The prevalence of apical periodontitis (AP) in Europe has been reported to affect 61% of individuals and 14% of teeth, and increase with age. Likewise, the prevalence of root canal treatment (RCT) in Europe is estimated to be around 30-50% of individuals and 2-9% of teeth with radiographic evidence of chronic persistent AP in 30-65% of root filled teeth (RFT). AP is not only a local phenomenon and for some time the medical and dental scientific community have analysed the possible connection between apical periodontits and systemic health. Endodontic medicine has developed, with increasing numbers of reports describing the association between periapical inflammation and systemic diseases. The results of studies carried out both in animal models and humans are not conclusive, but suggest an association between endodontic variables, that is AP and RCT, and diabetes mellitus (DM), tobacco smoking, coronary heart disease and other systemic diseases. Several studies have reported a higher prevalence of periapical lesions, delayed periapical repair, greater size of osteolityc lesions, greater likelihood of asymptomatic infections and poorer prognosis for RFT in diabetic patients. On the other hand, recent studies have found that a poorer periapical status correlates with higher HbA1c levels and poor glycaemic control in type 2 diabetic patients. However, there is no scientific evidence supporting a causal effect of periapical inflammation on diabetes metabolic control. The possible association between smoking habits and endodontic infection has also been investigated, with controversial results. The aim of this paper was to review the literature on the association between endodontic variables and systemic health (especially DM and smoking habits).

Endodontic medicine: connections between apical periodontitis and systemic diseases.

Developments, application, and performance of artificial intelligence in dentistry - A systematic review.

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol.

Key words: Apical periodontitis, diabetes mellitus, endodontics, root canal treatment.

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Diabetes mellitus, periapical inflammation and endodontic treatment outcome.

Segura-Egea JJ, Jimenez-PinzonA , Roos-Santos JV, Velasco-Ortega E, Cisneros-Cabello R, Poyato-Ferrera M. High prevalence of apical periodontitis amongst type 2 dia- betic patients. International Endodontic Journal, 38, 564-569, 2005. Aim To study the prevalence of AP in patients with and without type 2 diabetes mellitus. Methodology In a retrospective cohort study, the records of 38 subjects with diabetes and 32 control subjects were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periap- ical status was assessed using the periapical index score. Statistical analyses were conducted using the Cohen's j test, analysis of variance and logistic regression. Results Apical periodontitis in at least one tooth was found in 81.3% of diabetic patients and in 58% of control subjects (P ¼ 0.040; OR ¼ 3.2; 95% CI ¼ 1.1- 9.4). Amongst diabetic patients 7% of the teeth had AP, whereas in the control subjects 4% of teeth were affected (P ¼ 0.007; OR ¼ 1.8; 95% CI ¼ 1.2-2.8). Conclusions Type 2 diabetes mellitus is significantly associated with an increased prevalence of AP.

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High prevalence of apical periodontitis amongst type 2 diabetic patients.

Cross-susceptibility between periodontal disease and type 2 diabetes mellitus: an immunobiological perspective.

The aim of this study was to evaluate the use of a convolutional neural network (CNN) system for detecting vertical root fracture (VRF) on panoramic radiography. Three hundred panoramic images containing a total of 330 VRF teeth with clearly visible fracture lines were selected from our hospital imaging database. Confirmation of VRF lines was performed by two radiologists and one endodontist. Eighty percent (240 images) of the 300 images were assigned to a training set and 20% (60 images) to a test set. A CNN-based deep learning model for the detection of VRFs was built using DetectNet with DIGITS version 5.0. To defend test data selection bias and increase reliability, fivefold cross-validation was performed. Diagnostic performance was evaluated using recall, precision, and F measure. Of the 330 VRFs, 267 were detected. Twenty teeth without fractures were falsely detected. Recall was 0.75, precision 0.93, and F measure 0.83. The CNN learning model has shown promise as a tool to detect VRFs on panoramic images and to function as a CAD tool.

