Association between diabetes and the prevalence of radiolucent periapical lesions in root-filled teeth: systematic review and meta-analysis

The question of whether diabetes mellitus can influence the outcome of root canal treatment (RCT) remains unclear. The aim of this systematic review and meta-analysis was to analyze scientific available evidence on the association between diabetes and the presence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). The review question was as follows: in adult patients who had endodontically treated teeth, does the absence or presence of diabetes result in an increase in the prevalence of RPL associated to RFT? A systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus search was conducted using the following MeSH and keywords: Diabetes Mellitus OR Diabetes OR Diabetic OR Hyperglycemia, AND Endodontics, Periapical Periodontitis, Periapical Diseases, Apical Periodontitis, Periradicular Lesion, Periapical Radiolucency, Radiolucent Periapical Lesion, Root Canal Treatment, Root Canal Preparation, Root Canal Therapy, Root Filled Teeth, Endodontically Treated Teeth. Seven studies reporting data on the prevalence of RPL associated to RFT both in diabetic and control subjects were included. After the study selection, seven epidemiological studies fulfilled the inclusion criteria, representing data from 1593 root canal treatments, 1011 in non-diabetic control subjects, and 582 in diabetic patients. The calculated pooled odds ratio (OR = 1.42; 95 % CL = 1.11-1.80; p = 0.0058) indicates that diabetic patients have higher prevalence of RFT with RPLs than controls. Available scientific evidence indicates that diabetes is significantly associated to higher prevalence of periapical radiolucencies in endodontically treated teeth, being an important putative pre-operative prognostic factor in RCT. Taking into account that diabetes is the third most prevalent chronic medical condition among dental patients, endodontic providers should be aware of the relationship between the outcome of endodontic treatment and diabetes.