone or maxillary expansion. Current evidence shows that SCs also have potential to be used to regenerate infrabony alveolar defects and move the teeth into regenerated areas. Future application of SCs in orthodontics could involve accelerating tooth movement, regenerating resorbed roots and expanding tooth movement limitations. However, evidence supporting these roles is weak and further studies are required to evaluate the possibility of these ideas.

Correlation of OPG/RANKL expression in gingival crevicular fluid with inflammatory factors, free radical generation and bone metabolism in patients with diabetes mellitus complicated by periodontitis

Objective:To study the correlation of OPG/RANKL expression in gingival crevicular fluid with inflammatory factors, free radical generation and bone metabolism in patients with diabetes mellitus complicated by periodontitis.Methods:Patients with diabetes mellitus complicated by periodontitis who were treated in Xi'an No. 4 Hospital between March 2015 and May 2017 were selected as the periodontitis group for the research, and healthy volunteers who underwent periodontal examination during the same period were selected as the control group. The gingival crevicular fluid was collected to determine the expression of OPG/RANKL, the contents of inflammatory factors and bone metabolism molecules as well as the generation of free radicals.Results: OPG protein expression, OPG/RANKL expression ratio as well as ICTP and Runx2 contents in gingival crevicular fluid of periodontitis group were significantly lower than those of control group whereas RANKL protein expression, TNF-α, IL-1β, IL-17, HMGB1, DKK1 and MMP1 contents as well as ROS, MDA and 8-OHdG generation were significantly higher than those of control group;OPG/RANKL expression ratio in gingival crevicular fluid of periodontitis group was negatively correlated with TNF- , IL-1β, IL-17, HMGB1, DKK1 and MMP1 contents as well as ROS, MDA and 8-OHdG generation, and positively correlated with ICTP and Runx2 contents.Conclusion: The excessive activation of inflammation and oxidative stress in periodontal tissue of patients with diabetes mellitus complicated by periodontitis can cause OPG/RANKL expression disorder and then lead to bone metabolism disorder.

Scientific evidence for the relationship between periodontitis and cardiovascular disease

A lot of clinical studies have investigated the possible association between periodontitis and coronary heart disease (CHD). Some of them indicate the existence of an epidemiologic association between these two concepts, and support previous investigations that have found that chronic periodontal inflammation, persistent bacterial infection with the presence of major periodontal pathogens, deep periodontal pockets. The number of missing teeth and other periodontal markers, seem to be important risk factors for cardiovascular diseases. Nevertheless, it will be required to carry out better controlled and larger studies to identify if these biological mechanisms are responsible for these increased risks and to provide a convincing support of a casual association and to determine if periodontal treatments could prevent CHD. Since periodontal disease and cardiovascular disease are common, their association has a significant public health importance. They share common risk factors, such as increasing age, smoking, stress, socioeconomic status and body fat metabolism, and that is the reason why there could be significant bias.

Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough?

Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the &#x0201c;sixth&#x0201d; major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A &#x0201c;two way&#x0201d; relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.

有限元分析牙髓根尖周病根管治疗中的牙体力学性能

背景:根管治疗后牙髓根尖周病变患牙往往因失去较多健康牙体组织等原因导致抗折强度降低,如何增强牙齿抗折强度一直是临床医生密切关注的问题。有限元分析能直观地展示不同状态下患牙各个部分的受力情况,对牙体结构和材料力学性能等进行综合分析。目的:综述有限元分析在牙髓根尖周病根管治疗中的应用进展,并对未来的发展趋势进行展望。方法:在PubMed、Web of Science数据库和中国知网、万方数据库、维普数据库、中国生物医学文献服务系统中检索使用有限元法分析牙髓根尖周病根管治疗的相关文献,英文检索词为“FEA,finite element analysis,stress analysis,root canal treatment,pulp opening,root canal preparation,root canal filling,restoration”,中文检索词为“有限元分析,应力分析,牙髓根尖周病,根管治疗,开髓,根管预备,根管充填,修复”,最终纳入103篇文献进行综述。结果与结论:有限元分析可以通过构建牙体及周围组织的有限元模型分析牙齿在咀嚼、咬合等过程中的应力分布和变形情况。借助有限元分析,临床研究者能够对牙髓根尖周病根管治疗中不同开髓洞型、根管预备方式、根管充填材料及修复方案等对牙体力学性能的影响进行分析,从而选择出最佳的治疗方案,提高治疗效果和患者预后。有限元分析有助于医生在临床治疗中减少牙体组织的损失,提高治疗效果和患者预后。有限元模型是对实际情况的简化,需结合临床试验进行综合分析。