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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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Brown DWP. Paper points revisited: risk of cellulose fibre shedding during canal length confirmation. Int Endod J 2016; 50:620-626. [PMID: 27207259 DOI: 10.1111/iej.12663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/18/2016] [Indexed: 11/27/2022]
Abstract
AIM To compare the degree of fibre shedding by six brands of endodontic paper point when used for the paper point technique (PPT) of working length confirmation. METHODOLOGY An in vitro model simulating the clinical use of paper points in PPT was used to assess the degree of fibre shedding of six brands of size 20, .02 taper paper point. Whilst observing the artificial terminal foramen with polarized light microscopy, the number of fibres shed directly (point inserted 1 mm beyond the terminal foramen) and indirectly (point inserted to length then a gutta-percha point inserted) was assessed. The degree of direct fibre shedding as a function of brand was analysed with Fisher's exact test and multiple pairwise comparisons. Indirect fibre shedding was analysed with Kruskal-Wallis and Wilcoxon rank-sum tests. RESULTS All brands shed fibres both directly and indirectly, with a significant influence of brand on the proportion of fibres shed directly (P < 0.0306) and on the mean number of fibres shed indirectly (P < 0.0001). Post hoc analysis demonstrated a similar hierarchy of point integrity for both tests with Classic (UnoDent, Witham, UK) shedding significantly more than other brands and SS White (Gloucester, UK) and Antaeos® (VDW, Munich, Germany) shedding the least. CONCLUSION All brands of paper point may shed cellulose fibres both directly and indirectly with a significant influence of brand on the degree of fibre shedding. Further work should be undertaken to develop biocompatible absorbent dental points.
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Abstract
Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors -- located within the inflamed periapical tissue -- that can interfere with post-treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.
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Affiliation(s)
- P N R Nair
- Institute of Oral Biology, Section of Oral Structures and Development, Centre of Dental and Oral Medicine, University of Zurich, Zurich, Switzerland.
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Abstract
Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. The treatment of apical periodontitis, as a disease of root canal infection, consists of eradicating microbes or substantially reducing the microbial load from the root canal and preventing re-infection by orthograde root filling. The treatment has a remarkably high degree of success. Nevertheless, endodontic treatment can fail. Most failures occur when treatment procedures, mostly of a technical nature, have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful procedures are followed, failures still occur. This is because there are root canal regions that cannot be cleaned and obturated with existing equipments, materials, and techniques, and thus, infection can persist. In very rare cases, there are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The data on the biological causes of endodontic failures are recent and scattered in various journals. This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies.
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Affiliation(s)
- P N R Nair
- Institute of Oral Biology, Section of Oral Structures and Development, Center of Dental and Oral Medicine, University of Zürich, Plattenstrasse 11, CH-8028 Zürich, Switzerland.
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Abstract
A 24-year-old female with no contributory medical history had been treated by orthodontic alignment and transplantation of the lower left first premolar to the upper left first premolar site to correct for congenitally missing upper premolars. Subsequently, the transplanted premolar was treated by conventional endodontics and apical surgery for persistent periapical periodontitis over a span of 12 years. A combination of conventional endodontic retreatment and periapical surgery resulted in periapical healing. This case outlines the need for careful preoperative case assessment.
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Affiliation(s)
- Sajeev Koshy
- Department of Stomatology, School of Dentistry, University of Otago, PO Box 647, Dunedin, New Zealand
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Kalfas S, Figdor D, Sundqvist G. A new bacterial species associated with failed endodontic treatment: identification and description of Actinomyces radicidentis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:208-14. [PMID: 11505269 DOI: 10.1067/moe.2001.117268] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This report describes 2 endodontic patients who had persistent signs and symptoms after conventional root canal treatment. The aim of this study was to determine what microorganisms were present in the root canals of the teeth with failed endodontic therapy. STUDY DESIGN After removal of the root fillings, the canals were sampled by advanced microbiological techniques and the isolates were characterized by various tests. RESULTS Bacteria, which grew in pure cultures, were isolated in each case. The bacteria were similar to each other and were classified as Actinomyces on the basis of phylogenic and phenotypic evidence. The bacteria were different from others within the genus, thus warranting designation as a new species, Actinomyces radicidentis. CONCLUSIONS The 2 cases of endodontic failure were infected with A radicidentis, a new Actinomyces species. This bacterium joins a restricted group of other microorganisms that have been associated with failure of root canal treatment.
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Affiliation(s)
- S Kalfas
- Department of Oral Microbiology, Umeå University, Sweden
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Nair PN, Sjögren U, Figdor D, Sundqvist G. Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments, and periapical scars. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:617-27. [PMID: 10348524 DOI: 10.1016/s1079-2104(99)70145-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This report describes 6 cases that demonstrate persistent periapical radiolucent lesions after conventional root canal treatment. STUDY DESIGN Six teeth that had conventional root canal treatment or re-treatment with nonresolving periapical radiolucencies underwent periapical surgery. Biopsies were obtained and analyzed descriptively by correlative light and transmission electron microscopy for general features and microbial findings. RESULTS Three findings were identified: periapical lesions with persisting infection in the apical root canal system (2 cases); a cyst (1 case); and periapical healing by scar tissue formation (2 cases). CONCLUSIONS These results confirm previous observations that associated factors in the failure of endodontic treatment include persistent intraradicular infection and periapical cysts. In addition, unresolved periapical radiolucencies may occasionally be due to healing by scar tissue, which may be mistaken as a sign of failed endodontic treatment.
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Affiliation(s)
- P N Nair
- Department of Oral Structural Biology, Center for Dental and Oral Medicine, University of Zurich, Switzerland
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Abstract
Presence of cholesterol clefts in apical periodontitis lesions is a common histopathological observation. However, a potential aetiological association of cholesterol crystals to non-resolving apical periodontitis lesions after endodontic treatment has been suggested only recently. This article is an attempt to explain the biological basis for the inability of body cells to eliminate the local accumulation of cholesterol crystals, and to consolidate available clinical and experimental data in support of the view that massive accumulation of cholesterol crystals in inflamed periapical tissues can interfere with the periapical healing after conventional root canal treatment. As the irritating cholesterol crystals and certain other aetiological agents of failed endodontic treatment exist outside the root canal system, it is concluded that re-treatment alone, of such cases, is unlikely to resolve the factors that sustain the lesion. Apical surgery is indicated for successful management of such cases.
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Affiliation(s)
- P N Nair
- Department of Oral Structural Biology, Centre for Dental & Oral Medicine, University of Zurich, Plattenstrasse 11, CH-8028 Zurich, Switzerland
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