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COMPARISION OF INTERLEUKIN- 1β CONCENTRATIONS IN POST-TREATMENT

ENDODONTIC DISEASE AND OTHER PULPAL AND PERIAPICAL CONDITIONS – A
CLINICAL STUDY

ABSTRACT
Aim
To evaluate IL-1β concentrations in PTF in persistent apical periodontitis
requiring endodontic retreatment and to compare the levels of IL-1β with
chronic apical periodontitis, symptomatic irreversible pulpitis, normal pulpal,
and periapical tissues.
Materials and methods
The patients were selected based on inclusion and exclusion criteria and
divided into 4 groups based on the pulpal and periapical status:
PTED: Teeth with post-treatment endodontic disease due to failed primary Root
Canal Treatment having periapical radiolucency
PNAP: Teeth requiring root canal treatment due to pulpal necrosis having
periapical radiolucency

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SIP: Teeth with symptoms of symptomatic irreversible pulpitis with healthy

periapical tissues)
IRCT: Teeth requiring intentional RCT (healthy pulp and periapical tissues)
The access cavity was redefined and the pre-existing filling was removed using
H-files. The root canals were minimally enlarged followed by collection of
periapical tissue fluid using paper points, in the case of group PTED. For groups
PNAP, SIP, and IRCT, conventional access cavity preparation was done followed
by enlargement of canals till 20, 0.02. Periapical tissue fluid (PTF) was collected
using 15, 0.02 size absorbent points 2mm beyond the apex. IL-1β levels were
assessed by Enzyme-Linked Immunosorbent Assay.
Results
A statistically significant difference was seen in levels of IL-1β in all the groups.
The highest concentration was seen in group PTED (85.07 ± 11.57pg/mL)
followed by group PNAP(37.60 ± 10.94 pg/mL), group SIP(8.40 ± 1.99pg/mL),
and the least was seen in group IRCT (3.47 ± 1.36pg/mL).
Conclusion
The levels of IL- 1β were highest in PETD cases followed by PNAP, SIP, and IRCT.
This indicates the severity of inflammation in PETD cases as compared to other
endodontic diseases.

INTRODUCTION
Root canal treatment has a success rate of 86%–98%
de Chevigny, C., Dao, T.T., Basrani, B.R., Marquis, V., Farzaneh, M., Abitbol, S. et
al. Treatment outcome in endodontics: the Toronto study—phase 4: initial
treatment. Journal of Endodontia, 2008; 34(3) 258– 263.

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. However, studies have reported that the prevalence of post-treatment

endodontic diseases (PTED) such as persistent, recurrent, or emerging apical
periodontitis can exceed up to 15%
Kirkevang, L.L., Vaeth, M. & Wenzel, A. Ten-year follow-up of root-filled teeth: a
radiographic study of a Danish population. International Endodontic Journal,
2014; 47(10), 980–988.
. PTED is defined as an "endodontic failure" that warrants a clinical decision
and action
European Society of Endodontology. Quality guidelines for endodontic
treatment: consensus report of the European Society of Endodontology.
International Endodontic Journal, 2006; 39, 921–930.
. There are numerous potential contributors and systemic consequences for the
complex and varied process of PTED
Kraus, R.D., von Arx, T., Gfeller, D., Ducommun, J. & Jensen, S.S. Assessment of
the non-operated root after apical surgery of the other root in mandibular
molars: a 5- year follow- up study. Journal of Endodontia, 2015; 41(4), 442– 446.
. Endodontic failure can be due to root canal complexity, insufficient cleaning,
shaping and obturation, and breach in asepsis protocol
Carr, G.B., Schwartz, R.S., Schaudinn, C., Gorur, A. & Costerton, J.W.
Ultrastructural examination of failed molar retreatment with secondary apical
periodontitis: an examination of endodontic biofilms in an endodontic
retreatment failure. Journal of Endodontia, 2009; 35(9), 1303–1309.
. Endodontic retreatment (ERT) is one of the treatment options in these cases
Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical
endodontic treatment by microscopic inspection during endodontic
microsurgery. J Endod. 2011;37:1516–9

