Healing of Apical Periodontitis in Patients with Inflammatory Bowel Diseases and under Anti-tumor Necrosis Factor Alpha Therapy

Cotti E1, Mezzena S2, Schirru E2, Ottonello O2, Mura M2, Ideo F2, Susnik M2, Usai P3. J Endod. 2018 Dec;44(12):1777-1782. doi: 10.1016/j.joen.2018.09.004. Epub 2018 Nov 1.

Author information

1 Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy. Electronic address: cottiend@tin.it.

2 Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy.

3 Department of Medical Sciences, Division of Gastroenterology, University of Cagliari, Cagliari, Italy.


INTRODUCTION: We evaluated healing after nonsurgical primary/secondary endodontic treatment of apical periodontitis (AP) in patients with inflammatory bowel diseases (IBDs) treated with anti-tumor necrosis factor alpha biologic medications (BMs).

METHODS: Nineteen patients with 22 teeth affected by AP from the gastroenterology unit of the hospital with IBDs under treatment with BMs formed the study group (the IBD group). Fourteen patients with 22 teeth with AP, matched by age and sex, without systemic diseases and not taking medications formed the control group. Teeth underwent primary or secondary root canal treatments and clinical and radiographic follow-up every 3 months for 24 months. The periapical index score was recorded, and 2 trained and calibrated endodontists evaluated and compared radiographs (weighted kappa values, κ = 0.8). The Mann-Whitney, t, chi-square, Fisher, and Bruner-Langer tests and analysis of variance-type statistics were used as appropriate.

RESULTS: The recall rate was 100%. All teeth in the IBD patients and 81% in the control patients healed (P = .108). Initial healing was appreciable at 3 months in the IBD group and 6 months in the control group (P = .174). Overall healing was reached at 6 and 10.5 months in the IBD and control groups, respectively (P = .106). At any time of the experiment, teeth in the IBD patients showed a higher probability of healing (P < .05). Both groups exhibited a similar decrement of the periapical index (P = .291), more significant for the IBD at the 3-month follow-up (P < .05). The 2 BMs used showed a similar trend of healing (P = .628).

CONCLUSIONS: The treatment of AP in patients taking BMs had no complications; furthermore, it was associated with faster healing than the controls. These results support the possible therapeutic aid of BMs in treating AP.

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