Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis

Daniel Cabanillas-Balsera; Juan J Segura-Egea; María Bermudo-Fuenmayor; Jenifer Martín-González; María Carmen Jiménez-Sánchez; Victoria Areal-Quecuty; Benito Sánchez-Domínguez; Paloma Montero-Miralles; Eugenio Velasco-Ortega

doi:10.3390/jcm9113506

Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis

J Clin Med. 2020 Oct 29;9(11):3506. doi: 10.3390/jcm9113506.

Authors

Daniel Cabanillas-Balsera¹, Juan J Segura-Egea¹, María Bermudo-Fuenmayor¹, Jenifer Martín-González¹, María Carmen Jiménez-Sánchez², Victoria Areal-Quecuty¹, Benito Sánchez-Domínguez¹, Paloma Montero-Miralles¹, Eugenio Velasco-Ortega³

Affiliations

¹ Department of Stomatology, Section of Endodontics, School of Dentistry, University of Sevilla, 41009 Sevilla, Spain.
² Materials Science Institute of Sevilla (ICMS), Joint CSIC-University of Sevilla Center, 41092 Sevilla, Spain.
³ Department of Stomatology, Section of Comprehensive Dentistry, School of Dentistry, University of Sevilla, 41009 Sevilla, Spain.

Abstract

Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT).

Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279.

Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth-4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07-1.26; p = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias.

Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.

Keywords: endodontic medicine; persistent apical periodontitis; radiolucent periapical lesion; root canal treatment outcome; root-filled teeth; smoking habits.

Publication types

Review