Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : ZC52 - ZC55 Full Version

Comparative Evaluation of Periapical Healing Outcome Following Non Surgical Endodontic Treatment in Single-visit versus Multiple-visit in Type 2 Diabetes Mellitus Patients: A Randomised Clinical Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60177.18121
Krushn Savaliya, KV Kishan, Nimisha Shah, Harshit Tushar Mavani, Manan Gaurang Shroff, Devashree Darak

1. Ex-Postgraduate Student, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India. 2. Professor and Head, Department of Conservative Dentistry and Endodontics, Srinivas Institute of Dental Sciences, Srinivas Nagar, Mukka, Suratkal, Mangaluru, Karnataka, India. 3. Professor and Head, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India. 4. Postgraduate Student, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India. 5. Postgraduate Student, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Surat, Gujarat, India. 6. Postgraduate Student, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Surat, Gujarat, India.

Correspondence Address :
Dr. KV Kishan,
Professor and Head, Department of Conservative Dentistry and Endodontics, Srinivas Institute of Dental Sciences, Srinivas Nagar, Mukka, Suratkal, Mangaluru-575021, Karnataka, India.
E-mail: drkishankv@yahoo.co.in

Abstract

Introduction: Apical periodontitis is very common in those with diabetes mellitus. Diabetes alters immunity, which impacts how periapical tissue heals. The decision between one-visit and multiple-visit root canal therapy is currently up for debate.

Aim: To compare periapical healing following single-visit endodontic therapy and multiple-visit endodontic therapy in type 2 diabetic patients by clinical assessment.

Materials and Methods: The present randomised single-blinded clinical trial was conducted in the Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from December 2017 to October 2019. A total of 46 patients having type 2 diabetes, indicated for root canal treatment participated in the study and were randomly split into two groups: group I: Single-visit endodontic treatment and group II: Multiple-visit endodontic treatment. Thereafter, endodontic treatment was carried out on all the patients and the patients were recalled for evaluation at 1-week, 3-month and 6-month time intervals. The clinical assessment was done based on the absence of pain, swelling and sinus tract formation. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0.

Results: Results showed that the success rate based on clinical assessment at one week for a single-visit and multi-visit group was 56.52% for both the groups and at three months 90.47% and 86.36%, respectively. At six months, the single-visit group reported 100% success, while the multi-visit group reported 95% success. However, the difference between the groups was not statistically significant.

Conclusion: Within the limitation of the study, it was concluded that clinically, a higher success rate was found after six months in patients having type 2 diabetes mellitus who were treated in a single-visit, which was not statistically significant.

Keywords

Apical periodontitis, Clinical assessment, Glycated haemoglobin, Intracanal medicament, Strindberg criteria

A genetically diverse collection of disorders known as diabetes mellitus affects protein, lipid and carbohydrate metabolism (1). It is also characterised by hyperglycaemia and is further classified into type 1 and 2. Among both types, level of the insulin may be normal or reduced in type 2 category of diabetes mellitus. Although a high deficiency of insulin does not occur, the target tissues are resistant to insulin because of the decrease in the number of insulin receptors available in the target cell (2).

Diabetes mellitus causes an alteration in the migration of polymorphonuclear cells, and an increase in the detection rate of anaerobic bacteria in the dental pulp of diabetic patients (3). High levels of glucose in blood can interfere with macrophage function resulting in wound healing. The vascular system also gets affected by atheromatous deposits, which are deposited in the basal lumen membrane of blood vessels, and could interfere with tissue nutrition and pulp repair (4).

Apical periodontitis is highly prevalent in type-2 diabetes mellitus. The periodontium in the apical region that arises from the pulpal region is inflamed and destroyed and appears as a radiolucency in the periapical area (1). The periapical tissues’ ability to heal is influenced by the non specific immune system. Thus, the preoperative status and altered immune response can have an impact on the dental pulp’s capacity for repair and the periapical healing (5).

