Endodonzia: tecniche cliniche, strumenti, materiali e casi complessi – Modulo 5: Endodonzia in presenza di patologie cliniche sistemiche: tecniche operative e loro determinante importanza

OBJECTIVES The aim is to identify the systemic patologies having the greatest impact in endodontics and dentistry. The anamnesis procedures, a correct therapy and follow-up are also reported. The different procedures that must be adopted for a correct endodontic treatment in presence of a patient with a systemic disease are also clinically discussed. MATERIALS AND METHODS Articles, systematic reviews and international guidelines were analysed to describe and discuss the most important procedures that general dentist/endodontist specialist must adopt when approaching a patient with systemic disease. RESULTS Elderly patients and with a systemic pathology often have destructive carious lesions and a root canal complexities such as root canal calcifications. Patient with cardiovascular disease must be classified in a risk category before performing endodontic treatment. Patients under bisphosphonate therapy must perform dental screening to identify teeth with endodontic pathologies. Endodontic treatment can be useful to avoid the extraction of compromised dental elements (and to reduce the risk of bisphosphonate-induced osteonecrosis). Patients with diabetes, especially if not controlled, have greater susceptibility to develop post-endodontic flareups, a greater percentage of complications (persistent periapical lesions, periodontal abscesses, loss of periodontal support) and a lower healing rate. Patients with severe kidney disease should be adequately monitored prior any endodontic and surgical treatment. The coagulation profile must be checked before each treatment, while particular attention must be exercised in the type of antibiotics and painkillers to be prescribed. CONCLUSIONS Endodontists must be prepared for a constant and massive increase in the number of systemic pathologies and complex “personalized” therapies that are characteristic not only of elderly patients. It is therefore necessary to “personalize” endodontic therapy by adapting it to the clinical needs of the patient. A constant interaction with the medical colleagues responsible is needed for the patient’s internal/cardiovascular/ oncological management. CLINICAL SIGNIFICANCE Both endodontist specialist and the generic dentist must prepare for this important change in the management of patients with systemic pathology. This change is now occurring and involves a great percentage of our patients. However, even younger patients may present systemic pathology requires a modification of normal endodontic procedure. Some pathologies and pharmacological therapies – such as bisphosphonates – need great attention. For this reason, a new concept of “Preventive Endodontics” or “Endodonzia preventiva” is born.