RADIOLOGICAL ASSESSMENT OF THE PREVALENCE AND LOCATION OF ROOT RESORPTION IN EPILEPTIC PATIENTS: AN OBSERVATIONAL STUDY

Abstract

Objective Antiepileptic drugs used in the treatment of epilepsy patients have a negative effect on bone tissue, but as far as we know, tooth root resorption has not been investigated in these patients. The aim of this study was to evaluate the prevalence of external and internal root resorption and its distribution according to resorption sites in epilepsy patients using antiepileptic drugs. Material and Method Panoramic radiographs obtained before dental treatment were evaluated. While the case group consisted of only those with epilepsy, the control group included healthy subjects. The presence/absence of external and internal resorption of all teeth (except the third molars), region of resorption (cervical, middle, and apical region of the root), age, and sex were recorded in an excel file. Independent sample t-test or Mann- Whitney U test according to normality of distribution and a chi-square test to compare categorical variables were used. Results The resorption in 93 (21.9%) of 424 patients (236 healthy subjects and 188 epileptic patients), the groups did not significantly differ by the presence of external and internal resorption (p = 0.089 and 0.746). It was more common in those over 30 years and males (p = 0.018 and 0.013). Conclusion We concluded that the presence of resorption in epilepsy patients was not different from healthy subjects. However, in patients with epilepsy, resorption was mostly seen in the lower molars and middle 1/3 regions. Clinicians should consider our results when treating these patients.

Keywords

• Antiepileptic Drug
• Epilepsy
• Panoramic Radiography
• Resorption

EPİLEPSİ HASTALARINDA KÖK REZORPSİYON PREVALANSININ VE LOKASYONUNUN RADYOLOJİK DEĞERLENDİRMESİ–GÖZLEMSEL BİR ÇALIŞMA

Abstract

Amaç Epilepsi hastalarının tedavisinde kullanılan antiepileptik ilaçlar kemik dokusu üzerinde olumsuz etki yapmaktadır ancak bildiğimiz kadarı ile bu hastalarda diş kökü rezorpsiyonu araştırılmamıştır. Bu çalışmanın amacı, antiepileptik ilaç kullanan epilepsi hastalarında eksternal ve internal kök rezorpsiyon prevalansını ve rezorpsiyon bölgelerine göre dağılımını değerlendirmektir. Gereç ve Yöntem Diş tedavisi öncesi elde edilen panoramik radyografiler değerlendirildi. Vaka grubu sadece epilepsili bireylerden oluşurken, kontrol grubu sağlıklı bireylerden oluştu. Tüm dişlerde (üçüncü azı dişleri hariç) dış ve iç rezorpsiyon varlığı/yokluğu, rezorpsiyon bölgesi (kökün servikal, orta ve apikal bölgesi), yaşı ve cinsiyeti bir excel dosyasına kaydedildi. Dağılımın normalliğine göre bağımsız örneklem t-testi veya Mann-Whitney U testi ve kategorik değişkenleri karşılaştırmak için ki-kare testi kullanıldı. Bulgular 424 hastanın (236 sağlıklı birey ve 188 epileptik hasta) 93'ünde (%21,9) rezorpsiyon olduğunu gösterse de gruplar arasında eksternal ve internal rezorpsiyon varlığı açısından anlamlı farklılık yoktu (p = 0,089 ve 0,746). Rezorpsiyon 30 yaş üstü ve erkeklerde daha sıktı (p=0,018 ve 0,013). Sonuç Epilepsi hastalarında rezorpsiyon varlığının sağlıklı deneklerden farklı olmadığı sonucuna vardık. Ancak epilepsili hastalarda rezorpsiyon en çok alt azı dişleri ve orta 1/3 bölgede görüldü. Klinisyenler bu hastalarda diş tedavisi yaparken sonuçlarımızı dikkate almalıdır.

