国际口腔医学杂志

国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (2): 238-243.doi: 10.7518/gjkq.2019004

• 综述 • 上一篇    下一篇

持续性根尖周炎根管内外生物膜特性的研究进展

杨子,侯本祥()   

  1. 首都医科大学附属北京口腔医院牙体牙髓病科 北京 100050
  • 收稿日期:2018-04-22 修回日期:2018-10-15 出版日期:2019-03-01 发布日期:2019-03-15
  • 通讯作者: 侯本祥
  • 作者简介:杨子,硕士,Email：paranoia- yz@qq.com
  • 基金资助:
    北京市医院管理局临床医学发展专项基金(XMLX201-30);北京市东城区科技计划项目(2017-3-004)

Research progress on the extra- and intra-radicular biofilm associated with persistent apical periodontitis

Zi Yang,Benxiang Hou()   

  1. Dept. of Conservative Dentistry and Endodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
  • Received:2018-04-22 Revised:2018-10-15 Online:2019-03-01 Published:2019-03-15
  • Contact: Benxiang Hou
  • Supported by:
    This study was supported by Beijing Municipal Administration of Hospital Clinical Medicine Development of Special Funding(XMLX201-30);Science and Technology Project of Dongcheng District, Beijing(2017-3-004)

RichHTML

23

PDF (PC)

305

摘要：

持续性根尖周炎又称为难治性根尖周炎,其与细菌在根管内和根外形成的生物膜有关,是临床研究的热点。持续性根尖周炎根管内外生物膜虽相邻,但形态学及细菌构成等方面均有所区别,本文就近年来持续性根尖周炎根管内生物膜与根外生物膜的形态结构及细菌组成方面的异同,及其依存关系等方面的研究现状作一综述。

关键词: 持续性根尖周炎, 根管生物膜, 根外生物膜

Abstract:

Persistent apical periodontitis is commonly related to the presence of intraradicular biofilm that persists in the complex apical root canal system and extraradicular biofilm. This review highlights the main differences and similarities between intraradicular and extraradicular biofilms, especially in structure and microbial composition. In addition, the relationship between intraradicular and extraradicular biofilms is summarized.

Key words: persistent apical periodontitis, extraradicular biofilm, intraradicular biofilm

中图分类号: 

  • R781.05

表 1

PAP根管生物膜优势菌检出各研究比较"

研究者 入组要求 样本数目/例 取样方法 检测方法 优势菌
Gomes等[16] 至少于4年前行根管治疗,仍有持续性根尖周低密度影 45 根管再治疗取根充物后无菌纸尖取样 PCR 粪肠球菌（77.8%）、消化链球菌（51.1%）、牙龈卟啉单胞菌（35.6%）、Filifactor alocis（26.7%）、齿垢密螺旋体（24.4%）、中间普氏菌（22.2%）、产黑普氏菌 （11.1%）、福赛斯坦纳菌（4.4%）
R??as等[14] 至少1年前行根管治疗,但仍存在根尖周低密度影 17 再治疗时取根充物 反向捕捉棋盘杂交法 链球菌属（47%）、乳杆菌属（35%）、难见戴阿利斯特杆菌（29%）,肠杆菌（29%）、中间普氏菌（29%）、生痰新月形单胞菌（29%）、互养菌属基因型BA121（29%）、梅毒螺旋体（29%）
Sakamoto等[15] 至少于5年前行根管治疗,患牙无临床症状,但仍有持续性根尖周低密度影 19 再治疗时取根充物 16S rRNA基因克隆文库 厚壁菌门、放线菌门、拟杆菌门、变形菌门、梭杆菌门、互养菌门
研究者 入组要求 样本数目/例 取样方法 检测方法 优势菌
Schirrmeister等[12] 至少于4年前行根管治疗,根充物距根尖不大于4 mm,根尖周有持续性低密度影 20 再治疗取根充后无菌纸尖取样 16S rRNA测序方法 具核梭杆菌、微小微单胞菌、难见戴阿利斯特杆菌、Solobacterium moorei、河流漫游球菌
Subramanian和Mi-ckel[17] 根管治疗后根充恰填但仍存在根尖周低密度影 34 根尖手术取根尖,去除外表面细菌后进行涡旋取样 16S rRNA测序方法 丙酸杆菌属、奈瑟氏菌属、月单胞菌属、营养缺陷菌属、双歧杆菌
Li等[18] 至少于2年前行根管治疗但仍存在根尖低密度影 7 再治疗取根充物后无菌纸尖取样 16S rRNA测序方法 洋葱伯克霍尔德氏菌、嗜二氧化碳噬细胞菌属、卟啉单胞菌属、茄科雷尔氏菌
Murad等[13] 至少于1年前行根管治疗但仍存在根尖低密度影 36 再治疗取根充物后无菌纸尖取样 棋盘DNA杂交 粪肠球菌、难见戴阿利斯特杆菌、表皮葡萄球菌、幽门螺旋杆菌
Antunes等[19] 至少于1年前行根管治疗,无症状但存在根尖低密度影 27 根尖手术取根尖外表面消毒后冷冻研磨法取样 实时PCR 链球菌属（76%）、放线菌门（52%）、假分支乳杆菌（19%）
Henriques等[20] 根管治疗后根尖周病变持续存在 40 再治疗取根充物后10#K锉取样 棋盘DNA杂交 白喉棒状杆菌、牙龈卟啉单胞菌,表兄链球菌、嗜麦芽糖寡养单胞菌

