Title Diabetes Mellitus is Associated With Significant Reduction of The Success Rate of Endodontic Treatment of Teeth with Periradicular Lesions
Clinical Question Among patients who have root canal treatment, will treatment on patients with diabetes mellitus, as compared to the treatment on healthy patients, result in lower long-term success rate?
Clinical Bottom Line Patients with diabetes mellitus appear to have a significantly lower success rate for endodontic treatment. This finding is based on retrospective cohort studies and a cohort study.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
12555956Fouad/2003540 cases (incl. 73 patients with diabetes) with 2 years or more follow up data.Retrospective clinical record review
Key resultsElectronic health records were reviewed for patients having received nonsurgical endodontic therapy. For patients with diabetes mellitus, the overall 2+ year success rate was 68%. In patients with periapical pathology prior to initiation of treatment, patients with diabetes mellitus had a significantly lower success rate when compared to patients without diabetes mellitus (74% in patients from low glucose group (70-89mg/dL) as compared to 48% in patients from high glucose group (90-110 mg/dL).
14561970Britto/200353 subjects (30 patients with diabetes and 23 in control group).Retrospective clinical record review
Key resultsDiabetes is associated with decreased healing of periradicular lesions after endodontic treatment. Records from 30 diabetic patients and 23 control patients were assessed. Several covariates were analyzed. It was found that being a male with diabetes significantly reduced the success of nonsurgical endodontics with lesions at treatment initiation (p<0.05) or nonsurgical endodontic treatment without lesions at treatment initiation (p<0.05). These two variables individually did not produce a significant difference in treatment outcome.
15599359Marending/200566 patients recalled, 12 with compromised immune systemCohort study
Key resultsPatient’s non-specific immune system was found to significantly affect endodontic treatment outcome. 66 out of 84 patients were available for recall after ≥ 30 months (mean = 46 months) following RCT. Of the 66 available for recall, 12 patients had a compromised immune system and only 8 of the 66 teeth were considered “treatment failure”. Status of the immune system (P = .05), initial PAI (P = .04), and root filling quality (P = .01) were found to be the most important predictors for treatment outcome.
Evidence Search nonsurgical[All Fields] AND endodontic[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("diabetes mellitus"[MeSH Terms] OR ("diabetes"[All Fields] AND "mellitus"[All Fields]) OR "diabetes mellitus"[All Fields] OR "diabetes"[All Fields] OR "diabetes insipidus"[MeSH Terms] OR ("diabetes"[All Fields] AND "insipidus"[All Fields]) OR "diabetes insipidus"[All Fields]) ("immunity"[MeSH Terms] OR "immunity"[All Fields] OR ("immune"[All Fields] AND "status"[All Fields]) OR "immune status"[All Fields]) AND endodontic[All Fields] AND success[All Fields]
Comments on
The Evidence
Chart review or a cohort study are low quality of evidence due to risk of bias and lack of control of the variables being analyzed. Overall 659 subjects were followed up in these studies. In 2 studies there was approximately equal sex distribution and age range. The results suggest that patients with diabetes mellitus will have a lower long-term success rate than patients with normal immune systems. In particular, male patients and patients with periapical pathology at the initiation of treatment appear at greater risk of a poor treatment outcome. Fouad suggests that the significant reduction of microbial irritants during treatment is necessary to optimize prognosis, suggesting that one visit endodontic therapy on teeth with a pre-existing periapical lesion may be contraindicated, opting rather to place intracanal medicament to reduce the microbial load as much as possible. The evidence is weak due to study design (cohort studies) and higher quality research needs to be performed to establish more evidence based treatment decisions.
Applicability Clinicians should be aware that patients presenting with a positive history of diabetes mellitus may have a reduced success rate of RCT outcome compared to patents with a healthy immune system. In particular, male patients and patients with periapical pathology at the initiation of treatment may have compromised treatment outcomes.
Specialty (Endodontics) (General Dentistry)
Keywords Nonsurgical endodontics, diabetes mellitus, treatment outcome, periradicular lesion
ID# 2913
Date of submission 09/26/2015
Author Hayrapet Sahakyants
Co-author(s) e-mail
Faculty mentor Ethelyn Thomason, DMD
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
None available