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Dioguardi M, Quarta C, Alovisi M, Crincoli V, Aiuto R, Crippa R, Angiero F, Laneve E, Sovereto D, De Lillo A, Troiano G, Lo Muzio L. Microbial Association with Genus Actinomyces in Primary and Secondary Endodontic Lesions, Review. Antibiotics (Basel) 2020; 9:E433. [PMID: 32707891 PMCID: PMC7460180 DOI: 10.3390/antibiotics9080433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022] Open
Abstract
The main reason for root canal treatment failure is the persistence of microorganisms after therapy, or the recontamination of the root canal system due to an inadequate seal. In the mouth, Actinomyces spp. constitute a significant part of the normal flora, which is indicative of their ability to adhere to oral tissue and resist cleansing mechanisms, such as salivary flow. This review, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), aims to clarify the prevalence of microbial genera that are associated with the genus Actinomyces in primary and secondary endodontic infections (primary outcome), and to identify the most prevalent species of the Actinomyces genus in endodontic lesions (secondary outcome). A total of 11 studies were included in the qualitative and quantitative analysis, and a total of 331 samples were analyzed. Bacteria of the genus Actinomyces were found in 58 samples, and 46 bacterial genera were detected in association with bacteria of the genus Actinomyces. Bacteria of the genus Streptococcus and Propionibacterium were those most frequently associated with Actinomyces in the endodontic lesions considered, and Actinomyces israelii was the most frequently involved species.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.Q.); (E.L.); (D.S.); (A.D.L.); (G.T.); (L.L.M.)
| | - Cristian Quarta
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.Q.); (E.L.); (D.S.); (A.D.L.); (G.T.); (L.L.M.)
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School, University of Turin, 10127 Turin, Italy;
| | - Vito Crincoli
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Division of Complex Operating Unit of Dentistry, “Aldo Moro” University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Riccardo Aiuto
- Department of Biomedical, Surgical, and Dental Science, University of Milan, 20122 Milan, Italy;
| | - Rolando Crippa
- Department of Oral Pathology, Italian Stomatological Institute, 20122 Milan, Italy;
| | - Francesca Angiero
- Department of Medical Sciences and Diagnostic Integrated, S. Martino Hospital, University of Genova, 16132 Genova, Italy;
| | - Enrica Laneve
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.Q.); (E.L.); (D.S.); (A.D.L.); (G.T.); (L.L.M.)
| | - Diego Sovereto
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.Q.); (E.L.); (D.S.); (A.D.L.); (G.T.); (L.L.M.)
| | - Alfredo De Lillo
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.Q.); (E.L.); (D.S.); (A.D.L.); (G.T.); (L.L.M.)
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.Q.); (E.L.); (D.S.); (A.D.L.); (G.T.); (L.L.M.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.Q.); (E.L.); (D.S.); (A.D.L.); (G.T.); (L.L.M.)
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Karamifar K, Tondari A, Saghiri MA. Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities. Eur Endod J 2020; 5:54-67. [PMID: 32766513 PMCID: PMC7398993 DOI: 10.14744/eej.2020.42714] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.
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Affiliation(s)
- Kasra Karamifar
- From the Department of Restorative Dentistry, Rutgers School of Dental Medicine, New Jersey, USA
| | - Afsoon Tondari
- Department of Restorative Dentistry, Dental Branch, Shiraz Azad University, Shiraz, Iran
| | - Mohammad Ali Saghiri
- From the Department of Restorative Dentistry, Rutgers School of Dental Medicine, New Jersey, USA
- Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, USA
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Gutmann JL, Manjarrés V. Historical and Contemporary Perspectives on the Microbiological Aspects of Endodontics. Dent J (Basel) 2018; 6:E49. [PMID: 30249009 PMCID: PMC6313668 DOI: 10.3390/dj6040049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 12/27/2022] Open
Abstract
The microbiota of the oral cavity plays a significant role in pulpal and periapical diseases. Historically, 100 years ago little was known on microbiota, but after a century of investigations, only now can many of the intimate secrets of microbial growth, expansion, persistence, communal activities, and virulence be revealed. However, with the capabilities of the microbiota for mutation, quorum sensing, and information transference, researchers are hard-pressed to keep up with both the changes and challenges that an amazingly wide range of bacterial species pose for both the scientist and clinician. Fortunately, the development and expansion of a vast array of molecular biological investigative techniques have enabled dentistry and its associated medical fields to attempt to keep pace with the wide and fascinating world of oral microbiology.
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Affiliation(s)
- James L Gutmann
- Department of Endodontics, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
| | - Vivian Manjarrés
- Department of Endodontics, Nova Southeastern University, College of Dental Medicine, Davie, FL 33314, USA.