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. PTED is an inflammatory condition that develops as a result of interaction

between microbial challenge and the host immune system
Toia, C.C., Khoury, R.D., Corazza, B.J.M., Orozco, E.I.F. & Valera, M.C.
Effectiveness of 1- visit and 2- visit endodontic retreatment of teeth with
persistent/secondary endodontic infection: a randomized clinical trial with 18
months of follow- up. Journal of Endodontia, 2022; 48(1), 4– 14.
,
Tazawa K, Azuma Presse MM, Furusho H, Stashenko P, Sasaki H. Revisiting the
role of IL-1 signaling in the development of apical periodontitis. Front Dent Med.
2022;3:985558. doi: 10.3389/fdmed.2022.985558. Epub 2022; 36938490
,
Colic M, Vasilijic S, Gazivoda D, Vucevic D, Marjanovic M, Lukic A: Interleukin-17
plays a role in the exacerbation of inflammation within chronic periapical
lesions. Eur J Oral Sci 2007; 115:315–320.
. During this process, numerous mediators of inflammation like interleukins (IL),
tumor necrosis factor (TNF), and matrix metalloproteinases (MMPs) are
released and play a role in periapical bone destruction
Prso IB, Kocjan W, Simic H, Brumini G, Pezelj-Ribaric S, Borcic J, et al: Tumor
necrosis factor-alpha and interleukin 6 in human periapical lesions. Mediators
Inflamm 2007; 2007:1–4
,
Chandwani ND, Gedam UD, Deshmukh R, Dakshindas DM, Shrigiriwar M. Mines
of cytokine: A treasure trove in pulpal and periapical diseases. J Conserv Dent
Endod. 2024 Mar;27(3):227-232. doi: 10.4103/JCDE.JCDE_289_23. Epub 2024
Mar 6. PMID: 38634023; PMCID: PMC11019815.
.

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IL-1β may be increased in PTED 21. It is a proinflammatory cytokine having

numerous effects in inflammatory cascade like increasing the expression of
collagenolytic enzymes, and MMPs, which contribute to extracellular matrix
degradation and in turn lead to bone resorption and tissue destruction
Takeichi, O., Saito, I., Tsurumachi, T., Moro, I., & Saito, T. Expression of
inflammatory cytokine genes in vivo by human alveolar bone-derived
polymorphonuclear leukocytes isolated from chronically inflamed sites of bone
resorption. Calcified Tissue International, 1996; 58(4), 244–248.
,
Schett, G., Dayer, J. M. & Manger, B. Interleukin-1 function and role in rheumatic
disease. Nat. Rev. Immunol. 2016; 12, 14–24
,
Choudhary A, Kesarwani P, Koppula S, Verma S, Saumya S, Srivastava P.
Quantification and distribution of mast cells in oral periapical inflammatory
lesions. J Conserv Dent. 2021 Nov-Dec;24(6):580-584. doi:
10.4103/jcd.jcd_505_21. Epub 2022 Apr 1. PMID: 35558681; PMCID:
PMC9089770.
. Furthermore, it upregulates RANKL and thus stimulates osteoclast genesis
Huynh, N. C., Everts, V., Pavasant, P. & Ampornaramveth, R. S. Interleukin-1beta
induces human cementoblasts to support osteoclastogenesis. Int. J. Oral Sci.
2017; 9, e5
. All these mechanisms lead to bone resorption and thus, formation of
periapical radiolucency.
Numerous investigations have found these inflammatory mediators in
periapical tissue fluid (PTF)
Stashenko P, Dewhirst FE, Peros WJ, Kent RL, Ago JM. Synergistic interactions
between interleukin 1, tumor necrosis factor, and lymphotoxin in bone

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resorption. J Immunol. 1987;138(5):1464-1468.

