RECENT ADVANCES IN MANAGEMENT AND TREATMENT OF APICAL PERIODONTITIS
Apical periodontitis is an inflammatory response caused by pulp infection. It induces bone resorption in the apical and periapical regions of the tooth. The most conservative approach to treat this condition is nonsurgical endodontic treatment.
Because the jaws are in direct contact with the bone marrow through the teeth, there is no epithelial barrier that can limit the spread of the infection. Immunological responses play an important role in moderating the invasion of endodontic microbiota into other tissues. The pathogenic properties of bacteria play an active role in the inflammatory response, which ultimately results in the destruction of periapical tissues. Unfortunately, despite protective measures involving the use of the latest antimicrobial agents, root canal preparation, and root canal filling techniques, the incidence of endodontic failure remains high.
CONTEMPORARY THERAPIES:-
AREGENERATIVE ENDODONTICS – APICAL PERIODONTITIS
Research shows that regenerative endodontics is more effective than standard root canal treatment. Regeneration occurs in a sterile microenvironment, using tissue-forming processes to replace inflammatory tissues with local or ectopic tissues.
a) Three major factors in tissue engineering: stem cells, scaffolds, and growth factors. (b) Several stem cells including *SCAPs and *BMMSCs can differentiate into odontoblast-like cells. Biofilms integrated into dentin can activate the immune defence system and significantly affect the process of cell adhesion, and stem cell proliferation and differentiation. Root canal must be fully disinfected to promote regeneration. (c, d) Endogenous growth factors mainly come from dentin and blood clot in root canal, which can be released into root canal through root canal preparation and flushing. Platelet-rich plasma scaffolds showed significantly better results than platelet-poor plasma scaffolds, due to higher number of platelets which correspond to increased secretion of growth factors.B. BIOLOGIC MEDICATIONS FOR THE TREATMENT OF APICAL PERIODONTITIS
Biologic medications, biopharmaceuticals, and biological agents are substances that are manufactured or extracted from biological sources and target specific proinflammatory cells or their products. These include vaccines, blood components, recombinant tissue therapeutic proteins, stem cells, and gene therapy.
Bacterial invasion in the root canal stimulates periodontal cells and immunocytes to secrete proinflammatory cytokines (interleukin IL)-1, IL-6, tumor necrosis factor (TNF-α). (a) Biological medications, such as anti-TNF-α monoclonal antibodies (adalimumab), block the binding of TNF-α to TNF-α receptors, subsequently decreasing TNF-α and IL-6 production. (b-1) NC-2300, a cathepsine K inhibitor, inhibits the expression of TRAP and MHCII in osteoclasts. (b-2) Odanacatib inhibits osteoclast activation and differentiation. (b-3) AAv2 reduces the infiltration of T-cells and expression of osteoclasts and macrophages markers, such as Acp5, CD115, IL-1α, IL-1β, and IL-17a. (b-4) Atp6v1c1 inhibitors reduce bone resorption by impairing osteoclast activation and downregulate Th1 and Th17 expressionCONCLUSION
Challenges should be addressed by motivating patients, controlling risk factors, and, most importantly, by choosing the right treatment approaches. The worldwide prevalence of AP is high, and its treatment remains challenging. Both surgical and nonsurgical treatments have shown varying degrees of success; however, complete success has not been achieved. The findings from this review are not sufficient to conclude that modern nonsurgical treatments are the best treatment options for AP, although it can be established that they are better alternatives.
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