Variation of vascular and blood indicators of early endothelial dysfunction after root canal therapy: A clinical and biomolecular study

Aim: Apical periodontitis (AP) is correlated with a higher risk of developing cardiovascular disease (CVD). No data currently exist to suggest that endothelial dysfunction (ED) improves after endodontic treatment in patients who have AP, despite a link between chronic AP and ED. This study was designed to investigate the expression of early ED markers in young adults with chronic AP, before and after root canal treatment. Methodology: 41 subjects (20 controls and 21 patients with AP) were examined at enrolment. Patients with AP were also assessed 2 and 12 months after treatment. ENDO-PAT was used to measure endothelial flow reserve (EFR) and ELISAs were used to assess plasma levels of interleukin (IL)-1, IL-6 and TNF-alpha, vasoconstrictor ED endothelin (ET)-1, the circulating endothelial adhesion markers intercellular adhesion molecule-1 (ICAM)-1/ CD54 and soluble vascular cellular adhesion molecule-1 (sVCAM)-1/CD106, soluble CD14, and the endothelial leukocyte adhesion molecule E-selectin. Results: Baseline serum levels of ET-1, ICAM-1, E-selectin, IL-1, and sCD14 were elevated in patients with AP compared to the control group. There was no macroscopic evidence of reduced EFR in either group. Treatment for AP was associated with reduced inflammation and improved early ED, indicated by a lowering of IL-1, sCD14, ET-1, ICAM-1/ CD54 and E-selectin levels to resemble those of control subjects. Conclusions: Early vascular ED may be driven by AP but is reversible with effective endodontic treatment

Endothelial Dysfunction Marker Variation in Young Adults with Chronic Apical Periodontitis before and after Endodontic Treatment

Introduction: Cardiovascular diseases are the leading cause of mortality worldwide. Apical periodontitis (AP) has been associated with an increased risk of cardiovascular diseases. A correlation has been shown between chronic AP and endothelial dysfunction (ED), but there is no evidence to indicate ED improves after endodontic treatment in patients with periapical lesions. The aim of this study was to investigate vascular and molecular markers of early ED before and after root canal treatment in young adults with chronic AP. Methods: Twenty control subjects and 21 patients with AP were assessed at baseline. The AP patients were also evaluated 2 and 12 months post-treatment. Endothelial flow reserve was assessed via an endothelial function test, and enzyme-linked immunosorbent assays were used to evaluate plasma levels of proinflammatory cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor alpha; vasoconstrictor ED marker endothelin (ET)-1; circulating endothelial adhesion markers intercellular adhesion molecule 1 (ICAM-1)/CD54 and soluble vascular cellular adhesion molecule (sVCAM)-1/CD106; soluble CD14; and the endothelial leukocyte adhesion molecule (E-selectin). Results: AP was associated with increased serum levels of ET-1, ICAM-1, E-selectin, IL-1, and sCD14, suggesting early vascular ED, with no macroscopic evidence of a reduction in endothelial flow reserve. Root canal treatment ameliorated inflammation and early ED, lowering plasma levels of IL-1, sCD14, ET-1, ICAM-1/CD54, and E-selectin to those of control subjects. Conclusions: Our findings suggest that AP may drive early vascular ED and that the endodontic therapy of AP ameliorates early ED