. The main goal of identifying these inflammatory markers is to understand the
disease process and this can act as a potential tool for aid in the diagnosis of
severity of disease condition and also to evaluate the treatment prognosis.
Also, it may pave the road to targeted therapy. These inflammatory mediators
can be identified by using various molecular diagnostic tools like ELISA, and
PCR.
Studies comparing concentrations of IL- 1β in PTED and comparing it with other
conditions like symptomatic irreversible pulpitis, pulpal necrosis with apical
periodontitis, and normal pulp cases are lacking. Therefore, this study aims to
compare the levels of IL- 1β in periapical tissue fluid (PTF) from root canals in
PTED and other endodontic disease conditions like pulpal necrosis
symptomatic irreversible pulpitis and healthy periapical tissue(requiring
intentional RCT) using ELISA.

MATERIALS AND METHODS

Study Design
This observational study was carried out in the outpatient unit of the
Department of Conservative Dentistry and Endodontics, Meenakshi Ammal
Dental College, Chennai. Ethical clearance was obtained from the Institutional
Ethical Committee (MADC/IEC-I/26/2022) and consent was obtained from
patients in the vernacular language. Patients of age 18-45 years, having no
systemic diseases and having periapical radiolucency with PAI score more than
2 in case of pulpal necrosis with periapical radiolucency and PTED with
periapical radiolucency. The exclusion criteria for this study were anti-
inflammatory and antibiotic therapy up to 1 week before starting endodontic
therapy, teeth having complex anatomy, or non-restorable.

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Based on clinical signs and symptoms and radiographic assessment, the

patients were categorized into the following groups:

Group PTED: Teeth with failed primary endodontic treatment having periapical
radiolucency (PAI score >2) ie, symptomatic persistent apical periodontitis,
symptomatic periapical abscess
Group PNAP: Teeth requiring root canal treatment due to pulpal necrosis with
apical periodontitis (PAI score >2) ie, symptomatic and asymptomatic apical
periodontitis
Group SIP: Teeth with symptoms of symptomatic irreversible pulpitis without
apical periodontitis
Group IRCT: Teeth requiring intentional RCT (healthy pulp and periapical
tissues)
Sample Size Calculation
A pilot study was conducted with a sample size of five in each group and using
the results obtained, the final sample size was calculated with the power of
80% and alpha error of 0.05, resulting in a sample size of 15 per group i.e. n =
60 18

METHODOLOGY

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All patients who fulfilled the eligibility criteria and signed an informed consent
form before the treatment were included in the study. Local anesthesia was
administered with 2% lignocaine with 1:80000 epinephrine (Lignox 2%) and
Rubber dam (Coltene Rubber Dam Kit Hygenic, Coltene Whaledent Pvt. Ltd,
Maharashtra) isolation was done. For each group following protocol was
followed.
Group PTED: Teeth with failed primary endodontic treatment (having periapical
radiolucency)
The cavity was redefined with a high-speed airotor handpiece (NSK Nakanishi
Inc., Japan) and water coolant. The pre-existing root canal filling was removed
with the help of H-files (Mani Inc., Tochigi, Japan) and ProTaper retreatment
files (Dentsply Sirona, Ballaigues, Switzerland) without using chemical solvent
Shah T, Ramesh S, Sugumaran S, Choudhari S. Endodontic retreatment efficacy
with and without solvents: A systematic review. J Conserv Dent Endod. 2023
Nov-Dec;26(6):610-615. doi: 10.4103/JCDE.JCDE_86_23. Epub 2023 Nov 22.
PMID: 38292751; PMCID: PMC10823971.
, followed by, physiological saline irrigation. An electronic apex locator (J
Morita, Europe GVBH, Frankfurt, Germany) and intraoral radiograph (Soredex™
Digora™ optime Intraoral X-ray, KaVo Dental, Biberach and der Riss, Germany)
were used to re-establish working length. Apical patency was established using
a 10-size K-file (Mani Inc., Tochigi, Japan). Minimal enlargement of canals was
done till the 25 K size file (Mani Inc., Tochigi, Japan). The canals were flushed
with normal saline to remove the debris which was then dried with the
absorbent points. A PTF sample was collected. After cleaning and shaping till
25, 0.06, calcium hydroxide as intra-canal medicament was placed for 1 week.
Subsequently, obturation was done using a cold lateral compaction technique
with the help of AH plus sealer and gutta-percha.