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Yoneda N, Noiri Y, Matsui S, Kuremoto K, Maezono H, Ishimoto T, Nakano T, Ebisu S, Hayashi M. Development of a root canal treatment model in the rat. Sci Rep 2017; 7:3315. [PMID: 28607360 PMCID: PMC5468248 DOI: 10.1038/s41598-017-03628-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/02/2017] [Indexed: 11/09/2022] Open
Abstract
Root canal treatment is performed to treat apical periodontitis, and various procedures and techniques are currently used. Although animal models have been used in the developmental research of root canal treatment, little of this research has used small animals such as rats, because of their small size. In this study, root canal treatment was performed on the rat mandibular first molar, which had four root canals, using a microscope, and the therapeutic effect was evaluated bacteriologically, radiologically and histopathologically. By performing root canal treatment, the level of bacteria in the mesial root of the treated teeth was reduced by 75% compared with the control. Additionally, the volume of the periapical lesions of the treated teeth as measured by micro-computed tomography decreased significantly 2 weeks after the root canal treatment when compared with the control. Histological evidence of healing was observed in the treatment group 8 weeks after root canal treatment. These results suggest that a root canal treatment model using rats can be used in developmental research for novel methods of root canal treatment.
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Affiliation(s)
- Naomichi Yoneda
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, 565-0871, Japan
| | - Yuichiro Noiri
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan.
| | - Saori Matsui
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, 565-0871, Japan
| | - Katsutaka Kuremoto
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, 565-0871, Japan
| | - Hazuki Maezono
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, 565-0871, Japan
| | - Takuya Ishimoto
- Department of Biomaterials and Structural Materials Design, Osaka University Graduate School of Engineering, 1-2 Yamadaoka, Suita, 565-0871, Japan
| | - Takayoshi Nakano
- Department of Biomaterials and Structural Materials Design, Osaka University Graduate School of Engineering, 1-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shigeyuki Ebisu
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, 565-0871, Japan
| | - Mikako Hayashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, 565-0871, Japan
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Ravi Chandra PV, Kumar VH, Reddy SJ, Kiran DR, Krishna MN, Kumar GV. Biofilm forming capacity of Enterococcus faecalis on Gutta-percha points treated with four disinfectants using confocal scanning laser microscope: An in vitro study. Dent Res J (Isfahan) 2015; 12:331-6. [PMID: 26288622 PMCID: PMC4533190 DOI: 10.4103/1735-3327.161446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of this study was to evaluate and compare the in vitro biofilm forming capacity of Enterococcus faecalis on Gutta-percha points disinfected with four disinfectants. Materials and Methods: A total of 50 Gutta-percha points used in this study were divided into four test groups based on disinfectant (5.25% sodium hypochlorite, 2% chlorhexidine gluconate, 20% neem, 13% benzalkonium chloride [BAK]), and one control group. The Gutta-percha points were initially treated with corresponding disinfectants followed by anaerobic incubation in Brain Heart Infusion broth suspended with human serum and E. faecalis strain for 14 days. After incubation, these Gutta-percha points were stained with Acridine Orange (Sigma – Aldrich Co., St. Louis, MO, USA) and 0.5 mm thick cross section samples were prepared. The biofilm thickness of E. faecalis was analyzed quantitatively using a confocal scanning laser microscope. Results statistically analyzed using analysis of variance. P < 0.05 was considered to be significant. Results: Confocal scanning laser microscope showed reduced amount of E. faecalis biofilm on Gutta-percha points treated with BAK and sodium hypochlorite. Post-hoc (least square differences) test revealed that there is no statistically significant difference between BAK and sodium hypochlorite groups (P > 0.05). Conclusion: This study illustrates that the Gutta-percha points disinfected with sodium hypochlorite and BAK showed minimal biofilm growth on its surface.
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Affiliation(s)
| | - Vemisetty Hari Kumar
- Department of Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, India
| | | | - Dandolu Ram Kiran
- Department of Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, India
| | | | - Golla Vinay Kumar
- Department of Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, India
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Fabris AS, Nakano V, Avila-Campos MJ. Bacteriological analysis of necrotic pulp and fistulae in primary teeth. J Appl Oral Sci 2014; 22:118-24. [PMID: 24676582 PMCID: PMC3956403 DOI: 10.1590/1678-775720130358] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 01/13/2014] [Indexed: 11/21/2022] Open
Abstract
Objectives Primary teeth work as guides for the eruption of permanent dentition, contribute
for the development of the jaws, chewing process, preparing food for digestion,
and nutrient assimilation. Treatment of pulp necrosis in primary teeth is complex
due to anatomical and physiological characteristics and high number of bacterial
species present in endodontic infections. The bacterial presence alone or in
association in necrotic pulp and fistula samples from primary teeth of boys and
girls was evaluated. Material and Methods Necrotic pulp (103) and fistula (7) samples from deciduous teeth with deep caries
of 110 children were evaluated. Bacterial morphotypes and species from all
clinical samples were determined. Results A predominance of gram-positive cocci (81.8%) and gram-negative
coccobacilli (49.1%) was observed. In 88 out of 103 pulp samples, a
high prevalence of Enterococcus spp. (50%), Porphyromonas
gingivalis (49%), Fusobacterium nucleatum (25%) and
Prevotella nigrescens (11.4%) was observed.
