根尖周炎与局部边缘性牙槽骨丧失关系的回顾性研究

doi:10.13591/j.cnki.kqyx.2026.08.001

Abstract

Abstract:

Objective To investigate the association between apical periodontitis(AP) and local marginal alveolar bone loss(ABL) based on cone beam computed tomography(CBCT). Methods This study adopted an intra-subject contralateral paired design. A total of 48 patients with 60 pairs of matched teeth were included. Teeth with definite apical periodontitis, defined as a CBCT-periapical index(CBCT-PAI) score ≥3, were assigned to the AP group, while the contralateral teeth with normal periapical status(PAI≤1) served as the control group. ABL was measured on CBCT images, and the alveolar bone loss percentage(ABL%) was calculated. Group comparisons were performed using the Wilcoxon signed-rank test, McNemar test, and Stuart-Maxwell test. Multivariable linear mixed-effects models(LMMs) were used to evaluate the trend association between CBCT-PAI scores and the extent of bone loss. Results The AP group showed significantly greater mean ABL and ABL percentage than the control group. The impact of AP on alveolar bone loss is more significant in the anterior teeth and molars. After adjustment for tooth type and other relevant factors, AP remained an independent factor associated with increased mean ABL and ABL percentage. Among AP teeth, each 1-point increase in CBCT-PAI score was associated with a 0.64 mm increase in mean ABL and a 5.07% increase in ABL percentage. Conclusion Apical periodontitis is significantly associated with increased local marginal ABL.

Key words: apical periodontitis, alveolar bone loss, intra-subject paired study, periapical index, endodontic-periodontal relationship

CLC Number:

R781.4

SUN Xu, LI Jin, SHEN Da, WANG Xue. Relationship between apical periodontitis and local marginal alveolar bone loss: A retrospective study[J]. Stomatology, 2026, 46(8): 561-566.