Teeth having apical periodontitis can be treated by endodontic treatment. The success rate in such teeth is reported to be around approximately 87%. Single-visit endodontics has the advantage of reduced risk of interappointment infection compared to multiple visits, wherein there is a chance of loss of temporary restoration. Hence, the effectiveness of single-visit therapy is 6.3% better than multiple visits (6). Endodontic treatment typically requires several visits, with the length of the procedure being one of the primary causes (7). In necrosed teeth, application of an interappointment dressing such as calcium hydroxide should be done and then the canal can be obturated in the following visit (8).

There are conflicting data available in the literature regarding the success of single-visit and multiple-visit endodontics (9),(10). Hence, the current study was aimed to evaluate and compare the periapical healing outcome in both single-visit and multiple-visit endodontic therapy in patients suffering from type 2 diabetes by clinical assessment. The null hypothesis for the study was that no significant difference will be seen in periapical healing outcome for single-visit and multiple-visit endodontic therapy in patients suffering from type 2 diabetes.

Material and Methods

This was a randomised single-blinded clinical trial conducted in the Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from December 2017 to October 2019. Ethical approval (SVIEC/ON/DENT/BNPG17/D18007) was obtained from Institutional Ethical Committee to conduct the study. All the patients were informed about the benefits, harms, and alternative treatment choices before being included in the study, and informed consent was acquired from all the patients. Preoperative evaluation of periapical lesion was done clinically as well as radiographically.

Inclusion criteria: Patients between the age group of 25-70 years, with controlled diabetes based on Glycated Haemoglobin (HbA1c) level (11), who required endodontic intervention in single as well as multirooted teeth, with sufficient remaining tooth structure, and which could be restored by postendodontic restoration were considered in the study.

Exclusion criteria: Patients with history of smoking, pregnancy, steroid usage, uncontrolled diabetes or any other systemic illness, teeth with internal or external root resorption, non carious lesions, root caries, and cracked or fractured teeth were excluded from the study.

Sample size calculation: A sample size of 40 was achieved with 80% power to determine an effect size (W) of 0.40 using a 10 of freedom Chi-square test with a significance level (alpha) of 0.05 (6). Considering 15% drop-out, three extra samples were added to each group. Therefore, a total of 46 patients indicated for root canal treatment having type 2 diabetes participated in the study.

Study Procedure

All the patients were treated by the primary investigator. Sterilisation protocol was maintained and the treatment procedure was thoroughly monitored. Patients requiring endodontic therapy was randomly selected based on the flip coin method and divided into two groups; group I: Single-visit endodontic treatment and group II: Multiple-visit endodontic treatment.

In group I, administration of local anaesthesia (1:200000 lignocaine with adrenaline) was done, followed by rubber dam isolation. Access opening was done and the root canal orifices were located. Working length determination was done using apex locator (Root ZX mini, J Morita), and was confirmed radiographically. Cleaning and shaping were performed based on the canal configuration. The master apical file was determined corresponding to the initial apical file and it was confirmed radiographically. Irrigation was done using 5.25% sodium hypochlorite (Neelkanth), 17% Ethylenediaminetetraacetic acid (EDTA) (Prevest Dent Pro), and normal saline (0.9%w/v Otsuka) after changing each instrument and recapitulation. Chlorhexidine gluconate 2% (V-Consept) was used as a last irrigant. The obturation was completed with AH Plus sealer. The postendodontic restoration was done using nanohybrid composite (GC Solar X).

In group II, the root canal procedure was performed similarly to group I, except that in group II, calcium hydroxide (RC Cal, Prime dental) was the intracanal medicament used in the root canals, and temporary restoration was given for one week between two appointments. In the 2nd appointment, obturation was done followed by postendodontic restoration.

After the endodontic treatment, clinical evaluation and follow-up were carried out after 1-week, 3-months and 6-months. Since, it was a single-blinded study evaluation was done by a co-investigator who was blinded to whether the patient had undergone single-visit or multiple-visit endodontic treatment. Clinical assessment of periapical healing was done based on Strindberg’s criteria (12), i.e., the presence or absence of pain, swelling, and sinus tract formation.