Porphyromonas gingivalis was detected in three out of seven fistula
samples, Enterococcus spp. in two out of seven samples, and
F. nucleatum, P. nigrescens and D.
pneumosintes in one out of seven samples. Conclusions Our results show that Enterococcus spp. and P.
gingivalis were prevalent in necrotic pulp from deciduous teeth in
boys from 2 to 5 years old, and that care of the oral cavity of children up to
five years of age is important.
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Affiliation(s)
- Antonio Scalco Fabris
- Anaerobe Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, SP, Brazil
| | - Viviane Nakano
- Anaerobe Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, SP, Brazil
| | - Mario Julio Avila-Campos
- Anaerobe Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, SP, Brazil
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HAAPASALO MARKUS, SHEN YA, RICUCCI DOMENICO. Reasons for persistent and emerging post-treatment endodontic disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1601-1546.2011.00256.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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8
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Marques AMC, Gerbi MEMM, dos Santos JN, Noia MP, Oliveira PC, Junior AB, Zanin FAA, Pinheiro ALB. Influence of the parameters of the Er:YAG laser on the apical sealing of apicectomized teeth. Lasers Med Sci 2010; 26:433-8. [DOI: 10.1007/s10103-010-0792-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 04/26/2010] [Indexed: 11/30/2022]
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Bhuva B, Patel S, Wilson R, Niazi S, Beighton D, Mannocci F. The effectiveness of passive ultrasonic irrigation on intraradicularEnterococcus faecalisbiofilms in extracted single-rooted human teeth. Int Endod J 2010; 43:241-50. [DOI: 10.1111/j.1365-2591.2009.01672.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Estrela C, Sydney GB, Figueiredo JAP, Estrela CRDA. Antibacterial efficacy of intracanal medicaments on bacterial biofilm: a critical review. J Appl Oral Sci 2009; 17:1-7. [PMID: 19148398 PMCID: PMC4327605 DOI: 10.1590/s1678-77572009000100002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 05/27/2008] [Indexed: 11/21/2022] Open
Abstract
The purpose of this paper is to discuss critically the antibacterial efficacy of intracanal medicaments on bacterial biofilm. Longitudinal studies were evaluated by a systematic review of English-language articles retrieved from electronic biomedical journal databases (MEDLINE, EMBASE, CENTRAL) and handsearching records, using different matches of keywords for root canal biofilm, between 1966 and August 1st, 2007. The selected articles were identified from titles, abstracts and full-text articles by two independent reviewers, considering the tabulated inclusion and exclusion criteria. Disagreements were resolved by consensus. The search retrieved 91 related articles, of which 8.8% referred to in vivo studies demonstrating the lack of efficacy of endodontic therapy on bacterial biofilm. Intracanal medicaments were found to have a limited action against bacterial biofilm.
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Affiliation(s)
- Carlos Estrela
- Department of Oral Science, Federal University of Goiás, Goiânia, GO, Brazil.
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11
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Rocha CT, Rossi MA, Leonardo MR, Rocha LB, Nelson-Filho P, Silva LAB. Biofilm on the apical region of roots in primary teeth with vital and necrotic pulps with or without radiographically evident apical pathosis. Int Endod J 2008; 41:664-9. [DOI: 10.1111/j.1365-2591.2008.01411.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Panzarini SR, Souza V, Holland R, Dezan Júnior E. Association of calcium hydroxide and metronidazole in the treatment of dog's teeth with chronic periapical lesion. J Appl Oral Sci 2006; 14:334-40. [PMID: 19089054 PMCID: PMC4327224 DOI: 10.1590/s1678-77572006000500007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 09/01/2006] [Indexed: 11/21/2022] Open
Abstract
One of the primary objectives of endodontic treatment of teeth with pulp necrosis is the elimination of microorganisms from the root canal system, as effectively as possible, especially in cases with chronic periapical lesions. AIM: The purpose of this study was to analyze the response of the periapical tissue of dogs' teeth with chronic periapical lesions to endodontic treatment performed with utilization of metronidazole, calcium hydroxide, and an association of both as root canal dressings. METHODOLOGY: Forty root canals were submitted to pulpectomy and the root canals were kept exposed to the oral environment for 6 months. Then, they were submitted to biomechanical preparation and divided into 4 study groups with 10 specimens: group I – no root canal dressing; group II – calcium hydroxide; group III – metronidazole; group IV – calcium hydroxide associated to metronidazole. After 15 days, the root canals were filled with Fill Canal sealer. After 90 days, the animals were killed and the especimens processed for histological analysis. RESULTS: Calcium hydroxide dressing provided a significantly better outcome compared to other experimental groups (α = 0.01). Also, the results of the association of metronidazole and calcium hydroxide were similar to those observed for the metronidazole group. The worst results were obtained by the no root canal dressing group. CONCLUSION: The use of metronidazole alone or associated with Calcium hydroxide, did not improve periapical healing when compared to Calcium hydroxide dressing.