Keywords

• Antiepileptik İlaç
• Epilepsi
• Panoramik Radyografi
• Rezorpsiyon

References

1. 1. Word Health Organization; Epilepsy. [cited 11 March 2024] Available from: https://www.who.int/news-room/fact-sheets/ detail/epilepsy
2. 2. Dudley RW, Penney SJ, Buckley DJ. First-drug treatment failures in children newly diagnosed with epilepsy. Pediatr Neurol 2009;40:71-77.
3. 3. Fan HC, Lee HS, Chang KP, et al. The Impact of anti-epileptic drugs on growth and bone metabolism. Int J Mol Sci 2016;17:1242.
4. 4. Meier C, Kraenzlin ME. Antiepileptics and bone health. Ther Adv Musculoskelet Dis 2011;3:235-43.
5. 5. Siniscalchi A, Murphy S, Cione E, et al. Antiepileptic drugs and bone health: Current concepts. Psychopharmacol Bull 2020;50:36-44.
6. 6. Takahashi A, Saito T, Mayanagi H, et al. Effects of the antiepileptics phenytoin and zonisamide on dentin formation and bone mineral density of the mandible in growing rats. Methods Find Exp Clin Pharmacol 2004;26:769-773.
7. 7. Ogunbodede E, Adamolekun B, Akintomide A. Oral health and dental treatment needs in nigerian patients with epilepsy. Epilepsia 1998;39:590-594.
8. 8. Shaw MJ, Shaw L, Foster TD. The oral health in different groups of adults with mental handicaps attending Birmingham (UK) adult training centres. Community Dent Health 1990;7:135-141.