Treatment was considered successful when: (a) tooth that had no preoperative periradicular radiolucency of endodontic origin and continued to show no radiographic or clinical abnormalities at the time of follow-up; and (b) tooth that had preoperative periradicular radiolucency but showed bone deposition or no apical rarefaction. The periodontal ligament space was intact or up to twice the width of neighbouring teeth at the time of follow-up examination.

53Treatment was considered a failure when: (a) there is periradicular pain, swelling or a sinus tract related to the tooth being evaluated; (b) Periradicular radiolucency has been developed after completion of treatment; and (c) preoperative lesion had not resolved or had partially resolved in six months with or without pain, swelling, a sinus tract or deep isolated probing of endodontic origin (13).

Statistical Analysis

Data were analysed using Statistical Package for Social Sciences (SPSS) software version 20.0 (IBM SPSS, IBM Corp., Armonk, NY, USA). Student unpaired t-test and Chi-square test were used to statistically evaluate the results. For all the analysis, p-value <0.05 was considered statistically significant.

Results

The mean age of group I patients’ was 42±14.5 years, whereas in group II, mean age was 47±13 years. No significant difference between the groups was found by unpaired t-test (p-value=0.087). There were 13 males and 10 females in group I, while in group II there were 11 males and 12 females. Chi-square test showed no significant difference between groups (p-value=0.554). On assessment of preoperative glycosylated haemoglobin, mean HbA1c of patients in group I was 7.9%, while in group II was 8.2% (Table/Fig 1). No significant difference was seen between the two groups (p-value=0.764)

In group I, 23 patients were examined at one week. Twenty one patients were examined at three months, i.e., 2 (8.69%) subjects lost to follow-up. At six months, 20 subjects were examined, i.e., 3 (13.04%) subjects lost to follow-up. In group II, 23 patients were examined at one week. Twenty one patients were examined at three months, i.e., 1 (4.34%) subject was lost to follow-up. At six months, 20 subjects were examined i.e., 3 (13.04%) subjects were lost to follow-up. (Table/Fig 2) shows a Consolidated Standards of Reporting Trials (CONSORT) flowchart of study enrollment and randomisation.

Comparison between Experimental Groups

The Chi-square test revealed a non significant difference between the two experimental groups in periapical healing at one week (p-value=0.056), three months (p-value=0.189), and six months (p-value=0.966) (Table/Fig 3).

The success and failure rate for group I and group II were 56.52% and 43.47%, respectively at one week (p-value=1.000). The success rate at six months for group I and II were 100% and 95%, respectively. While there were no failures in group I after six months, there was a 5% failure rate in group II after six months (p-value=0.311) (Table/Fig 4),(Table/Fig 5),(Table/Fig 6).

Discussion

In the present study, clinical assessment of periapical healing during the course of six months was done using Strindberg criteria (12), and the results showed that the rate of success of clinical assessment at one week for single-visit and multi-visit groups was 56.52%, at three months was 90.47% and 86.36%, respectively. At six months, 54the single-visit group showed a 100% success rate however, only 95% success was achieved in the multi-visit group. Statistically significant difference was not observed amongst both the groups over six months, but a clinically higher success rate was found in single-visit group as compared to the multi-visit group. It could result from less bacterial contamination in single-visit group as there was no need for provisional restoration, which might lead to microleakage in-between the appointments. It also minimises the possible chance of iatrogenic errors. However, more randomised controlled studies are required for further clinical and radiographic evaluation (14).

Diabetes mellitus is considered as a metabolic disease, that it is marked by high blood sugar levels brought on by a malfunction in insulin secretion (3). Among both types, type 2 is more common in which insulin production is diminished due to dysfunction of β-cells (15). During an inflammatory response, leucocytes get attached to the endothelial cells with the help of adhesion receptors on either of the cells whereas, in the case of diabetes mellitus, due to the down-regulation of adhesion molecules, the interaction between leucocytes and adhesion molecules is disturbed. Hence, the immune system is compromised and wound healing is impaired (16). Diabetes also promotes a decrease in osteoblast formation, which affects the specific bone matrix secretion. In addition, glucose transportation by osteoclast culture is about two times as high in bone in comparison to cultures from outside the bone. This increases the levels of bone resorption in hyperglycaemic conditions (14).

