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A growing body of research supports an association between periapical inflammation and an increased risk of developing systemic diseases. There is currently no scientific evidence to support a causal effect of inflammation on the onset of insulin resistance (IR) in patients with apical periodontitis (AP). The aim of this in vitro study was to evaluate any association between AP and levels of serum inflammatory factors potentially associated with the onset of IR, and to investigate the effect of root canal treatment (RCT) on these systemic inflammation markers and on the response in vitro to insulin. A total of 27 control subjects and 27 patients with AP were enrolled. Patients with AP underwent RCT and were followed-up 6 and 12 months post-treatment. Enzyme-linked immunosorbent assays were used to evaluate serum levels of proinflammatory cytokines interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor (TNF)-α. The response in vitro to insulin was assessed by measuring glucose consumption in a human pancreatic epithelioid carcinoma cell line treated with sera from healthy and AP subjects. At baseline AP was associated with significant higher levels of IL-1, IL-6, and IL-8 in the serum of untreated (AP) patients vs controls (P <.001). Glucose consumption decreased in pancreatic cells incubated with baseline serum from patients with AP, in a manner proportional to total cytokines amount. Notably, endodontic treatment was associated with reduced levels of cytokines (P <.001) and improved response to insulin in AP group (P <.001). Our findings suggest that AP may promote inflammatory-driven IR in an in vitro model, and that RCT may ameliorate inflammatory mediators in vivo and the cellular response to insulin in vitro. [ABSTRACT FROM AUTHOR]

To evaluate shear stress (SS) and normal pressure (NP) at the tooth-restoration interface of highly-filled flowable resin composite applied to deep margin elevation technique through FEM analysis generated by a microCT scan. A reference maxillary molar with two class II cavities was prepared according to deep margin elevation protocol. A geometrical model was segmented from a micro-CT scan generating separate volumes of enamel, dentin and restorative materials. The 3D Finite Element (FE) model was subsequently built-up and an axial chewing load was simulated. Data concerning the tooth-restoration interface were analyzed in terms of SS and NP. Different materials and techniques were tested in order to evaluate the effects of the restorative material, the usage of a highly-filled flowable composite as liner and the substrate of the cervical area. Both SS and NP presented similar distribution, but showed significant differences between tested materials. Composites showed more homogeneous behavior in stress distribution compared to ceramic. The use of a highly-filled flowable composite as liner on the cervical margin significantly reduced SS and NP on the cavity floor and the cervical margin area. Lastly, stress distribution in the cavity floor area varied according to the cervical margin substrate: enamel showed a protective role in stress distribution. Highly-filled flowable resin composites showed encouraging results when applied to deep margin elevation from an interfacial mechanical point of view. Further studies are needed to validate these data and to better define the role of cervical enamel in stress distribution. • Micro-CT can be used to create a realistic finite element model of the tooth-restoration complex. • Highly-filled flowable resin reduced shear and normal pressure stresses on the cavity floor. • Shear and normal pressure stresses presented similar distributions, being influenced by the different materials. • Resin-based materials showed a more homogeneous behavior in stress distribution compared to ceramic. [ABSTRACT FROM AUTHOR]