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Collection of PTF Sample

The periapical tissue fluid in the root canal was then obtained by using a
sterilized absorbent point of size #15, 0.02 (DiaDent Group International, South
Korea) which was inserted into the root canal 1mm beyond the established
working length. The absorbent point was held for 60s with the help of a tweezer
and a digital stopwatch was used to record the time. This procedure was
repeated three times. In case of bleeding, the absorbent point containing the
streak of blood was discarded, and after 1 minute, the periapical tissue fluid
was collected.
For groups PNAP, SIP, and IRCT, access opening was prepared using a high-
speed airotor handpiece (NSK Nakanishi Inc., Japan) with water coolant. An
electronic apex locator (J Morita, Europe GVBH, Frankfurt, Germany) and
intraoral periapical radiograph (Soredex™ Digora™ optime Intraoral X-ray, KaVo
Dental, Biberach an der Riss, Germany) were used to determine the working
length. Apical patency was determined using a 10 size K- file (Mani Inc., Tochigi,
Japan). After completing minimal canal enlargement till 20 K file (Mani Inc.,
Tochigi, Japan), the canals were irrigated with physiological saline and canals
were dried with absorbent points. PTF was collected as in group PTED. The
canals were obturated using a cold lateral compaction technique using AH plus
sealer and gutta percha after cleaning and shaping till 25, 0.06.
Sample collection and Storage
After sample collection it was stored in 1x phosphoric buffer solution at
samples were stored at -20°C. The ELISA test was conducted for the samples
using EliKine™ Human IL-1β ELISA.
Statistical analysis
Statistical analysis was done using SPSS (Statistical Package for Social
Sciences, version 23, IBM Corp., Armonk, New York). Student t-test was used to

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test the significant differences among the groups. All data was expressed in
mean standard deviation and percentage. The correlation between the
observed parameters was detected using the Pearson Correlation. (p< 0.05) in
group PTED and PNAP. In group SIP and IRCT correlation was not applicable.
Results
Sample were collected from a total of 60 patients (38 females, 22 males; mean
age 35 years) that is 15 patients in each group having multi-rooted teeth
(molars) were included.
In PTED, retreatment was done in 15 patients due to under-obturation in 8
patients, missed canals in 5 patients, and untreated canals in 2 patients.
The concentration of IL-1β was statistically significant in different endodontic
disease conditions. The highest concentrations were in cases that presented
with PTED followed by patients with pulpal necrosis with periapical
radiolucency(PNAP) then symptomatic irreversible pulpitis(SIP) and the least
was seen in cases requiring intentional root canal treatment(IRCT) as shown in
table 1.
Linear correlation was determined between the measured values of IL-1β
concentration and size of the radiolucency and symptoms of patients, by
applying the Pearson correlation test. The examined relationship between
these values demonstrated a high positive correlation in the size of
radiolucency and symptoms of patients with IL-1β concentration in PTED(r =
0.807, p < 0.05 for PAI score, and r = 0.775, p < 0.05 for symptoms) and low
positive value for PNAP (r = 0.61 for PAI score and r = 0.314, p < 0.05 for
symptoms) as shown in table 2. For group SIP and IRCT correlation was not
applicable.

