Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments, and periapical scars

Nair, Prashant; Sjögren, U.; Figdor, David; Sundqvist, Göran

doi:10.1016/s1079-2104(99)70145-9

Cited by 184 publications

(170 citation statements)

References 40 publications

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“…The participation of a bacterial complex in the process of pulp and periapical aggression has been thoroughly discussed in several studies (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Sundqvist and Figdor (13) reported that infection of the root canal is not a random event.…”

Section: Root Canal Infection and Its Consequencesmentioning

confidence: 99%

Characterization of Successful Root Canal Treatment

et al. 2014

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Knowing the outcome of root canal treatment (RCT) is determinant to substantiate the clinical decision making process, especially when RCT is weighed against the extraction of natural teeth or replacement by prosthetic elements. The ideal scenario in all clinical situations should combine healing/prevention of disease (apical periodontitis) and the functional retention of the tooth. Understanding the risk factors associated with endodontic failure is a key factor to increase the chances of success. The logical action is to reverse the existing disease, which requires intervention to neutralize the bacterial invasion and disrupt the bacterial biofilm within the complex anatomy. Success is more predictable when the immune host defenses are favorable. However, success has different meanings to the dentist, to the patient and to the tooth itself. The life of an endodontically treated tooth depends on the accuracy of the diagnosis and planning, excellence of disinfection, instrumentation and filling procedures (antimicrobial strategies, root canal shaping and coronal and apical seal) and finally the rehabilitation management. The interpretation of constant or intermittent pain and/or discomfort associated with apical periodontitis (AP) in endodontically treated tooth may be suggestive of endodontic failure. The success features of RCT, namely absence of pain, regression of AP, tight seal of canal and coronal spaces, and recovery of tooth function, must be reevaluated over time. In case of doubt between success and failure, cone beam computed tomography (CBCT) could be indicated for detection and precise localization of AP. The possibility of map reading on CBCT images characterizes the real multidimensional structure, providing accurate information on the presence, absence or regression of AP. The survival of an endodontically treated tooth implies understanding the biological and mechanical outcomes as multifactorial events over the individual's life span. The objective of this review of literature is to discuss relevant factors associated with patient's health, tooth and dentist that could account for a successful RCT.

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Section: Root Canal Infection and Its Consequencesmentioning

confidence: 99%

Characterization of Successful Root Canal Treatment

et al. 2014

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“…Moreover, this species is resistant to calcium hydroxide, 35 a commonly used intracanal medicament. Combinations of Ca(OH) 2 with CHX 22 are used to enhance antimicrobial properties. All of these factors help to explain why E. faecalis is so prevalent in patients in whom endodontic treatment has failed.…”

Section: Discussionmentioning

confidence: 99%

“…1 In most cases where endodontic treatment fails, failure is the result of treatment procedures not having met a satisfactory standard for control and elimination of infection. 2 Modern endodontic treatment procedures aim to eliminate microorganisms during root canal preparation and disinfection. Follow-up studies examining the outcome of endodontic therapy revealed a very high success rate when a negative bacterial culture was a prerequisite before root filling, 3 although there is clear evidence that a negative culture does not correlate with a bacteria-free root canal system.…”

Section: Introductionmentioning

confidence: 99%

PCR identiﬁcation of endodontic pathogens and DNA quantiﬁcation in samples from teeth with posttreatment apical periodontitis

et al. 2014

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The aim of this clinical study was to quantify the concentration of DNA and to detect selected bacterial species from samples of infected root-fi lled teeth with post-treatment apical periodontitis after removal of gutta-percha (S1), after chemo-mechanical preparation at the fi rst appointment (S2), 5 days after the canal was fi lled with sterile physiological solution (S3), after reinstrumentation at the second appointment (S4), and 14 days after an intracanal dressing was placed at the third appointment (S5). Methods: Fifteen root-fi lled teeth were selected. Removal of gutta-percha was performed using the crown-down technique. Chemo-mechanical preparation was performed with hand fi les associated with 2% chlorhexidine gel. An intracanal dressing based on Ca(OH) 2 was used. DNA was extracted from the samples and 14 endodontic 16S rDNA species-specifi c primers were tested. The concentration of DNA was quantifi ed using a NanoDropTM 2000 spectrophotometer. Results: Bacteria were present in all cases at all sampling times, as revealed by a universal primer. DNA was isolated from all samples, with an average concentration of 4.24 ± 2.9 ng/µL (S1), 3.39 ± 1.54 ng/µL (S2), 4.0 ± 1.94 ng/µL (S3), 2.66 ± 0.98 ng/µL (S4) and 3.97 ± 2.32 ng/µL (S5). Parvimonas micra and Enterococcus faecalis (S1), P. micra (S2), Porphyromonas endodontalis and E. faecalis (S3), E. faecalis and Prevotella nigrescens (S4/S5) were the species most frequently deteced. DNA concentration reductions were detected between S3 and S4 (p = 0.0256), whereas an increase was found between S4 and S5. Conclusion: A wide variety of bacterial species was detected in root-fi lled teeth with post-treatment apical periodontitis. Moreover, the use of an intracanal dressing was unable to further reduce the concentration of bacterial DNA.descrIPtors | Endodontics; Treatment Failure; Periapical Periodontitis; Bacteria; Polymerase Chain Reaction; DNA; Chlorhexidine.resuMo | Identifi cação de patógenos endodônticos por PCR e quantifi cação de DNA em amostras extraídas de dentes com periodontite apical pós-tratamento • Objetivo: O objetivo deste estudo clínico foi quantifi car a concentração de DNA e detectar algumas espécies bacterianas de amostras de dentes tratados endodonticamente com periodontite apical após a remoção da guta-percha (S1), após o preparo químico-mecânico na primeira sessão (S2), 5 dias após o preenchimento do canal com solução fi siológica estéril (S3), após reinstrumentação na segunda sessão (S4), e 14 dias após a inserção da medicação intracanal na terceira sessão (S5). Métodos: Quinze dentes tratados endodonticamente foram selecionados. A remoção da guta-percha foi realizada por meio da técnica coroa-ápice. Utilizaram-se limas manuais associadas à clorexidina gel a 2% durante o preparo químico-mecânico. A medicação intracanal selecionada foi à base de hidróxido de cálcio. DNA foi isolado das amostras e foram investigadas 14 espécies bacterianas (primer espécie-específi co16S rDNA). A concentração de DNA foi quantifi cada utilizando o espect...