The main aim of endodontic therapy is to eliminate microorganisms by means of cleaning, shaping, disinfecting and filling the root canals, thereby creating a favourable environment for healing of the existing lesion (17). The rate of success of endodontic treatment of patients with diabetes is 62%, while it is regarded as high as 80% in non diabetic patients. In diabetes, various factors such as altered functions of leukocytes, decreased secretion of microphage growth factors, and increased release of proinflammatory cytokines affect the success rate of the endodontic treatment (15).

In the present study, diagnosis of diabetes was carried out by the estimation of the blood level of HbA1c in all the patients, which provides an accurate and objective measure of blood glucose levels in the previous three months (18).

Usually, endodontists favour carrying out a single-visit endodontic treatment for vital teeth. However, a dilemma exists whether to do a single-visit or multiple-visit therapy in cases of pulpal necrosis irrespective of the periapical status. In such cases, only chemomechanical preparation is not effective for the removal of bacteria as it may penetrate the dentinal tubules, lateral canals and apical deltas. Hence, placement of intracanal medicament is necessary for a longer period to decrease or remove bacteria which will lead to better healing (19).

In the present study, the biomechanical preparation technique was performed based on canal configuration and care was taken to avoid the periapical extrusion of debris, which could alter the healing potential [20,21]. Calcium hydroxide was the intracanal medicament used in the root canals of the multi-visit group. Numerous academic works claimed that the placement of intracanal medication increased success rates owing to its benefits, however the present study’s findings were in direct opposition to those claims (22).

The results of the present study are in agreement with the study done by Sathorn C et al., in which, single-visit root canal treatments were more effective, and had a recovery rate that was 6.3% greater than that of several visits, with no statistically significant difference between these two therapy modalities (23). Another study done by Rudranaik S et al., results of which revealed that the clinical and radiographic healing outcome of single visit endodontic therapy was delayed in diabetic patients, which was contradictory to the results of the present study (6). Su Y et al., in their systemic review stated that the healing rate for an infected tooth is similar for a single-visit as compared to multi-visit endodontic treatment. Patients reportedly suffer less instances of immediate postobturation discomfort after a single-visit endodontic treatment than those treated in multiple visits (24).

Limitation(s)

In the present study, the sample size was relatively smaller, thus more studies are required with a greater sample size, which will give a more accurate idea, regarding the periapical healing outcome. Radiographic assessment of the healing outcome requires a lot of standardisation and precision, which was not followed in the study.

Conclusion

Within the limitation of the study, it was concluded that clinically a higher success rate was found in single-visit endodontic therapy in type 2 diabetic patients after six months, which was statistically not significant. However, a greater number of samples and a longer duration of follow-up period are required for a further acceptable and reliable result.