表 2

PAP根尖生物膜优势菌的检出比较"

研究者 入组要求 样本数目/例 取样方法 检测方法 优势菌
Noguchi等[21] 根管治疗后病变持续存在需行根尖手术者 27 根尖手术术中刮取牙根外表面生物膜 16S rRNA测序方法 具核梭杆菌、牙龈卟啉单胞菌、假丝酵母菌
Fujii等[22] 根管治疗后病变持续存在需行根尖手术者 20 根尖手术取根尖 16S rRNA测序方法 丙酸杆菌、表皮葡萄球菌、铜绿假单胞菌、具核梭杆菌
Wang等[8] 至少1年前行根管治疗,根尖病变直径<1 cm,需行根尖手术者 23 根尖手术取根尖 电子显微镜、改良Brown以及Brenn染色、PCR扩增及测序 放线菌属、丙酸杆菌属、普雷沃菌属、链球菌、牙龈卟啉单胞菌、伯克霍尔德氏菌
[1] Nair PN . On the causes of persistent apical periodon-titis: a review[J]. Int Endod J, 2006,39(4):249-281.
doi: 10.1111/j.1365-2591.2006.01099.x pmid: 16584489
[2] Zakaria MN, Takeshita T, Shibata Y , et al. Microbial community in persistent apical periodontitis: a 16S rRNA gene clone library analysis[J]. Int Endod J, 2015,48(8):717-728.
doi: 10.1111/iej.12361 pmid: 25088120
[3] Nair PN, Sjögren U, Figdor D , et al. Persistent peri-apical radiolucencies of root-filled human teeth, failed endodontic treatments, and periapical scars[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999,87(5):617-627.
doi: 10.1016/S1079-2104(99)70145-9 pmid: 10348524
[4] Carr GB, Schwartz RS, Schaudinn C , et al. Ultra-structural examination of failed molar retreatment with secondary apical periodontitis: an examination of endodontic biofilms in an endodontic retreatment failure[J]. J Endod, 2009,35(9):1303-1309.
doi: 10.1016/j.joen.2009.05.035 pmid: 1972023725
[5] Wang J, Chen W, Jiang Y , et al. Imaging of extra-radicular biofilm using combined scanning electron microscopy and stereomicroscopy[J]. Microsc Res Tech, 2013,76(9):979-983.
doi: 10.1002/jemt.22555 pmid: 23857917
[6] Sousa BC, Gomes FA, Ferreira CM , et al. Persistent extra-radicular bacterial biofilm in endodontically treated human teeth: scanning electron microscopy analysis after apical surgery[J]. Microsc Res Tech, 2017,80(6):662-667.
doi: 10.1002/jemt.22847 pmid: 28161897
[7] Su L, Gao Y, Yu C , et al. Surgical endodontic treat-ment of refractory periapical periodontitis with ex-traradicular biofilm[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010,110(1):e40-e44.
doi: 10.1016/j.tripleo.2009.12.051 pmid: 20610294
[8] Wang J, Jiang Y, Chen W , et al. Bacterial flora and extraradicular biofilm associated with the apical seg-ment of teeth with post-treatment apical periodontitis[J]. J Endod, 2012,38(7):954-959.
doi: 10.1016/j.joen.2012.03.004 pmid: 22703660
[9] Ferreira J, Coelho P, Guerreiro D , et al. Resolution of persistent infection by periapical surgery: a case report[J]. Int J Oral Maxillofac Surg, 2013,42(10):1314.
doi: 10.1016/j.ijom.2013.07.490
[10] Łysakowska ME, Ciebiada-Adamiec A, Sienkiewicz M , et al. The cultivable microbiota of primary and secondary infected root canals, their susceptibility to antibiotics and association with the signs and symptoms of infection[J]. Int Endod J, 2016,49(5):422-430.
doi: 10.1111/iej.12469 pmid: 26011084