Figures/Tables 7

Fig.1

Tab.1

Fig.2

Tab.2

Tab.3

Tab.4

Fig.3

References 21

[1]	Jivoinovici R, Suciu I, Dimitriu B, et al. Endo-periodontal lesion: Endodontic approach[J]. J Med Life, 2014, 7(4):542-544. pmid: 25713618
[2]	Bakhsh A, Joseph S, Mannocci F, et al. Apical periodontitis microbiome association with salivary and serum inflammatory burden[J]. Int Endodontic J, 2025, 58(3): 504-515. doi: 10.1111/iej.v58.3
[3]	Jansson L, Ehnevid H, Lindskog S, et al. Relationship between periapical and periodontal status: A clinical retrospective study[J]. J Clin Periodontol, 1993, 20(2): 117-123. pmid: 8436630
[4]	Ehnevid H, Jansson L, Lindskog S, et al. Periodontal healing in teeth with periapical lesions: A clinical retrospective study[J]. J Clin Periodontol, 1993, 20(4): 254-258. doi: 10.1111/j.1600-051x.1993.tb00354.x pmid: 8473535
[5]	Jansson L, Ehnevid H, Lindskog S, et al. The influence of endodontic infection on progression of marginal bone loss in periodonti-tis[J]. J Clin Periodontol, 1995, 22(10): 729-734. pmid: 8682918
[6]	Stassen IGK, Hommez GMG, De Bruyn H, et al. The relation between apical periodontitis and root-filled teeth in patients with periodontal treatment need[J]. Int Endodontic J, 2006, 39(4): 299-308. doi: 10.1111/iej.2006.39.issue-4
[7]	Timmerman MF, Vander Weijden GA. Bone level around endodontically treated teeth in periodontitis patients[J]. J Clin Periodontol, 2006, 33(9): 620-625. pmid: 16856903
[8]	Jansson L. Relationship between apical periodontitis and marginal bone loss at individual level from a general population[J]. Int Dent J, 2015, 65(2): 71-76. doi: 10.1111/idj.12143 pmid: 25412991
[9]	Ruiz XF, Duran-Sindreu F, Shemesh H, et al. Development of periapical lesions in endodontically treated teeth with and without periodontal involvement: A retrospective cohort study[J]. J Endod, 2017, 43(8): 1246-1249. doi: 10.1016/j.joen.2017.03.037
[10]	El Ouarti I, Chala S, Sakout M, et al. Prevalence and risk factors of apical periodontitis in endodontically treated teeth: Cross-sectional study in an adult moroccan subpopulation[J]. BMC Oral Health, 2021, 21(1): 124. doi: 10.1186/s12903-021-01491-6 pmid: 33731077
[11]	Sǎlceanu M, Dascǎlu C, Melian AC, et al. Assessment of periodontitis risk factors in endodontically treated teeth: A cross-sectional study[J]. Diagnostics, 2024, 14(17): 1972. doi: 10.3390/diagnostics14171972
[12]	Estrela C, Bueno MR, Azevedo BC, et al. A new periapical index based on cone beam computed tomography[J]. J Endod, 2008, 34(11): 1325-1331. doi: S0099-2399(08)00733-4 pmid: 18928840
[13]	Mackiewicz E, Bonsmann T, Kaczor-Wiankowska K, et al. Volumetric assessment of apical periodontitis using cone-beam computed tomography: A systematic review[J]. Int J Environ Res Public Health, 2023, 20(4): 2940. doi: 10.3390/ijerph20042940
[14]	Mahasneh SA, Al-Hadidi A, Kadim Wahab F, et al. A cone beam CT study on the correlation between crestal bone loss and periapical disease[J]. J Clin Med, 2023, 12(6):2423. doi: 10.3390/jcm12062423
[15]	Patil BA, Shakeel S. Evaluation of endo perio lesions using cone beam computed tomography (CBCT): A cross sectional study[J]. Int J Periodontics Restorative Dent, 2023, 43(7): s235-s243.
[16]	Sǎlceanu M, Melian A, Dascǎlu C, et al. Endo-periodontal lesions in endodontically treated teeth with periapical pathology[J]. Diagnostics (Basel), 2025, 15(13):1663.
[17]	Chen B, Zhu Y, Lin M, et al. Expert consensus on the diagnosis and therapy of endo-periodontal lesions[J]. Int J Oral Sci, 2024, 16(1):55. doi: 10.1038/s41368-024-00320-0 pmid: 39217161
[18]	Ruetters M KimTS, Krisam J, et al. Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients: A retrospective pilot study[J]. Clin Oral Investig, 2021, 25(4): 2373-2380. doi: 10.1007/s00784-020-03560-6
[19]	Gill S, Tabiyar K, Balachandran R, et al. Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: A systematic review and meta-analysis[J]. Clin Oral Investig, 2023, 27(11): 6371-6382. doi: 10.1007/s00784-023-05286-7
[20]	Fan YQ, Sun F, Zhu QY, et al. Effects of different treatment sequences on the efficacy of combined periodontal-endodontic lesions: A systematic review and meta-analysis[J]. Int Dent J, 2026, 76(1): 104021. doi: 10.1016/j.identj.2025.104021
[21]	Al-Sibassi A, Niazi SA, Clarke P, et al. Management of the endodontic-periodontal lesion[J]. Br Dent J, 2025, 238(7): 536-544. doi: 10.1038/s41415-025-8327-x

变量	根尖周炎组	对照组	检验方法	P
近中ABL/mm	3.90±1.71	3.46±1.50	Wilcoxon检验	<0.001^***
远中ABL/mm	3.86±1.69	3.48±1.60	Wilcoxon检验	0.002^**
平均ABL/mm	3.88±1.68	3.47±1.53	Wilcoxon检验	<0.001^***
ABL比例/%	28.85±12.50	25.52±11.39	Wilcoxon检验	<0.001^***
ABL分级/n(%)			Stuart-Maxwell检验	0.052
轻	9(15.0)	14(23.3)
中	28(46.7)	29(48.3)
重	23(38.3)	17(28.3)
存在角形骨缺损/n(%)	19(31.7)	20(33.3)	McNemar检验	>0.999
存在根分叉受累/n(%)	5(17.2)	6(20.7)	McNemar检验	>0.999

牙型	变量	根尖周炎组	对照组	P
前牙	平均ABL/mm	3.15±1.37	2.63±1.33	0.011^*
	ABL比例/%	22.74±9.48	18.95±9.77	0.006^**
	ABL分级/n(%)			0.062
	轻	5(29.4)	10(58.8)
	中	9(52.9)	4(23.5)
	重	3(17.6)	3(17.6)
前磨牙	平均ABL/mm	4.00±2.07	3.36±1.63	0.060
	ABL比例/%	28.80±14.96	24.34±11.26	0.132
	ABL分级/n(%)			0.607
	轻	3(21.4)	3(21.4)
	中	6(42.9)	8(57.1)
	重	5(35.7)	3(21.4)
磨牙	平均ABL/mm	4.26±1.56	4.01±1.41	0.040^*
	ABL比例/%	32.46±11.74	29.94±10.62	0.009^**
	ABL分级/n(%)			0.264
	轻	1(3.4)	1(3.4)
	中	13(44.8)	17(58.6)
	重	15(51.7)	11(37.9)

