Healing of Apical periodontitis-the Effect of Diabetes Mellitus and Tobacco Smoking
Condition: Periapical Periodontitis
MeSH terms: Periodontitis; Periapical Periodontitis; Diabetes Mellitus
Study type: Observational

Summary: 
      Apical periodontitis is an inflammatory process located around the apex of the root. It is
      mainly caused by a microbial infection of the pulp space. Diabetes mellitus and tobacco
      smoking are modulating factors that may influence the healing of apical periodontitis.
      Present studies have disclosed an association between smoking and apical periodontitis and
      diabetes mellitus and apical periodontitis. The aim of this study is to compare the healing
      of periapical bone in smokers and non-smokers and patients with diabetes mellitus type 2 and
      healthy participants. The hypothesis of this study is that smokers and patients diagnosed
      with diabetes mellitus will experience slower healing with a lower success rate in comparison
      to control groups. Apical periodontitis will be diagnosed through means of clinical
      examination and radiological analysis. Healing of apical periodontitis will be determined
      using periapical radiographs utilizing periapical index. This prospective study will
      contribute to the development of clinical guidelines concerning smokers and patients with
      diabetes mellitus type 2.
    

Detailed description: 
      Apical periodontitis is an inflammatory process located around the apex of the root. It is
      mainly caused by a microbial infection of the pulp space. Diabetes mellitus and tobacco
      smoking are modulating factors that may influence the healing of apical periodontitis.
      Present studies have disclosed an association between smoking and apical periodontitis and
      diabetes mellitus and apical periodontitis. The aim of this study is to compare the healing
      of periapical bone in smokers and non-smokers and patients with diabetes mellitus type 2 and
      healthy participants. The hypothesis of this study is that smokers and patients diagnosed
      with diabetes mellitus will experience slower healing with a lower success rate in comparison
      to control groups. Apical periodontitis will be diagnosed through means of clinical
      examination and radiological analysis. Healing of apical periodontitis will be determined
      using periapical radiographs utilizing periapical index (PAI). One observer will be
      calibrated by evaluation of periapical status in 100 reference radiographs according to
      periapical index scoring system .

      In each participant only one tooth will be included in the study. This will be first tooth
      submitted to endodontic treatment according to diagnostic priority. The survey will include
      only teeth with adequate endodontic treatment according to following criteria: post-operative
      periapical radiograph demonstrating adequate length and homogeneity of root canal filling (no
      visible voids, one millimeter shorter than radiologic apex) , and clinically and
      radiologically adequate permanent crown restoration. Participants will attend clinical and
      radiological follow-up in six months and one year following root-canal treatment to assess
      healing rate. In diabetic participants glycemic control will be determined according to the
      level of glycated hemoglobin, which is routine procedure in these patients. In smokers,
      intensity and duration of smoking habit will be recorded. This prospective study will
      contribute to the development of clinical guidelines concerning smokers and patients with
      diabetes mellitus type 2.
    

Intervention name(s): non-surgical endodontic treatment
Intervention type(s): Procedure
Intervention description(s): standard non-surgical endodontic treatment performed by endodontic specialist
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Cohort of patients attending Dental Clinic of the Rijeka Clinical Hospital Centre requiring
        root canal treatment of at least one tooth with radiological diagnosis of apical
        periodontitis.
      
Keywords: Diabetes mellitus; Periapical periodontitis; Smoking