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S.NO.
Group
Mean ± Standard deviation
Standard Error
P value
1
PTED
85.07 ± 11.57
2.9848
0.000
2
PNAP
37.60 ± 10.94
2.8230
0.000
3
SIP
8.40 ± 1.99
0.5146
0.000
4
IRCT
3.47 ± 1.36
0.3501
0.000

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Table 1: Expression of IL-1β in different clinical scenarios

Group
Symptoms
Pearson Correlation
Radiolucency size
Pearson Correlation
PTED
Pus discharge (6)
0.775
PAI Score
(PAI score 2- n= 6, PAI Score 3- n=9)
0.807
PNAP
Pain on percussion, pain (7)
0.314
PAI Score
(PAI score 2- n=8, PAI Score 3- n=7)
0.061
Table 2: Correlation between symptomatic cases and PAI score with IL-1β levels

Figure 1: Graphical representation of IL-1β concentration in different clinical

scenarios

Discussion

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Among the various important messengers involved in the progression of apical

periodontitis, 2 important messengers are IL-1 and TNF- α.
Matsuo T, Ebisu S, Nakanishi T, Yonemura K, Harada Y, Okada H. Interleukin-1
alpha and interleukin-1 beta periapical exudates of infected root canals:
correlations with the clinical findings of the involved teeth. J Endod. 1994;
20(9):432-5.
. IL-1 is a key mediator of pulpal and periapical inflammation and is released in
higher levels (12 folds)
Ataoğlu T, Ungör M, Serpek B, Haliloğlu S, Ataoğlu H, Ari H. Interleukin-1beta
and tumor necrosis factor-alpha levels in periapical exudates. Int Endod J.
2002; 35(2):181-5.
. Moreover, IL-1β is a potent osteoclastic mediator and is significantly higher in
PTF of teeth with larger radiolucent areas16. To our knowledge, this is the first
study conducted to compare the levels of IL-1 β in PTED and primary
endodontic infections like chronic periodontitis and symptomatic irreversible
pulpitis. Permanent molars having PAI scores of 2-3 were selected in PTED 2,
Martinho FC, Chiesa WM, Leite FR, Cirelli JA, Gomes BP. Correlation between
clinical/radiographic features and inflammatory cytokine networks produced
by macrophages stimulated with endodontic content. J Endod 2012; 38(6):
740−5.
and in patients with no systemic diseases
Kuo ML, Lamster IB, Hasselgren G. Host mediators in endodontic exudates. I.
Indicators of inflammation and humoral immunity. J Endod. 1998;24(9):598-
603.
. Cleaning and shaping were done till 20, 0.02, and following this samples were
immediately collected to decrease the influence of cleaning and shaping on IL-
1β levels

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Chapman, C.E. (1969) A microscopic study of the apical region of human

anterior teeth. Journal of the British Endodontic Society,3(4), 52– 58

,
Schindler R, Ghezzi P, Dinarello CA. IL-1 induces IL-1. IV. IFN-gamma suppresses
IL-1 but not lipopolysaccharide-induced transcription of IL-1. J Immunol.
1990;144:2216–2222.

.
Most periapical inflammatory mediators have been investigated either at the
transcriptome (ie, mRNA) using PCR or proteomic levels (i.e., actual released
protein or metabolite like inflammatory markers, antigen, antibody, etc) with
ELISA
Vogel C, Marcotte EM. Insights into the regulation of protein abundance from
proteomic and transcriptomic analyses. Nat Rev Genet. 2012;13(4):227-232.
. Due to post-transcriptional or translational changes, a weak correlation
between concentrations of protein and its respective mRNA has been seen
Vogel C, Abreu Rde S, Ko D, et al. Sequence signatures and mRNA concentration
can explain two-thirds of protein abundance variation in a human cell line. Mol
Syst Biol. 2010;6:400.
. Since ELISA assesses the protein itself, it is a better method for evaluating IL-
1β than PCR. Hence in this study, ELISA(sandwich technique) was used due to
its higher sensitivity
Kohl TO, Ascoli CA. Immunometric Double-Antibody Sandwich Enzyme-Linked
Immunosorbent Assay. Cold Spring Harb Protoc. 2017;2017(6):pdb.prot093724.
.
Bacterial infection is the primary cause of PTED