结局变量	影响因素	β(95% CI)	P
平均ABL/mm	根尖周炎	0.30(0.00,0.61)	0.050
	根长	0.29(0.02,0.55)	0.035^*
	根管治疗史	0.14(-0.29,0.58)	0.521
	桩核修复史	-0.58(-1.17,0.01)	0.053
	存在冠部修复体	0.31(-0.07,0.69)	0.110
	牙型(Ref:前牙)
	前磨牙	0.17(-0.38,0.73)	0.540
	磨牙	0.75(0.23,1.26)	0.005^**
ABL比例/%	根尖周炎	2.24(0.01,4.47)	0.049^*
	根管治疗史	0.94(-2.27,4.14)	0.563
	桩核修复史	-4.11(-8.35,0.12)	0.057
	存在冠部修复体	2.26(-0.53,5.05)	0.110
	牙型(Ref:前牙)
	前磨牙	1.40(-2.70,5.51)	0.500
	磨牙	5.29(1.65,8.92)	0.005^**

研究对象	结局变量	β(95% CI)	P
全部牙齿	平均ABL/mm	0.11(0.05,0.18)	0.001
(n=120)	ABL比例/%	0.92(0.44,1.40)	<0.001
仅根尖周炎牙齿	平均ABL/mm	0.64(0.26,1.03)	0.002
(n=60)	ABL比例/%	5.07(2.10,8.04)	0.001

Relationship between apical periodontitis and local marginal alveolar bone loss: A retrospective study

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 21

Related Articles 14

Recommended Articles

Metrics

Comments

[1]	WANG Ke, YOU Jing, LU Wei. Evaluation of the efficacy of selective curettage in endodontic microsurgery [J]. Stomatology, 2024, 44(5): 375-380.
[2]	LEI Gang, WEI Xin, YAN Ming, ZHOU Lili, YU Jinhua, WANG Juan, WU Jintao. Clinical effects of iRoot BP plus and mineral trioxide aggregate in treatment of apical periodontitis with open apical permanent teeth [J]. Stomatology, 2023, 43(2): 118-124.
[3]	YAN Fei, YAO Ning. Clinical effects of apexification for immature premolars with different root canal shapes [J]. Stomatology, 2022, 42(2): 149-152.
[4]	. Diagnosis and treatment of radicular cyst resulting from apical periodontitis of primary teeth: A case report [J]. , 2021, 41(11): 1016-1018.
[5]	. Application of CBCT in the evaluation of resolution of maxillary sinus mucositis from maxillary teeth with apical periodontitis after endodontic treatment [J]. , 2019, 39(7): 612-615.
[6]	. Efficacy evaluation of root canal disinfectant alleviating clinical symptoms of periapical periodontitis of primary molar teeth [J]. , 2018, 38(8): 728-730.
[7]	. Intentional replantation for a mandibular molar of refractory periapical periodontitis: a case report [J]. , 2018, 38(7): 636-638.
[8]	. The clinical research of the rotary nickeltitanium instruments and the ultrasonic root canal irrigation which were applied to the single-visit root canal therapy of the chronic apical periodontitis [J]. , 2018, 38(2): 162-165.
[9]	. fimA genetic polymorphism of Porphyromonas gingivalis in periapical periodontitis [J]. , 2016, 36(1): 18-21.
[10]	. A type III dens invaginatus in mandibular lateral incisor and a literature review [J]. , 2015, 35(5): 399-401.
[11]	. Status of extraradicular bacterial colonization in teeth with persistent periapical periodontitis [J]. , 2015, 35(2): 85-88.
[12]	. Comparison of two different treatments on acute periapical periodontitis of primary teeth [J]. , 2015, 35(11): 933-935.
[13]	. Randomized controlled clinical studies of Light-SpeedLSX system in single-visit and two-visit root canal treatment of chronic apical periodontitis [J]. , 2015, 35(10): 864-866.
[14]	. Therapeutic evaluation of active silver ion antibacterial solution in treatment of periapical periodontitis [J]. , 2014, 34(12): 901-903.