[11] Tronstad L, Barnett F, Riso K , et al. Extraradicular endodontic infections[J]. Endod Dent Traumatol, 1987,3(2):86-90.
doi: 10.1111/edt.1987.3.issue-2
[12] Schirrmeister JF, Liebenow AL, Pelz K , et al. New bacterial compositions in root-filled teeth with peri-radicular lesions[J]. J Endod, 2009,35(2):169-174.
doi: 10.1016/j.joen.2008.10.024 pmid: 19166766
[13] Murad CF, Sassone LM, Faveri M , et al. Microbial diversity in persistent root canal infections investi-gated by checkerboard DNA-DNA hybridization[J]. J Endod, 2014,40(7):899-906.
doi: 10.1016/j.joen.2014.02.010 pmid: 24935532
[14] Rôças IN, Hülsmann M, Siqueira JF Jr . Micro-organisms in root canal-treated teeth from a German population[J]. J Endod, 2008,34(8):926-931.
doi: 10.1016/j.joen.2008.05.008 pmid: 18634922
[15] Sakamoto M, Siqueira JF Jr, Rôças IN , et al. Mole-cular analysis of the root canal microbiota associated with endodontic treatment failures[J]. Oral Microbiol Immunol, 2008,23(4):275-281.
doi: 10.1111/j.1399-302X.2007.00423.x pmid: 18582326
[16] Gomes BP, Pinheiro ET, Jacinto RC , et al. Microbial analysis of canals of root-filled teeth with periapical lesions using polymerase chain reaction[J]. J Endod, 2008,34(5):537-540.
doi: 10.1016/j.joen.2008.01.016 pmid: 18436030
[17] Subramanian K, Mickel AK . Molecular analysis of persistent periradicular lesions and root ends reveals a diverse microbial profile[J]. J Endod, 2009,35(7):950-957.
doi: 10.1016/j.joen.2009.04.010 pmid: 19567313
[18] Li X, Zhu XF, Zhang CF , et al. Endodontic bacteria from primary and persistent endodontic lesions in Chinese patients as identified by cloning and 16S ribosomal DNA gene sequencing[J]. Chin Med J (Engl), 2013,126(4):634-639.
doi: 10.3760/cma.j.issn.0366-6999.20122285 pmid: 23422180
[19] Antunes HS, Rôças IN, Alves FR , et al. Total and specific bacterial levels in the apical root canal system of teeth with post-treatment apical periodontitis[J]. J Endod, 2015,41(7):1037-1042.
doi: 10.1016/j.joen.2015.03.008 pmid: 25892512
[20] Henriques LC, de Brito LC, Tavares WL , et al. Mic-robial ecosystem analysis in root canal infections refractory to endodontic treatment[J]. J Endod, 2016,42(8):1239-1245.
doi: 10.1016/j.joen.2016.05.014 pmid: 27377440
[21] Noguchi N, Noiri Y, Narimatsu M , et al. Identification and localization of extraradicular biofilm-forming bacteria associated with refractory endodontic patho-gens[J]. Appl Environ Microbiol, 2005,71(12):8738-8743.
doi: 10.1128/AEM.71.12.8738-8743.2005 pmid: 1317348
[22] Fujii R, Saito Y, Tokura Y , et al. Characterization of bacterial flora in persistent apical periodontitis lesions[J]. Oral Microbiol Immunol, 2009,24(6):502-505.
doi: 10.1111/j.1399-302X.2009.00534.x pmid: 19832803
[23] Siqueira JF Jr, Antunes HS, Rôças IN , et al. Micro-biome in the apical root canal system of teeth with post-treatment apical periodontitis[J]. PLoS One, 2016,11(9):e0162887.