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Siqueira JF Jr, Rôças IN, Ricucci D, Hülsmann M. Causes and management of

post-treatment apical periodontitis. Br Dent J. 2014;216(6):305-312.
. Most often, an infection is found inside the root canal system (intra-radicular
infection)
Halkai RS, Hegde MN, Halkai KR. Evaluation of Enterococcus faecalis adhesion,
penetration, and method to prevent the penetration of Enterococcus faecalis
into root cementum: Confocal laser scanning microscope and scanning electron
microscope analysis. J Conserv Dent. 2016 Nov-Dec;19(6):541-548. doi:
10.4103/0972-0707.194025. PMID: 27994316; PMCID: PMC5146770.
, although it can spread to the peri-radicular tissues (extra-radicular infection).
The persistence or secondary nature of the intra-radicular infection depends
on the time at which the bacteria enter the root canal system. Microbes present
during the first therapy, but not effectively eradicated or controlled likely result
in persistent infection that can be attributed to either insufficient root canal
debridement or an imperfect root canal seal leading to PTED
Siqueira J FJr, Rôças I N. Clinical implications and microbiology of bacterial
persistence after treatment procedures. J Endod 2008; 34: 1291–1301.
. In this study, the highest levels of IL-1β levels were present in PTED which is
similar to the previous study
Popovska, Lidija & Dimova, Cena & Evrosimovska, Biljana & Stojanovska, Vera &
Muratovska, Ilijana & Cetenovic, Bojana & Marković, Dejan. Relationship
between IL-1β production and endodontic status of human periapical lesions.
Vojnosanitetski pregled. 2016; 74. 309-309. 10.2298/VSP151228309P.
. In contrast to this, a study by Henriques et al (2011), reported lower IL-1 mRNA
levels in cases of PTED. However, IL-1β levels were evaluated using PCR in that
study and hence the difference in result is seen 28.

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During PTED, IL-1β is a key cytokine in apical periodontitis that causes

increased local blood flow, neutrophil infiltration, and leucocyte recruitment in
the inflammatory site12. MMPs, collagenolytic enzymes, and cytokines like
PGE2 and RANKL that aid in the breakdown of extracellular matrix and
ultimately cause bone resorption and tissue damage, are upregulated in
expression when exposed to IL-1β
Kobayashi, M. et al. Role of interleukin-1 and tumor necrosis factor alpha in
matrix degradation of human osteoarthritic cartilage. Arthritis Rheum. 2005;52,
128–135
, 12. Hence, increased production of IL-1β could be the reason for the patient
presenting with symptoms of pain, tenderness on percussion, and swelling.
No direct studies are comparing IL-1β and clinical symptoms in patients
requiring retreatment due to PTED. However, studies aimed at associating IL-1β
levels with clinical symptoms in cases of pulpal necrosis with apical
periodontitis, have shown inconsistent results. Lim et al (1994), demonstrated
that peri-radicular lesions in humans with symptoms tended to have higher
levels of IL-1β than lesions without symptoms. Kuo et al. (1998) have
documented levels of IL-1β in the exudates suppurating teeth to be 3 times
greater than non-discharging canals16 Similar results were seen in this study,
IL-1β concentration(105pg/ml) was higher in patients having pain, tender on
percussion and pus discharge. Also, it was seen that a higher PAI score(2/3) had
a higher concentration of IL-1β. A high positive correlation was seen between
PAI score and symptoms with levels of IL-1β concentration which was
statistically significant. Although the correlation coefficient was determined
but severity of the symptoms was not analyzed. Further investigation in this
regard is required.
In PNAP, IL-1β values were similar to previous studies

