Endodontic medicine: interrelationships among apical periodontitis, systemic disorders, and tissue responses of dental materials

Abstract: Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors—systemic diseases, endodontic infection, and endodontic dental materials—and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing.

摘要：牙髓医学（Endodontic medicine）聚焦牙髓感染（endodontic infections）与全身性疾病（systemic diseases）之间的双向关联，目前已在牙髓病学领域备受关注。大量研究证据表明，全身性疾病可影响牙髓感染的发病机制，反之牙髓感染亦可引发全身性病理改变。这类改变包括根尖周区域（periapical area）更严重的骨吸收与炎症反应，以及全身性疾病症状的加重。类似地，多项研究报告也阐述了全身性疾病对牙科材料（dental materials）相关组织应答的影响。反之，局部应用牙科材料则可能通过改变生物标志物（biomarkers）的生成水平，引发全身性效应。因此，深入探究上述关联背后的作用机制具有重要学术意义。基于此背景，本综述旨在分析并讨论当前关于三大关联因素——全身性疾病、牙髓感染及牙髓治疗用牙科材料——的现有文献，以阐明这些关联如何影响全身性健康状态与以根尖周创口愈合（periapical wound healing）为代表的牙髓治疗预后效果。