9. 9. Károlyházy K, Kovács E, Kivovics P, et al. Dental status and oral health of patients with epilepsy: An epidemiologic study. Epilepsia 2003;44:1103-1108.
10. 10. Galas-Zgorzalewicz B, Borysewicz-Lewicka M, Zgorzalewicz M, et al. The effect of chronic carbamazepine, valproic acid and phenytoin medication on the periodontal condition of epileptic children and adolescents. Funct Neurol 1996;11:187-193.
11. 11. Dahllof G, Preber H, Eliasson S, et al. Periodontal condition of epileptic adults treated long‐term with phenytoin or carbamazepine. Epilepsia 1993;34:960-964.
12. 12. Endodontists AAO. Glossary of endodontic terms: American Association of Endodontists; 2003.
13. 13. Trope M. Cervical root resorption. J Am Dent Assoc 1997;128:56S-59S.
14. 14. Tronstad L. Root resorption-etiology, terminology and clinical manifestations. Dent Traumatol 1988;4:241-252.
15. 15. Fuss Z, Tsesis I, Lin S. Root resorption–diagnosis, classification and treatment choices based on stimulation factors. Dent Traumatol 2003;19:175-182.
16. 16. Patel S, Saberi N. The ins and outs of root resorption. Br Dent J 2018;224:691-699.
17. 17. Patel S, Kanagasingam S, Ford TP. External cervical resorption: a review. J Endod 2009;35:616-625.
18. 18. Saccomanno S, Passarelli PC, Oliva B, et al. Comparison between two radiological methods for assessment of tooth root resorption: An in vitro study. Biomed Res Int 2018;2018:5152172.
19. 19. Dudic A, Giannopoulou C, Leuzinger M, et al. Detection of apical root resorption after orthodontic treatment by using panoramic radiography and cone-beam computed tomography of super-high resolution. Am J Orthod Dentofacial Orthop 2009;135:434-437.
20. 20. Lima T, Gamba TdO, Zaia AA, et al. Evaluation of cone beam computed tomography and periapical radiography in the diagnosis of root resorption. Aust Dent J 2016;61:425-431.
21. 21. Rahmel S, Schulze RK. Accuracy in detecting artificial root resorption in panoramic radiography versus tomosynthetic panoramic radiographs. J Endod 2019;45:634-639.
22. 22. Kweon HH, Lee JH, Youk TM, et al. Panoramic radiography can be an effective diagnostic tool adjunctive to oral examinations in the national health checkup program. J Periodontal Implant Sci 2018;48:317-325.
23. 23. Svenson B, Ståhlnacke K, Karlsson R, et al. Dentists’ use of digital radiographic techniques: Part ii–extraoral radiography: A questionnaire study of swedish dentists. Acta Odontol Scand 2019;77:150-57.
24. 24. Snel R, Van De Maele E, Politis C, et al. Digital dental radiology in belgium: A nationwide survey. Dentomaxillofac Radiol 2018;47:20180045.
25. 25. Soares AJ, Souza GA, Pereira AC, et al. Frequency of root resorption following trauma to permanent teeth. J Oral Sci 2015;57:73-78.
26. 26. Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993;94:646-50.
27. 27. Tsesis I, Fuss Z, Rosenberg E, et al. Radiographic evaluation of the prevalence of root resorption in a Middle Eastern population. Quintessence Int 2008;39(2):40-44.
28. 28. Mikušková K, Vaňuga P, Adamicová K, et al. Multiple idiopathic external cervical root resorption in patient treated continuously with denosumab: a case report. BMC Oral Health 2022;22:129.
29. 29. Dobroś K, Myciński P, Borowy P, et al. Multiple invasive cervical resorption and celiac disease: A case report. Quintessence Int 2018;49:407-412.
30. 30. Patel S, Saberi N. External cervical resorption associated with the use of bisphosphonates: A case series. J Endod 2015;41:742-748.
31. 31. Alyahya L, Myers GL. Denosumab use as a predictor variable for external cervical resorption: A case-control study. J Endod 2021;47:366-373.
32. 32. Marinescu IR, Bănică AC, Mercuţ V, et al. Root resorption diagnostic: role of digital panoramic radiography. Curr Health Sci J 2019;45:156-166.
33. 33. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174.
34. 34. McNab S, Battistutta D, Taverne A, et al. External apical root resorption of posterior teeth in asthmatics after orthodontic treatment. Am J Orthod Dentofacial Orthop 1999;116:545-551.
35. 35. Irinakis E, Aleksejuniene J, Shen Y, et al. External cervical resorption: A retrospective case-control study. J Endod 2020;46:1420-1427.
36. 36. Dao V, Mallya SM, Markovic D, et al. Prevalence and characteristics of root resorption identified in cone-beam computed tomography scans. J Endod 2023;49:144-154.
37. 37. Bănică AC, Marinescu IR, Gheorghe DN, et al. Root resorption prevalence in adults from dolj county, Romania–a radiological evidence. Romanian Journal of Oral Rehabilitation 2018;10:170-179
38. 38. Laux M, Abbott PV, Pajarola G, et al. Apical inflammatory root resorption: A correlative radiographic and histological assessment. Int Endod J 2000;33:483-493.
39. 39. Aydın Ü, Aybar Y. Panoramik radyografilerde ortaya çıkan hataların tipleri ve sıklığı. SDÜ Tıp Fak Derg 2004;11:2.
40. 40. Patel S, Foschi F, Mannocci F, Patel K. External cervical resorption: A three-dimensional classification. Int Endod J 2018;51:206-214.
41. 41. Futyma-Gąbka K, Różyło-Kalinowska I, Piskórz M, et al. Evaluation of root resorption in maxillary anterior teeth during orthodontic treatment with a fixed appliance based on panoramic radiographs. Pol J Radiol 2022;87:545-548.
42. 42. Sirisoontorn I, Hotokezaka H, Hashimoto M, et al. Tooth movement and root resorption; the effect of ovariectomy on orthodontic force application in rats. Angle Orthod 2011;81:570-577.
43. 43. Griepp DW, Kim DJ, Ganz M, et al. The effects of antiepileptic drugs on bone health: A systematic review. Epilepsy Res 2021;173:106619. 118