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Braz-Silva PH, Bergamini ML, Mardegan AP, De Rosa CS, Hasseus B, Jonasson P.
Inflammatory profile of chronic apical periodontitis: a literature review. Acta
Odontol Scand. 2019 Apr;77(3):173-180.
, however, it was significantly lower than PTED and was significantly higher in
concentration when compared with SIP and IRCT. lower levels in PNAP than
PTED can be attributed to the pathogens that can withstand adverse conditions
created due to failed primary endodontic treatment than in pulpal necrosis and
apical periodontitis
Rôças IN, Siqueira JF Jr. Characterization of the microbiota of root canal-
treated teeth with posttreatment disease. J Clin Microbiol. 2012; 50(5):1721-4.
. Higher levels of IL-1β in PNAP as compared to SIP can be attributed to pulpal
necrosis that leads to the progression of inflammation in periapical tissues and
harbors micro-organisms that are more virulent. The highest concentration of
PNAP was (56pg/mL) in patients having PAI radiolucency 3 with symptoms of
pain, and tenderness on percussion. Which is similar to PTED and previous
studies 24. Interestingly, in this group, it was seen that patients who were
asymptomatic with PAI score 2 had IL-1β concentration at par with
symptomatic patients. This could be the reason for the low positive correlation
between the PAI score and symptoms with the IL-1β concentration. However,
the correct interpretation of these data to the amount of bone loss is not
possible, and a greater number of patients must be taken into consideration for
the correct interpretation of results.
In SIP, the disease is limited to the pulpal tissue and not the periapical tissues,
which were evaluated by clinical and radiographic examinations
Balachandran J, Gurucharan N. Evaluation of the correlation between dental
caries and periodontitis - A clinico- immunological analysis. J Conserv Dent.

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2020 May-Jun;23(3):280-283. doi: 10.4103/JCD.JCD_186_19. Epub 2020 Dec 4.

PMID: 33551600; PMCID: PMC7861068.
. The presence of IL-1β in SIP is significantly higher than in IRCT, suggesting that
the inflammation is progressing into the periapical tissues despite lacking any
clinical or radiographic signs or symptoms of apical periodontitis. As the
disease is restricted to the pulpal tissues and does not affect the periapical
tissues, the concentration of IL-1β is statistically significantly less than in the
PTED and PNAP groups. Since there are no previous studies evaluating IL-1β in
PTF of symptomatic irreversible pulpitis, therefore, results of this study can be
taken as a preliminary study for identifying the markers in PTF for evaluating
the prognosis of treatment or as a method to diagnose apical periodontitis.
However, further studies are required in this regard to device methods to
diagnose the disease more accurately and efficiently, making the treatment
more predictable.
In IRCT healthy pulpal and periapical tissues are present, hence the IL-1β
concentration is the least in this group. This is seen in previous studies as well
Henriques LC, de Brito LC, Tavares WL, Vieira LQ, Ribeiro Sobrinho AP. Cytokine
analysis in lesions refractory to endodontic treatment. J Endod. 201;
37(12):1659-62.

. The presence of IL-1β in IRCT indicates that inflammatory mediators are seen
in normal tissues and these inflammatory mediators increase on onset of
disease. This helps in limiting the disease in the local tissues and prevents
bacteremia
Graunaite I, Lodiene G, Maciulskiene V. Pathogenesis of apical periodontitis: a
literature review. J Oral Maxillofac Res. 2012; 2(4):e.
.

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Report: manuscript.edited

The strength of this study is that ELISA was used to evaluate IL-1β and
concentrations of IL-1β were compared in different endodontic disease
conditions. The limitations of this study are, the PA radiolucency being
assessed using 2 D imaging only, the Correlation between individual symptoms
and IL- 1β levels was not done and multiple proinflammatory mediators could
be involved in the disease progression, which requires further investigation.

CONCLUSION
Within the limitation of this study, IL- 1β levels were higher in PETD cases
followed by pulpal necrosis with periapical radiolucency, symptomatic
irreversible pulpitis, and cases requiring intentional RCT. PTED cases show a
strong positive correlation between symptoms and IL- 1β concentration. A weak
positive correlation was seen in pulp necrosis with PA radiolucency and
symptoms.

REFERENCES

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