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Affiliation(s)
- Sônia Regina Panzarini
- Department of Surgery and Integrated Clinics, Dental School of Araçatuba - UNESP - São Paulo State University, Araçatuba, São Paulo, Brazil.
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Abstract
When root canal therapy is done according to accepted clinical principles and under aseptic conditions, the success rate is generally high. However, it has also been reported that 16% to 64.5% of endodontically treated teeth are associated with periapical radiolucent lesions. There are great variations among clinicians when suggesting treatment of these failed endodontic cases. This article will discuss factors influencing treatment decisions on these particular cases, and the pros and cons of nonsurgical retreatment versus surgical retreatment. The advancement of modern endodontic microsurgery will also be discussed.
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Takemura N, Noiri Y, Ehara A, Kawahara T, Noguchi N, Ebisu S. Single species biofilm-forming ability of root canal isolates on gutta-percha points. Eur J Oral Sci 2005; 112:523-9. [PMID: 15560836 DOI: 10.1111/j.1600-0722.2004.00165.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The participation of bacterial biofilms in the over-filled gutta-percha points associated with refractory periapical periodontitis has recently been reported. This study investigated the initial biofilm-forming ability of root canal isolates (Enterococcus faecalis, Streptococcus sanguis, Strep. intermedius, Strep. pyogenes, Staphylococcus aureus, Fusobacterium nucleatum, Propionibacterium acnes, Porphyromonas gingivalis and Prevotella intermedia) on gutta-percha points in vitro. Each bacterial strain was suspended in 100% cell culture medium or in culture medium containing 4.5, 45 or 90% (vol/vol) serum. The bacterial suspensions were then co-incubated anaerobically with gutta-percha points for 7 d. The gutta-percha points were processed for scanning electron microscopic observation and examined for biofilm presence and thickness. E. faecalis, Strep. sanguis, Strep. intermedius, Strep. pyogenes and Staph. aureus biofilms were generated on the surfaces of the specimens incubated in culture medium supplemented with 45 or 90% (vol/vol) serum. The E. faecalis and Strep. sanguis biofilms were significantly thicker than those of Strep. intermedius, Strep. pyogenes and Staph. aureus. No biofilms were detected on the specimens incubated with F. nucleatum, Prop. acnes, Porph. gingivalis and Prev. intermedia. These findings suggest that Gram-positive facultative anaerobes have the ability to colonize and form extracellular matrices on gutta-percha points, while serum plays a crucial role in biofilm formation.
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Affiliation(s)
- Naoki Takemura
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Abstract
The purpose of this investigation was 2-fold: (a) to complete a thorough search of published literature related to clinical studies on the success and failure of nonsurgical retreatment, and (b) to assign levels of evidence to these publications. Clinical studies related to success and failure of retreatment since 1970 were identified using both electronic and manual literature searches. After identification of pertinent literature, each article received a level of evidence (LOE) from one (high) to five (low). Thirty-one clinical studies and six review articles related to this subject were identified. There was no LOE 1 Randomized Control Trials (RCT). There were three LOE 2 RCTs, one LOE 2 Cohort, and two LOE 3 Case Control Studies. Thirteen Case Series (LOE 4), which comprise the most highly quoted success and failure data, were found. Twelve Case Reports (LOE 5) and six review articles (LOE 5) were found. Based on these findings, it appears that few high level studies have been published in the past 34 yr related to the success and failure of endodontic retreatment.
