Comment on the article: inflammatory mediators’ essence in apical periodontitis [Letter to the editor]

Year 2025, Volume: 59 Issue: 3, 222 - 222, 08.10.2025

Saeed Asgary

https://doi.org/10.26650/eor.20251569056

Abstract

I would like to address an outdated concept highlighted in the recent invited review titled "Inflammatory Mediators’ Essence in Apical Periodontitis" (1). While this review provides an excellent overview of the role of inflammatory mediators in apical periodontitis (AP), it perpetuates the old notion that AP only occurs in teeth with necrotic pulp. This is a misconception that must be revised in light of recent evidence.

Apical periodontitis can indeed occur in vital teeth as well. Inflammation in the periradicular tissues may arise due to various causes, including trauma, extensive caries, or invasive dental procedures, even when the pulp remains vital (2,3). The association of AP exclusively with non-vital teeth overlooks significant clinical scenarios where vital teeth exhibit apical radiolucencies and periapical inflammation. This distinction is crucial, as it has important implications for diagnosis, treatment planning, and patient outcomes.

As our understanding of the pathophysiology of AP advances, it is essential to acknowledge that periradicular inflammation is not solely confined to non-vital teeth. I encourage the dental community to embrace a more comprehensive view of AP that includes both vital and non-vital teeth in the etiopathogenesis.

Thank you for your attention to this critical issue. I hope this letter serves to initiate further discussions and corrections in our field regarding the clinical understanding of apical periodontitis.

Keywords

Apical Periodontitis , Endodontics , review

References

• Nikola M, Ema KL, Lazar L, Dobroslav P, Milana M, Aleksandar J. Inflammatory mediators’ essence in apical periodontitis. European Oral Res 2024; 58:160-8. google scholar
• Abbott PV. Classification, diagnosis and clinical manifestations of apical periodontitis. Endodontic topics 2004; 8:36-54. google scholar
• Asgary S, Aminoshariae A, Wesselink PR. Apical Periodontitis in Vital and Nonvital Teeth: Clinical and Radiographic Features. Iranian Endodontic Journal 2024; 19:148. google scholar