Impairment of the angiogenic process may contribute to lower success rate of root canal treatments in diabetes mellitus

Abstract

Aim To investigate the association between root canal treatment outcome, diabetes mellitus, and alterations of the angiogenic process. Methodology A retrospective observational study was conducted in healthy (control group, CG) and diabetic (type II diabetes mellitus group, DG) patients after root canal treatment. The follow‐up appointments were performed to clinically and radiographically observe symptoms, the healing of periapical lesions and the quality of root fillings. In the animal model study, diabetic Goto‐Kakizaki (GK) rats and control Wistar rats were used. After 21 days of pulp exposure and the development of apical periodontitis (AP), the mandibles were removed for scintigraphic, radiographic, histopathological and molecular analyses. Chi‐square tests were performed to examine the variables related to endodontic outcome and differences between animal groups were assessed using the Student's t‐test. Results The group of patients with diabetes had a significantly lower rate of success following root canal treatment than the CG (p < .001). Logistic regression suggested that diabetes is a risk factor for success of root canal treatment. In the animal study, GK rats had significantly higher fasting glycaemia at t0 and t21 (p < .001) and triglycerides levels (p < .05) and area under the curve (AUC) during the insulin tolerance test at t21 (p < .001). AP area was significantly greater in GK rats (p < .05). Histologically, diabetic rats had increased signs of periodontal ligament inflammation 21 days after the induction of apical periodontitis, with fibro‐hyaline matrix filling and vessel with undefined walls. Wistar rats had significantly increased vascular endothelial growth factor (VEGF) levels and VEGF/Ang‐2 ratio 21 days after AP induction (p < .08; p < .07). GK rats had intrinsically lower levels of VEGF than control rats (p < .05), which did not change after AP. Conclusion Diabetes mellitus should be considered as an important factor in the prognosis of root canal treatment and its outcomes over time. Future strategies to improve angiogenesis and tissue repair should be pursued to achieve better root canal treatment outcomes in diabetic patients.

Impact of systemic health on treatment outcomes in endodontics

“…Another retrospective observational study has been conducted comparing the outcome of RCT in diabetic patients and control subjects, showing a significantly lower success rate following RCT in diabetics (Martinho et al, 2021). The same authors carried out an experimental study using Wistar rats, finding that diabetic rats with increased AP had angiogenic deficits and impaired tissue repair.…”

Interaction between apical periodontitis and systemic disease (Review)

“…In a retrospective case-control study, Uğur Aydın et al (61) assessed changes of fractal dimension and concluded that dM has a negative effect on the healing progress of periapical lesions after RcT. In the light of clinical and radiographic healing outcomes, the success rate of RCT is significantly lower in patients with DM or poor glycemic control due to impairment of the angiogenic process in dM (62,63), which is in accordance with other clinical studies (32,(64)(65)(66)(67). Similar results have been observed in patients with type 1 diabetes (68).…”

PROBE 2023 guidelines for reporting observational studies in endodontics: Explanation and elaboration

“…From Martinho et al (2021)—‘This retrospective clinical study revealed that type 2 diabetes mellitus (DM) is linked to a lower success rate of root canal treatment, when compared to controlling nondiabetic subjects in a Portuguese population sample. Moreover, type 2 diabetic rats with increased apical periodontitis (AP) supported such observations, showing angiogenic deficits and impaired tissue repair’.…”