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Affiliation(s)
- Stephen Paik
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA
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Leonardo MR, Rossi MA, Silva LAB, Ito IY, Bonifácio KC. EM evaluation of bacterial biofilm and microorganisms on the apical external root surface of human teeth. J Endod 2002; 28:815-8. [PMID: 12489650 DOI: 10.1097/00004770-200212000-00006] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the presence of bacterial biofilm on the external surface of the root apex in teeth with pulp necrosis, with and without radiographically visible periapical lesions, and in teeth with a vital pulp. Twenty-one teeth were extracted, eight with pulp necrosis and periapical lesions, eight with pulp necrosis without radiographically visible periapical lesions, and five with a vital pulp. The roots were sectioned, and the root apexes (+/- 3 mm) were processed for scanning electron microscope evaluation. The surface of the apical root was evaluated for the presence of microorganisms, root resorption, and biofilm. There were no microorganisms on the apical root surface of either teeth with pulp vitality or with pulp necrosis with no radiographically visible periapical lesions. Microorganisms were always present in teeth with pulp necrosis and radiographically visible periapical lesions. These included cocci, bacilli, and filaments and the presence of an apical biofilm. Apical biofilm is clinically important because microbial biofilms are inherently resistant to antimicrobial agents and cannot be removed by biomechanical preparation alone. This may cause failure of endodontic treatment as a consequence of persistent infection.
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Affiliation(s)
- Mário R Leonardo
- Department of Restorative Dentistry, School of Dentistry of Araraquara, Faculdade de Odontologia de Araraquara, UNESP, SP, Brazil
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Trope M, Bergenholtz G. Microbiological basis for endodontic treatment: can a maximal outcome be achieved in one visit? ACTA ACUST UNITED AC 2002. [DOI: 10.1034/j.1601-1546.2002.10104.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Friedman S. Considerations and concepts of case selection in the management of post-treatment endodontic disease (treatment failure). ACTA ACUST UNITED AC 2002. [DOI: 10.1034/j.1601-1546.2002.10105.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Noiri Y, Ehara A, Kawahara T, Takemura N, Ebisu S. Participation of bacterial biofilms in refractory and chronic periapical periodontitis. J Endod 2002; 28:679-83. [PMID: 12398163 DOI: 10.1097/00004770-200210000-00001] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine morphologically the participation of extraradicular biofilm in refractory periapical periodontitis. Six teeth and five extruded root filling gutta-percha points associated with refractory periapical periodontitis were investigated by scanning electron microscope. In nine of 11 samples examined, bacterial biofilms were seen at the extraradicular area. The gutta-percha surface was covered with glycocalyx-like structures, and filaments, long rods, and spirochete-shaped bacteria were predominant in the extraradicular sites. Planktonic cells, which were filaments and spirochete-shaped bacteria, emigrated from the glycocalyx structures in some spots. In the extracted teeth, biofilm consisting of both bacteria and glycocalyx-like structures were observed on the periapical root surfaces. Next to the residual periodontal ligament, a few filaments, rods, and fusiforms were attached on the healthy cementum surface. The present findings suggested that bacterial biofilms formed in the extraradicular areas were related to refractory periapical periodontitis.
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Affiliation(s)
- Yuichiro Noiri
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate, School of Dentistry, Suita, Japan
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Leonardo MR, da Silva LA, Filho MT, Bonifácio KC, Ito IY. In vitro evaluation of the antimicrobial activity of a castor oil-based irrigant. J Endod 2001; 27:717-9. [PMID: 11771574 DOI: 10.1097/00004770-200112000-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The antimicrobial activity of irrigating solutions--Endoquil (castor oil detergent), 2% chlorhexidine gluconate solution, and 0.5% NaOCl solution-was evaluated against gram-positive cocci (Micrococcus luteus, Staphylococcus aureus, Enterococcus faecalis, Staphylococcus epidermidis, Streptococcus mutans, and Streptococcus sobrinus), gram-negative rods (Escherichia coli and Pseudomonas aeruginosa), and the yeast Candida albicans. Activity was evaluated using the two-layer agar diffusion technique. The base layer was obtained by pouring 10.0 ml of Muller Hinton Medium or 10.0 ml of Brain Heart Infusion agar in a Petri dish. After solidification a 5.0 ml seed layer of Muller Hinton Medium or Brain Heart Infusion agar with inoculum (106/ml) was added. Absorbent paper disks (6.0 mm in diameter) immersed in the solutions were placed at equidistant points. Plates were maintained at room temperature for 2 h for prediffusion of the solutions and incubated at 37 degrees C for 24 h. The candle jar system was used for the Brain Heart Infusion agar plates. All tests were performed in duplicate. After incubation the medium was optimized with 0.05 g% triphenyltetrazolium chlorate gel and inhibition halos were measured. All bacterial strains were inhibited by 2.0% chlorhexidine gluconate. Endoquil was effective against gram-positive microorganisms, and 0.5% NaOCl was effective only against S. aureus.