Evaluation of an artificial intelligence system for detecting vertical root fracture on panoramic radiography

Diabetes mellitus is associated with depression of natural defenses against infection and increases the risk of periodontal disease. However, the effects of diabetes on periradicular tissue, which differs structurally from periodontal tissue, are not known. In this study, we evaluated the effects of type 2 diabetes on the development of periradicular lesions after exposure of the pulp in the left mandibular first molar through the occlusal surface in rats. GK rats with spontaneous non-insulin-dependent diabetes mellitus and Wistar rats (controls) received a normal laboratory diet and either water or a 30% sucrose solution. At both 2 and 4 weeks after pulp exposure, histologic analysis showed that alveolar bone resorption was most severe and the periradicular lesions were largest in diabetic rats given the sucrose solution. These results suggest that the metabolic conditions produced by type 2 diabetes enhance the development of periradicular lesions in rats.

The Effect of High Sugar Intake on the Development of Periradicular Lesions in Rats with Type 2 Diabetes

Summary Titanium or zirconium computer-aided design/computer-aided manufacturing abutments are now widely used for aesthetic implant treatments; however, information regarding microscopic structural differences that may influence the biological and mechanical outcomes of different implant systems is limited. Therefore, the characteristics of different connection systems were investigated. Optical microscopic observation and scanning electron microscopy showed different characteristics of two internal systems, namely the Astra Tech and the Replace Select system, and for different materials. The scanning electron microscopic observation showed for the Astra Tech that the implant–abutment interface seemed to be completely sealed for both titanium and zirconium abutments, both horizontally and sagittally; however, the first implant–abutment contact was below the fixture top, creating a microgap, and fixtures connected with titanium abutments showed significantly larger values (23·56 μm ± 5·44 in width, and 168·78 μm ± 30·39 in depth, P   0·70), creating an inverted microgap. Thus, microscopy evaluation of two commonly used internal systems connected to titanium or zirconium abutments showed that the implant–abutment interface was perfectly sealed under no-loading conditions. However, an inverted microgap was seen in both systems, which may result in bacterial accumulation as well as alteration of stress distribution at the implant–abutment interface.

Characteristics of implant-CAD/CAM abutment connections of two different internal connection systems

Objective The purpose of this study was to investigate the relationship between type 2 diabetes mellitus and anaerobic bacteria detected in infected root canals. Study design Normal Wistar rats (control) received a standard laboratory diet with water (group A), and GK rats (type 2 diabetes mellitus rats) a normal laboratory diet with water (group B) or a 30% sucrose solution (group C). Chemotaxis assay was conducted on polymorphonuclear leukocytes from the 3 groups, and the numbers of anaerobic bacteria in infected root canals were determined. Results In the chemotaxis assay on the polymorphonuclear leukocytes, the chemotactic response of cells in group C was lower than that for groups A and B ( P P Conclusion The metabolic condition produced by type 2 diabetes mellitus in rats might lower the general host resistance against bacterial infection.

Increased number of anaerobic bacteria in the infected root canal in type 2 diabetic rats

This study aimed to clarify the relationship between the panoramic radiographic appearance and the longitudinal cone-beam computed tomography (CBCT) classification of root configurations of the mandibular second molar. Panoramic radiographs of 1058 mandibular second molars were classified into five types according to the number and configuration of the roots. These molars were also examined with CBCT at four levels between the pulp chamber and the root apex, and axial images perpendicular to the root axis were categorized into three patterns: single (fused root with small grooves on both buccal and lingual sides or a round root with one canal); double (two separate roots with a trabecular appearance between them); and C-shaped (root with a deep groove opening only on the lingual or buccal side relative to the opposite side). Based on these patterns and their scan levels, the CBCT root morphology appearance in each tooth unit was classified into seven groups. Relationships were investigated between these seven CBCT groups and the five panoramic root types. In panoramic types 1 and 2 (with separate roots), 85% had roots with a double pattern (groups II and III) on the CBCT images. In panoramic types 3 and 4 (with fused roots), 85% had C-shaped CBCT patterns at the lower scan levels. When panoramic images show fused root types, CBCT examinations should be planned to clarify the root canal configuration.

Naoki Shibata

Papers

Evaluation of an artificial intelligence system for detecting vertical root fracture on panoramic radiography

The Effect of High Sugar Intake on the Development of Periradicular Lesions in Rats with Type 2 Diabetes

Characteristics of implant-CAD/CAM abutment connections of two different internal connection systems

Increased number of anaerobic bacteria in the infected root canal in type 2 diabetic rats

Cone-beam computed tomography classification of the mandibular second molar root morphology and its relationship to panoramic radiographic appearance