Title	Non-surgical Endodontic Therapy Success In The HIV Positive Patient Population
Clinical Question	In patients undergoing non surgical endodontic therapy, how does the HIV patient population compare to the non HIV patient population, in terms of lack of post treatment complications?
Clinical Bottom Line	In patients undergoing non surgical endodontic therapy, research shows that the HIV population compares similarly to non the HIV population by having exceedingly low or no post operative complications.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 11868838 Patton/2002 HIV positive and HIV negative subjects Systematic Review Key results HIV positive and HIV negative controls were evaluated at one to three months after final obturation to follow-up for post operative complications. Complication rates were exceedingly low in the HIV positive group (1/32) and nonexistent for the HIV negative control group. 16491142 Suchina/2006 HIV positive subjects Retrospective Clinical Study Key results Follow-up clinical evaluation found that non surgical endodontic therapy was successful in 88%, questionable in 10%, and failure in 2%. Mean periapical lesion size decreased by 71% after non surgical endodontic therapy. Radiographic evaluation was considered successful in 80%, no change in 15%, and failure in 5%. HIV infection and AIDS should not be considered as a contraindication to endodontic therapy due to the high degree of success in the majority of the HIV patients.
Evidence Search	pubmed.gov-->clinical queries-->Search "HIV, Root Canal"
Comments on The Evidence	Patton LL et., al. The sample included 48 adults males with a mean age of 34 years, 67% being HIV positive. A total of 57 teeth underwent endodontic therapy. The HIV positive patient who presented with the complication (pain and swelling after initial endodontic therapy) received local debridement and antibiotic therapy and no further complications occurred. Weaknesses in the study included limited sample size, failure to regularly take into account important group characteristics like socio-economic status, and lack of total number of studies. Individual studies used were assessed for validity. Suchina JA et alStudy followed 54 HIV patients for at least 6 months clinically post op and 26 months radiographically post op. Weaknesses in study included limited sample size, lack of a HIV negative control group, and not being a double blind study. There was 100% completion with subjects and adequate follow up.
Applicability	Some evidence implies that the rate of complications increases in patients with immuno-compromising conditions even though complications can result in any healthy individual undergoing dental procedures. Patients with HIV may be perceived to be at increased risk for complications with dental treatments. But the belief that HIV-infected patients have a greater potential for experiencing complications from dental treatment has been controversial.
Specialty	(Endodontics) (General Dentistry) (Restorative Dentistry)
Keywords	HIV, Non surgical endodontic therapy, root canal, complications, post operative complications, AIDS
ID#	2058
Date of submission	05/18/2011
E-mail	samuelt@livemail.uthscsa.edu
Author	Tom A. Samuel
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kevin M. Gureckis, DMD
Faculty mentor e-mail	gureckis@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by David Bingham and Kareem Metwalli (San Antonio, TX) on 11/29/2017 A PubMed search conducted in November of 2017 found a limited amount of related or updated evidence with regards to this published CAT. However, one comparative study done by Tootla. 2012 (PMID 23951785) supports the original conclusions of this CAT. The study results show that there was no significant difference in the final outcome of HIV+ and HIV- patients that underwent endodontic therapy. As discussed in the CAT, increased post-operative complications from non-surgical endodontic therapy with HIV positive patients remains controversial. Weakness in confidence to this question stems from lack of adequate research, small sample sizes and a failure to account for important group characteristics like socio-economic status, comorbidities etc.