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Affiliation(s)
- M R Leonardo
- Department of Endodontics, School of Dentistry of Araraquara, University of the State of São Paulo, UNESP, Brazil
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23
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Abstract
Over 30% of root filled teeth in the population present with endodontic infective disease, which has either persisted or emerged after treatment. Management of these "failed" cases is a challenge to the clinician, at the levels of diagnosis, case selection, communication and decision, and that is even before techniques are considered. Diagnosis should differentiate between endodontic and other aetiologies, and focus on the site of infection. Case selection should be based on how best to control the infection, but also on the benefit-risk balance of the alternative treatment modalities, the attitudes of the patient and the capability of the clinician. All of the above must be communicated to the patient, who then should make the informed decision regarding the selected treatment. This article discusses the treatment rationale, diagnosis, case selection and communication related to post-treatment endodontic disease.
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Affiliation(s)
- S Friedman
- University of Toronto, 164 Cumberland Street, Toronto, Ontario, M5R 1A8, Canada
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24
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Márton IJ, Kiss C. Protective and destructive immune reactions in apical periodontitis. ORAL MICROBIOLOGY AND IMMUNOLOGY 2000; 15:139-50. [PMID: 11154396 DOI: 10.1034/j.1399-302x.2000.150301.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Apical periodontitis is initiated primarily by the mixed microflora of infected root canals. Continuous flow of bacteria and their products through the apical foramen induces influx, activation and coordinated interaction of immune-inflammatory cells within the periapical area. Successful mobilization of host defense mechanisms prevents abundant extraradicular bacterial invasion. However, anti-infective effector mechanisms are not restricted to killing the invading microorganisms but also destroy normal tissue components and induce bone absorption, resulting ultimately in the loss of the affected teeth. Moreover, autocrine and paracrine loops of stimulation may lead to the perpetuation of the local inflammatory lesion and may also alter the function of remote tissues and organs. This review attempts to summarize current knowledge about the pathogenic mechanism of apical periodontitis, focusing on the formation of a special granulation tissue that effectively fights bacteria originated from the infected pulp chamber and, by exerting this protective function, also contributes to harmful local and distant events. The dynamic equilibrium between defensive and destructive mechanisms may provide a pathobiological basis for better understanding of clinical signs and symptoms of various forms of apical periodontitis lesions and influence treatment strategy and practice.
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Affiliation(s)
- I J Márton
- Department of Restorative Dentistry, University Medical School of Debrecen, P.O. Box 13, H-4012 Debrecen, Hungary
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25
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Estrela C, Pimenta FC, Ito IY, Bammann LL. Antimicrobial evaluation of calcium hydroxide in infected dentinal tubules. J Endod 1999; 25:416-8. [PMID: 10530241 DOI: 10.1016/s0099-2399(99)80269-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to evaluate the antimicrobial activity of calcium hydroxide in infected dentinal tubules. Four microorganisms, strains of ATCC (Streptococcus faecalis (ATCC-29212), Staphylococcus aureus (ATCC-6538), Bacillus subtilis (ATCC-6633), and Pseudomonas aeruginosa (ATCC-27853)) and one mixture of these were used. These strains were inoculated in brain heart infusion (BHI) and incubated at 37 degrees C for 24 h. Sixty-three human maxillary central incisors were prepared and sterilized by autoclaving. Five groups of 12 teeth each were contaminated for 28 days using new 24-h cultures every 72 h, prepared and adjusted to tube 2 of the MacFarland scale (6 x 10(8) cells/ml). Root canals were then irrigated with 5 ml of saline, dried, and completely filled with calcium hydroxide paste. At intervals of 0, 48, and 72 h, and 7 days, dressings were removed and teeth were immersed in 5 ml of BHI and incubated at 37 degrees C for 48 h to observe the growth and multiplication of the microorganisms. Three uninoculated teeth were maintained in a humid environment as an aseptic control. These teeth were immersed in BHI and maintained at 37 degrees C for 7 days to determine microbial growth. Bacterial growth was shown by turbidity of the culture medium and confirmed by seeding these broths on BHI agar at 37 degrees C for 24 h. The positive BHI tubes were selected, and inoculum was spread on the surface of BHI agar, followed by the same incubation conditions. Gram stain was conducted from BHI growth and from colonies growing on solid medium. Calcium hydroxide in infected dentinal tubules showed no antimicrobial effect on S. faecalis, S. aureus, B. subtilis, P. aeruginosa, or on the bacterial mixture used throughout the experiment.
