Improving the Effectiveness of Treatment of Dental Pulp Injuries in Patients with Chronic Periodontitis: Clinical, Radiological, and Immunological Evaluation
chronic periodontitis, pulp injury, endoperiodontal lesions, cone-beam computed tomography, electroodontodiagnostics, cytokines, alexidine, ultrasonic irrigation, bioceramic sealer.
AuthorsAbstractChronic periodontitis is a major cause of tooth loss in the world. Combined lesions of the periodontium and dental pulp are often closely related, and often occur without any symptoms and signs, resulting in delay in diagnosis and irreversible tissue loss. To establish an algorithm for diagnosis and an optimized therapeutic regimen for dental pulp injuries in chronic periodontitis patients to enhance the treatment results. A clinical study with 154 patients (35–40 years) with chronic periodontitis and secondary pulp involvement was undertaken. The PMA index, PI index and CPITN index were used to evaluate periodontal status. Cone-Beam Computed Tomography (CBCT) was used for bone destruction evaluation and for pulpal pathways evaluation, while electro-odonto diagnostics (EOD) was used for evaluating vitality. Levels of IL-, IL-, TNF- and IL-10 were measured by ELISA to arrive at an IL-1β/IL-10cytokine balance index in gingival crevicular fluid (GCF). Patients were treated with optimized treatment consisting of standard periodontal therapy, passive ultrasonic activation (PUA) of alexidine irrigation with 0.1% and calcium-silicate bioceramic obturation, and followed up for 12 months. Deep periodontal pockets, furcation involvement, large amounts of alveolar bone loss and reduced electrical excitability were good predictors of retrograde pulpal disease. A cytokine balance index >6.0 was a reliable biological index for irreversible pulpitis. The optimized protocol was highly effective in controlling local inflammation, improving periodontal parameters and with clinical success of 92.1%. Combining 3D imaging, functional EOD and analysis of cytokines by GCF allows for early precise diagnosis of retrograde pulp injuries. The use of PUA-energized alexidine along with bioceramic sealers, increases the efficacy of disinfection of the root canals and helps in the regeneration of tissues, thus preserving the tooth for a long time.
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