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“…Several species of actinomyces and Propionibacterium propionicum (formerly Arachnia propionica) have been frequently isolated from root canals of human teeth with primary and persistent apical lesions. Less frequently, in about 5% of all periapical lesions, (1)(2)(3) they have been reported to establish in periapical tissues as periapical actinomycosis and cause failures of endodontic treatment. Traditionally, a diagnosis of actinomycosis in tissue sections has been reached on the basis of demonstration of typical "ray-fungus" colonies (1,4) and by specific immunohistochemical staining of such colonies.…”

Section: Methodsmentioning

confidence: 99%

Building biofilms in vital host tissues: a survival strategy of Actinomyces radicidentis

Nair

Brundin

Sundqvist

et al. 2008

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, an

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OBJECTIVE: To investigate the ability of Actinomyces radicidentis to survive and establish in soft connective tissue that grew into subcutaneously implanted tissue cages in Sprague-Dawley rats. STUDY DESIGN: Known concentrations of A. radicidentis suspension, grown on blood agar and broth cultures, were inoculated into tissue cages in rats. The cage contents were retrieved after 7, 14, and 28 days for culturing and correlative light and transmission electron microscopy. RESULTS: Cell suspensions harvested from both types of cultures showed substantial decline in numbers in tissue cages during the observation period. However, correlative light and transmission electron microscopy revealed numerous aggregates of coccoid bacteria already by 7 days of observation compared with the formation of well established colonies with characteristic actinomycotic features by 14 days after inoculation. CONCLUSIONS: These results suggest that the pathogenicity of A. radicidentis is due to its ability to form large aggregates of cells held together by embedding themselves in an extracellular matrix in vital host tissues. Thus, A. radicidentis, like other pathogenic Actinomyces, existing in the protected biofilm-environment can collectively evade destruction and elimination by host defenses, including phagocytosis. tissue sections has been reached on the basis of demonstration of typical "ray-fungus" colonies (1,4) and by specific immunohistochemical staining of such colonies. (5,6) Since the advent of molecular methods, an unequivocal identification and typing of the organism has been achieved by molecular genetic methods, particularly by sequencing of 16s rRNA gene and by whole cell protein profiling. (7) Recently, two strains of previously not described actinomyces-like organisms were recovered in pure culture from root canals of two teeth with persistent apical periodontitis. (8) Evidence based on biochemical analysis, phenotypic characterization, whole-cell protein profiling and sequencing of 16s rRNA, the two isolates were found to be identical and has been proposed to be classified as a new species (7) , entitled Actinomyces radicidentis (Latin: radix dentis = out of the root of the tooth) and was validated. (9) The organism was isolated from two human teeth with persistent apical periodontitis. (8) No immunohistochemical or microscopic analysis of the periapical tissues of the two diseased teeth was done. As such, it was not possible to clarify whether the A. radicidentis established itself in extraradicular periapical tissue as periapical actinomycosis and prevented periapical healing in the two cases reported.(8) The question as to whether A. radidicidentis is an etiological agent of persistent apical periodontitis, therefore, remains unanswered. The key to the pathogenicity of Actinomyces israelii, the species most implicated in extraradicular periapical infections, seems to be its ability to form cohesive colonies consisting of branching filamentous organisms in host tissues. (4) A. radicidentis do not form bra...

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Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments, and periapical scars

Cited by 184 publications

References 40 publications

Characterization of Successful Root Canal Treatment

Characterization of Successful Root Canal Treatment

PCR identiﬁcation of endodontic pathogens and DNA quantiﬁcation in samples from teeth with posttreatment apical periodontitis

Building biofilms in vital host tissues: a survival strategy of Actinomyces radicidentis

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