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Affiliation(s)
- C Estrela
- Federal University of Goiás, Goiânia, Brazil
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26
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Vigil GV, Wayman BE, Dazey SE, Fowler CB, Bradley DV. Identification and antibiotic sensitivity of bacteria isolated from periapical lesions. J Endod 1997; 23:110-4. [PMID: 9220741 DOI: 10.1016/s0099-2399(97)80256-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Periradicular tissues from 28 refractory endodontic cases requiring surgical intervention were submitted for histological diagnosis and microbiological culture. Bacteria isolated from these lesions were identified and then tested for their antibiotic sensitivity to a panel of common antibiotics. The periapical tissue specimens of 22 out of 28 lesions (79%) contained microorganisms. Of the 22 cases showing positive growth cultures, 15 were polymicrobial and 7 were single species isolates. Fifty-three different species were recovered: 29 anaerobes, 19 facultative anaerobes, and 5 aerobes. Microbes were observed under light microscopy in only one case. The most common organisms isolated were Propionibacterium acnes, Staphylococcus epidermidis, Streptococcus intermedius, Wolinella recta, Fusobacterium species, and Clostridium species. Antibiotic susceptibility results showed no clear cut evidence of significant antibiotic resistance among the species tested. The results of this study seem to corroborate earlier studies regarding the microbial population of periapical lesions refractory to nonsurgical endodontics.
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Affiliation(s)
- G V Vigil
- Clinical Dentistry Flight, 7th Dental Squadron, Dyess AFB, Texas 79607-1367, USA
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27
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Calişkan MK, Sen BH. Endodontic treatment of teeth with apical periodontitis using calcium hydroxide: a long-term study. ENDODONTICS & DENTAL TRAUMATOLOGY 1996; 12:215-21. [PMID: 9206366 DOI: 10.1111/j.1600-9657.1996.tb00518.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to evaluate clinically and radiographically the long-term results of endodontic therapy. A total of 172 mature teeth with periapical radiolucencies with and without symptoms were treated endodontically using calcium hydroxide paste as the intracanal medicament and a calcium hydroxide containing root canal sealer. In 58 teeth, the dressing was accidentally or intentionally extruded into the lesions. All cases were followed up for a period of 2-5 years. The teeth in which the dressing was extruded did not show a different healing pattern from the ones treated conventionally. The complete healing rate for all cases was 80.8% while incomplete healing had taken place in 7.6% of the cases.
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Affiliation(s)
- M K Calişkan
- Department of Endodontics, School of Dentistry, Ege University, Izmir, Türkiye
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28
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Lomçali G, Sen BH, Cankaya H. Scanning electron microscopic observations of apical root surfaces of teeth with apical periodontitis. ENDODONTICS & DENTAL TRAUMATOLOGY 1996; 12:70-6. [PMID: 9028200 DOI: 10.1111/j.1600-9657.1996.tb00100.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to observe apical root surfaces of teeth with chronic periapical lesions. Five premolars and three molars with radiographically demonstrable periapical lesions were extracted and fixed in 2.5% phosphate-buffered glutaraldehyde solution for 9 days. The apical 3-mm portion of 17 roots was removed and prepared for scanning electron microscope. Lacunar resorption zones were frequently observed on the root surfaces. Bacteria and yeast cells were detected in some of the lacunae. Periapical bacterial plaque with a smooth structure was present mostly around the main apical foramen. Cementum-like tissue deposits indicative of repair were seen adjacent to some resorption areas. Clastic cells tightly attached to crater-like depressions with finger-like projections were observed laterally on the specimens. Current research should be focused on new procedures to eliminate extraradicular microrganisms and periapical bacterial plaque in persistent periapical infections.
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Affiliation(s)
- G Lomçali
- Department of Oral Diagnosis, Ege University, Izmir, Turkey
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29
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Weiger R, Manncke B, Werner H, Löst C. Microbial flora of sinus tracts and root canals of non-vital teeth. ENDODONTICS & DENTAL TRAUMATOLOGY 1995; 11:15-9. [PMID: 7641609 DOI: 10.1111/j.1600-9657.1995.tb00673.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The occurrence of bacteria in 12 endodontically induced periodontal lesions associated with sinus tracts was examined. The microbial flora encountered in the sinus tract was compared with that of the root canal of the involved teeth which had not experienced any prior endodontic therapy. All microbiological samples taken from the sinus tract and from the root canal system contained bacteria. Seventy-one strains were detected in the extraradicular lesions. Of the anaerobic species, Fusobacterium nucleatum (7 strains), Prevotella intemedia (4 strains) and P. oralis (4 strains) were most frequently found. In the group of the facultative anaerobes Streptococcus spp. were predominant. Ninety-four strains were isolated from the root canal system of the 12 teeth. P. intermedia (6 strains), P. buccae (5 strains), F. nucleatum (5 strains) and Lactobacillus plantarum (5 strains) were most common. In 9 cases, species present in the root canal could be revealed in the extraradicular lesions. It was concluded that a variety of microorganisms were capable of colonizing endodontically induced, extraradicular lesions clinically characterized by sinus tracts.
