Table 2.
Main features of human studies included on the review.
| Author, Year | Level of Evidence/Degree of Recommendation | Sample and Groups | Association AP and DM | Results |
|---|---|---|---|---|
| López-López et al., 2011 [40] | 3b/B/CS |
n = 100 TG: n = 50, patients with DM2 CG: n = 50, patients without DM |
Yes | DM2 is significantly associated with a higher prevalence of AP and root canal treatment. |
| NG YL et al., 2011 [30] | 2b/B/ PCT |
n = 1617 teeth in 1214 patients. Group 1: Primary RCT Group 2: Secondary RCT |
Nr | A 95% survival of primary and secondary root canal treatment after 4 years was found with 13 common factors, DM being one of the significant patient’s factors. |
| Marota et al., 2012 [31] | 3b/B/CS |
n = 90 TG: n = 30, patients with DM2 CG: n = 60, patients without DM |
Yes | A higher prevalence was found in patients with DM than in patients without previous history of DM. |
| Ferreira et al., 2014 [32] | 3b/B/RCT |
n = 62 TG: n = 37 teeth CG: n = 25 teeth |
No | No significant difference was found between both groups for AP. |
| Mesgarani et al., 2014 [41] | 3b/B/CS |
n = 122 Long-term DM patients (>48 months): n = 85 Short-term DM patients (<48 months): n = 37 |
Yes | The frequency of AP was more significant in patients with long-term DM than in those with short-term DM. |
| Sánchez-Dominguez et al., 2015 [33] | 3b/B/CS |
n = 83 CG: n = 24, good control DM (HbA1c < 6.5%) TG: n = 59, poor control DM (HbA1c > 6.5%) |
Yes | AP is significantly associated with HbA1c levels in patients with DM and root canal treatment. |
| Rudranaik et al., 2016 [34] | 2b/B/PCT |
n = 80 Group 1: n = 40, patients without DM Group 2: n = 40, patients with DM2 |
Nr | Patients with diabetes were more prone for chronic periapical disease with larger lesions. Healing outcome at one year was unsuccessful in poor controlled patients with diabetes when compared to fair and good controlled patients in group 2. |
| Segura-Egea et al., 2016 [11] | 1a/A/M |
n = 7 Epidemiological studies: 1593 teeth with root canal treatment GT: n = 582 patients with DM GC: n = 1011 patients without DM |
Yes | AP is significantly associated with diabetes with a higher prevalence of periapical lesions on the teeth with root canal treatment. |
| Smadi L. 2017 [35] | 3b/B/CS |
n = 291 patients Group 1: n = 145 patients; n = 3111; 409 teeth with DM + AP Group 2: n = 146 patients; n = 3127; 372 teeth with No DM + AP |
Nr | A higher prevalence of AP in DM patients but this difference was not statistically significant. |
| Arya et al., 2017 [36] | 2b/B/PCT |
n = 46 Group 1: 21 patients with DM/12 with DM + AP Group 2: 25 patients without DM/5 No DM + AP |
Nr | Periapical healing showed a significantly lower success rate at 1 year follow up in the type 2 diabetic group than the nondiabetic group. However, even among type 2 diabetics, 90% of cases showed an improved periapical status. No significant difference in healing between good controlled and poor controlled patients or those with raised HbA1c levels was found. |
| Al-Nazhan et al., 2017 [37] | 3b/B/CS |
n = 926 patients 36 patients with DM + AP 556 with no DM + AP |
Nr | This study revealed a higher prevalence of AP in diabetic subjects, although the sample of diabetic patients was small. |
AP: apical periodontitis; CG: control group; CS: cross-sectional study; DM: diabetes mellitus; DM2: diabetes mellitus type 2; M: meta-analysis; no-DM: no diabetes mellitus; HbA1c: glycated haemoglobin; n: sample; PD: periodontal disease; PCT: prospective clinical trial; RCT: retrospective clinical trial; TG: treatment group; Nr: not reported.