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Histopathological Changes in Dental Pulp Associated with Periodontitis: A Systematic Review and Meta Analysis
Ibrahim, Christine Roushdy
Ibrahim, Christine Roushdy
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2025-05
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Oral Biology
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https://doi.org/10.34944/fc9c-s770
Abstract
Background: Periodontitis, a prevalent chronic inflammatory condition, impacts not only the tooth-supporting structures but may also induce significant histopathological changes in the dental pulp. While some studies suggest associations, others remain inconclusive, necessitating a comprehensive evaluation of this relationship.
Objectives: This systematic review and meta-analysis aim to assess histopathological changes in the dental pulp associated with periodontitis.
Methods: A comprehensive search was conducted in PubMed, Embase, Dentistry and Oral Science Source (EBSCOhost, CINAHL) and Web of Science Core Collections and manual search for studies published up to July 2024. Eligible studies focused on permanent human teeth with control groups. Study quality was assessed using the Joanna Briggs Institute risk of bias tool for case-control studies. Meta-analysis was performed using random-effects models to estimate pooled prevalence and odds ratio, with heterogeneity assessed by I² and τ² statistics.
Results: Teeth with periodontitis were significantly more likely to exhibit histopathological changes compared to controls. The odds ratio (OR) for calcification was 7.98 (95% CI: 0.83–76.84; p=0.07), with pooled event rates of 34% in periodontitis teeth versus 5% in controls. Fibrosis showed an OR of 7.34 (95% CI: 1.15–46.99; p=0.035), with event rates of 56% versus 19%. Necrosis was 42.31 times more likely in periodontitis teeth (95% CI: 4.66–364.91; p=0.001), with pooled event rates of 32% versus 2%. Inflammation was the most prevalent finding, with an OR of 18.96 (95% CI: 1.45–248.50; p=0.025) and pooled event rates of 63% in periodontitis teeth versus 9% in controls. High heterogeneity was observed for most outcomes, except necrosis (I²=0%). Meta- analysis was conducted for 4 out of the 8 studies included in the Systematic Review
Conclusion: This meta-analysis demonstrates a potential association between periodontitis and histopathological pulpal changes. Despite significant findings, high heterogeneity, confidence intervals and the limited number of studies reduce the reliability of prediction intervals. Further high-quality research with standardized methods is required to clarify this relationship.
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