Involvement of Root Canal Treatment in Pro-Inflammatory Processes - A Real-World Study.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL Pragmatic and Observational Research Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI:10.2147/POR.S479124
Joé Diederich, Kurt E Müller
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Abstract

Purpose: Endodontic inflammation typically results from root canal infections and sensitizations to filling materials after root canal treatment (RCT), potentially leading to systemic inflammation and disease. We therefore aimed to characterize the inflammatory alterations after RCT as well as the inflammatory molecule levels following tooth extraction or renewed RCT.

Patients and methods: All (a total of 2585) walk-in patients with or without RCT history were included in this retrospective study. During the 3-year observation period, blood levels of RANTES/CCL5 (regulated on activation, normal T-cell expressed and secreted/chemotactic cytokine ligand 5), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukin-10 (IL-10) were measured before and after tooth extraction or renewed RCT. Control patients did not undergo any dental treatment.

Results: A total 49.38% of patients had a history of at least one RCT. In RCT patients, RANTES/CCL5 values were significantly reduced by both tooth extraction (p=0.03) and renewed dental RCT (p=0.038), while a non-significant increase was observed in untreated patients. TNF-α levels were reduced by tooth extraction (p=0.014) but not by renewed RCT and no intervention. CRP levels were not significantly changed by either treatment. Tooth extraction significantly lowered IFN-γ levels (p=0.003), while in control patients, IFN-γ levels did not change. IL-10 levels were non-significantly reduced by tooth extraction (p=0.061). In a subcohort of RCT patients, the lymphocyte transformation test revealed an allergic reaction to at least one of the root filling materials in 39.46% of patients, with raw gutta percha (56%) and eugenol (19%) being frequent triggers.

Conclusion: Here, we demonstrate the involvement of root-treated teeth in inflammatory processes, as tooth extraction and renewed RCT could significantly reduce individual cytokine levels. Our data support the use of biomarkers for in vivo monitoring of treatment success.

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根管治疗与促炎过程的关系--一项真实世界的研究。
目的:根管炎症通常是由根管感染和根管治疗(RCT)后充填材料致敏引起的,有可能导致全身炎症和疾病。因此,我们旨在描述根管治疗后的炎症改变以及拔牙或重新根管治疗后的炎症分子水平:这项回顾性研究纳入了所有(共计 2585 名)有或无 RCT 病史的步行患者。在为期 3 年的观察期内,在拔牙或重新进行 RCT 之前和之后测量了血液中的 RANTES/CCL5(正常 T 细胞表达和分泌的活化调节因子/细胞因子配体 5)、C 反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)和白细胞介素-10(IL-10)的水平。对照组患者未接受任何牙科治疗:结果:49.38%的患者至少有过一次RCT病史。在 RCT 患者中,拔牙(p=0.03)和重新进行牙科 RCT(p=0.038)均可显著降低 RANTES/CCL5 值,而未治疗患者的 RANTES/CCL5 值则无显著增加。拔牙可降低 TNF-α 水平(p=0.014),但重新进行 RCT 和不进行干预则不会降低 TNF-α 水平。CRP水平在两种治疗方法中均无明显变化。拔牙明显降低了IFN-γ水平(p=0.003),而对照组患者的IFN-γ水平没有变化。IL-10水平在拔牙后无明显降低(p=0.061)。在 RCT 患者的子群中,淋巴细胞转化试验显示 39.46% 的患者对至少一种牙根充填材料产生过敏反应,其中生胶(56%)和丁香酚(19%)是常见的诱发因素:在此,我们证明了牙根处理过的牙齿参与了炎症过程,因为拔牙和重新RCT可以显著降低单个细胞因子的水平。我们的数据支持使用生物标志物对治疗成功与否进行体内监测。
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来源期刊
Pragmatic and Observational Research
Pragmatic and Observational Research MEDICINE, GENERAL & INTERNAL-
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期刊介绍: Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.
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