References

1.
Arya S, Duban J, Tewari S, Sangwan P, Ghalaut V, Aggarwal S. Healing of apical periodontitis after nonsurgical treatment in patients with Type 2 diabetes. J Endod. 2017;43(10):1623-27. [crossref][PubMed]
2.
Marrota P, Fontes T, Armada L, Lima K, Rocas I, Sequeira J. Type 2 diabetes mellitus and prevalence of apical periodontitis and endodontic treatment in an adult Brazilian population. J Endod. 2012;38(3):297-300. [crossref][PubMed]
3.
Leite M, Ganzerla E, Marques M, Nicolau J. Diabetes induces metabolic alterations in dental pulp. J Endod. 2008;34(10):1211-14. [crossref][PubMed]
4.
Segura-Egea JJ, Jimenez-pinzon A, Rios-santos JV, Velasco-Ortega E, Cisneros- Cabello R, Poyato-Fwrrera M. High prevalence of apical periodontitis amongst Type 2 diabetic patients. Int Endod J. 2005;38(8):564-69. [crossref][PubMed]
5.
Ng YL, Mann V, Rahbaran S. Outcome of primary root canal treatment: A systematic review of the literature-part 2. Influence of clinical factors. Int Endod J. 2008;41(1):06-31.
6.
Rudranaik S, Nayak M, Badshet M. Periapical healing outcome following Single- visit Endodontic treatment in patients with type 2 diabetes mellitus. J Clin Exp Dent. 2016;8(5):498-504. [crossref][PubMed]
7.
Wong AW, Zhang C, Chu CH. A systemic review of non surgical single visit versus multiple-visit endodontic treatment. Clin Cosmet Investig Dent. 2014;8(6):45-56. [crossref][PubMed]
8.
Rao KN, Kandaswamy R, Umashetty G, Rathore VP, Hotkar C, Patil BS. Post- Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth. J Int Oral Health. 2014;6(2):28-32. [crossref][PubMed]
9.
Oginni AO, Udoye CI. Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital. BMC Oral Health. 2004;4(1):01-06. [crossref][PubMed]
10.
Gesi A, Hakeberg M, Warfvinge J, Bergenholtz G. Incidence of osteolytic lesions and clinical symptoms after pulpectomy–a clinical evaluation of one versus two-session treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:379-88. [crossref][PubMed]
11.
Colagiuri S. Glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus- practical implications. Diabetes research and clinical practice. 2011;93(3):312-13. [crossref][PubMed]
12.
Chugal N, Mallya SM, Kahler B, Lin LM. Endodontic treatment outcomes. Dental Clinics. 2017;61(1):59-80. [crossref][PubMed]
13.
Fouad AF, Burleson J. The effect of diabetes mellitus on endodontic treatment outcome: data from an electronic patient record. The Journal of the American Dental Association. 2003;134(1):43-51. [crossref][PubMed]
14.
Jiao H, Xiao E, Graves DT. Diabetes and its effect on bone and fracture healing. Curr Osteoporos Rep. 2015;13(5):327-35. [crossref][PubMed]
15.
Ferreira MM, Carrilho E, Carrilho F. Diabetes Meliitus and its influence on the success of endodontic treatment: A retrospective clinical study. Acta Med Port. 2014;27(1):15-22. [crossref][PubMed]
16.
Chakravarthy PV. Diabetes mellitus: An endodontic perspective. Eur J Gen Dent. 2013;2(3):241-45. [crossref]
17.
Figini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for endodontic treatment of permanent teeth: A Cochrane Systemic review. J Endod. 2007;34(9):1041-47. [crossref][PubMed]
18.
Dominguez B, Lopez J, Salas E. Glycated hemoglobin levels and prevalence of apical periodontitis in Type 2 diabetic patients. J Endod. 2015;41(5):601-06. [crossref][PubMed]
19.
Alomaym MA, Aldohan MF, Alharbi MJ, Alharbi NA. Single versus multiple sitting endodontic treatment: Incidence of postoperative pain- A randomised controlled trial. J Int Soc Prev Community Dent. 2019;9(2):172-77. [crossref][PubMed]
20.
Iqbal A. Antimicrobial irrigants in the endodontic therapy. Int J Health Sci (Qassim). 2012;6(2):186-92. [crossref][PubMed]
21.
Doumani M. A review: the applications of EDTA in endodontics (Part I). (IOSR- JDMS). 2017;16(9):83-85.
22.
Bansode PV, Pathak SD, Wavdhane MB, Phad LD. Single versus multi visit endodontic treatment of teeth with periapical pathology: A critical review. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2019;18(8):33-38.
23.
Sathorn C, Parashos P, Messer HH. Effectiveness of single-visit versus multiple- visit endodontic treatment of teeth with apical periodontitis: A systemic review and meta- analysis. Int Endod J. 2005;38(6):347-55. [crossref][PubMed]
24.
Su Y, Wang C, Ye L. Healing rate and post obturation pain of single versus Multiple-visit Endodontic treatment for infected root canals: A systematic review. J Endod. 2011;37(2):125-13.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/60177.18121

Date of Submission: Sep 16, 2022
Date of Peer Review: Nov 17, 2022
Date of Acceptance: Jan 27, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 03, 2022
• Manual Googling: Dec 21, 2022
• iThenticate Software: Jan 25, 2023 (18%)

ETYMOLOGY: Author Origin

EMENDATIONS: 7

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