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Affiliation(s)
- R Weiger
- Department of Conservative Dentistry, University of Tübingen, Germany
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30
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Perez F, Calas P, de Falguerolles A, Maurette A. Migration of a Streptococcus sanguis strain through the root dentinal tubules. J Endod 1993; 19:297-301. [PMID: 8228750 DOI: 10.1016/s0099-2399(06)80460-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The persistent presence of bacteria in the root canal system often leads to the failure of treatment. The aim of this study was to study the in vitro penetration of root dentinal tubules by bacteria. Bovine dentin was inoculated with a strain of Streptococcus sanguis, NCTC 7863; samples were taken at 10, 20, and 28 days, and bacterial penetration of the tubules was demonstrated using two techniques, scanning electron microscopy and light microscopy after Brown and Brenn staining. The results showed that S. sanguis can penetrate deep inside the tubules (792 microns). The maturity of the dentin blocks seems to be a major factor in tubule penetration.
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Affiliation(s)
- F Perez
- Service d'Odontologie Conservatrice-Endodontie, Faculté de Chirurgie Dentaire, Toulouse, France
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31
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Abstract
The role of intracanal medication as a root canal dressing is re-examined. In pulpectomy and some root canal treatments, where the root canal contains vital pulp tissue, it is doubtful whether a routine intracanal medicament is needed. In infected root canals, intracanal medication has been advocated for many purposes. An intracanal medicament is used to: (i) eliminate any remaining bacteria after canal instrumentation; (ii) reduce inflammation of periapical tissues and pulp remnants; (iii) render canal contents inert and neutralize tissue debris; (iv) act as a barrier against leakage from the temporary filling; (v) help to dry persistently wet canals. However, most of the indications for intracanal medicaments are questionable. Intracanal medicaments should only be used for root canal disinfection as part of controlled asepsis in infected root canals, and their role is secondary to cleaning and shaping of the root canal. Thorough canal debridement and adequate canal preparation are more pertinent, and their importance is emphasized. Bacteriological sampling may be necessary if a tooth does not respond to treatment, to help in the choice of intracanal medicament.
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Affiliation(s)
- B S Chong
- United Medical and Dental Schools, Guy's Hospital, London, UK
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32
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Abstract
In essence, endodontics as a clinical discipline is concerned with the prevention and treatment of pulpal and periapical infection. In recent research the infective process has been investigated as well as the mechanisms by which the pulp and periodontium deal with microbial insults. With regard to the pulp, findings on the hemodynamics of pulpitis suggest that the inflammatory response in this tissue is much less influenced by the special anatomic environment of the tooth than was previously believed. Pulpal diseases are being underdiagnosed, mostly because of inadequate examination methods. Laser Doppler flowmetry which gives a vascular rather than a nervous response may gain importance in pulpal diagnostics in the future. It is established that apical periodontitis with bone resorption cannot develop in the absence of bacteria in the root canal system. Root canal infection is characterized by a wide variety of combinations of relatively few anaerobic bacteria, and bacterial synergism plays an important role in maintaining the infection. Microbial invasion of an apical granuloma may take place. Non-oral and environmental organisms like Pseudomonas aeruginosa are frequently isolated from treatment-resistant cases. Success of endodontic treatment depends on the reduction or elimination of the infecting bacteria. This may predictably be obtained after a thorough chemo-mechanical instrumentation and disinfection of the root canal with calcium hydroxide. The standardized technique which entails the preparation of a cylindrical apical box with removal of significant amounts of dentin near the root apex predictably gives a clean canal. This technique has provided excellent clinical and radiographic results in well documented follow-up studies.
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Affiliation(s)
- L Tronstad
- Division of Endodontics, Faculty of Dentistry, University of Oslo, Norway
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33
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Mayhall JT. Aptitude testing and the selection of dental students. Aust Dent J 1990; 35:548. [PMID: 2090087 DOI: 10.1111/j.1834-7819.1990.tb04689.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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34
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Barnett F, Stevens R, Tronstad L. Demonstration of Bacteroides intermedius in periapical tissue using indirect immunofluorescence microscopy. ENDODONTICS & DENTAL TRAUMATOLOGY 1990; 6:153-6. [PMID: 2133307 DOI: 10.1111/j.1600-9657.1990.tb00411.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The presence of bacteria in periapical lesions of teeth with necrotic pulp has been demonstrated by microbiological sampling of periapical lesions during endodontic surgery. The purpose of this study was to confirm the presence of Bacteroides intermedius in a periapical granuloma using an indirect immunofluorescence technique. Histologic sections of a periapical granuloma were incubated with a rabbit antiserum to B. intermedius. After incubation with secondary antibody (fluorescein-conjugated goat anti-rabbit IgG), an intense fluorescent staining was observed in areas of the tissue sections. Control tissue sections that were incubated without the antibody remained unstained. The results obtained with the indirect immunofluorescence technique supported our cultural findings that microorganisms, e.g. B. intermedius, were present in the tissue of the periapical granuloma.
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Affiliation(s)
- F Barnett
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia
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