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

Elisabetta Cotti; Silvia Mezzena; Elia Schirru; Olimpia Ottonello; Michela Mura; Francesca Ideo; Marta Susnik; Paolo Usai

doi:10.1016/j.joen.2018.09.004

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

J Endod. 2018 Dec;44(12):1777-1782. doi: 10.1016/j.joen.2018.09.004. Epub 2018 Nov 1.

Authors

Elisabetta Cotti¹, Silvia Mezzena², Elia Schirru², Olimpia Ottonello², Michela Mura², Francesca Ideo², Marta Susnik², Paolo Usai³

Affiliations

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.

PMID: 30390972
DOI: 10.1016/j.joen.2018.09.004

Abstract

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.

Keywords: Anti-TNF; Apical periodontitis; biologic medications; healing; inflammatory bowel diseases.

MeSH terms

Antibodies, Monoclonal / pharmacology
Antibodies, Monoclonal / therapeutic use*
Female
Follow-Up Studies
Humans
Inflammatory Bowel Diseases / complications*
Inflammatory Bowel Diseases / drug therapy*
Male
Middle Aged
Periapical Periodontitis / complications
Periapical Periodontitis / diagnostic imaging
Periapical Periodontitis / physiopathology*
Periapical Periodontitis / therapy*
Root Canal Therapy*
Time Factors
Treatment Outcome
Tumor Necrosis Factor-alpha / immunology*
Wound Healing* / drug effects

Substances

Antibodies, Monoclonal
Tumor Necrosis Factor-alpha