doi: 10.1371/journal.pone.0162887 pmid: 5045198
[24] Ping YF, Wang J, Liang JP . Pyrosequencing analysis of apical microbiota of teeth with persistent apical periodontitis[J]. J Dent Sci, 2015,10(4):365-371.
doi: 10.1016/j.jds.2015.06.001
[25] Hong BY, Lee TK, Lim SM , et al. Microbial analysis in primary and persistent endodontic infections by using pyrosequencing[J]. J Endod, 2013,39(9):1136-1140.
doi: 10.1016/j.joen.2013.05.001 pmid: 23953286
[26] Keskin C, Demiryürek Eö, Onuk EE . Pyrosequen-cing analysis of cryogenically ground samples from primary and secondary/persistent endodontic infec-tions[J]. J Endod, 2017,43(8):1309-1316.
doi: 10.1016/j.joen.2017.03.019 pmid: 28648489
[27] Tzanetakis GN, Azcarate-Peril MA, Zachaki S , et al. Comparison of bacterial community composition of primary and persistent endodontic infections using pyrosequencing[J]. J Endod, 2015,41(8):1226-1233.
doi: 10.1016/j.joen.2015.03.010 pmid: 25906920
[28] Provenzano JC, Antunes HS, Alves FR , et al. Host-bacterial interactions in post-treatment apical perio-dontitis: a metaproteome analysis[J]. J Endod, 2016,42(6):880-885.
doi: 10.1016/j.joen.2016.02.013 pmid: 27068493
[29] Kishen A . Periapical biomechanics and the role of cyclic biting force in apical retrograde fluid move-ment[J]. Int Endod J, 2005,38(9):597-603.
doi: 10.1111/j.1365-2591.2005.00986.x pmid: 16104972
[30] Tronstad L, Barnett F, Cervone F . Periapical bacterial plaque in teeth refractory to endodontic treatment[J]. Endod Dent Traumatol, 1990,6(2):73-77.
doi: 10.1111/j.1600-9657.1990.tb00394.x pmid: 2132213
[31] Ricucci D, Siqueira JF Jr, Lopes WS , et al. Extra-radicular infection as the cause of persistent symp-toms: a case series[J]. J Endod, 2015,41(2):265-273.
doi: 10.1016/j.joen.2014.08.020
[32] Ricucci D, Candeiro GT, Bugea C , et al. Complex apical intraradicular infection and extraradicular mineralized biofilms as the cause of wet canals and treatment failure: report of 2 cases[J]. J Endod, 2016,42(3):509-515.
doi: 10.1016/j.joen.2015.12.014 pmid: 26831049
[33] Ricucci D, Siqueira JF Jr, Bate AL , et al. Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients[J]. J Endod, 2009,35(4):493-502.
doi: 10.1016/j.joen.2008.12.014 pmid: 19345793
[34] Kuremoto K, Noiri Y, Ishimoto T , et al. Promotion of endodontic lesions in rats by a novel extraradicular biofilm model using obturation materials[J]. Appl Environ Microbiol, 2014,80(13):3804-3810.
doi: 10.1128/AEM.00421-14 pmid: 24747900
[35] Hülsmann M, Tulus G . Non-surgical retreatment of teeth with persisting apical periodontitis following apicoectomy: decision making, treatment strategies and problems, and case reports[J]. Endod Topics, 2016,34(1):64-89.
doi: 10.1111/etp.2016.34.issue-1
[36] Zhou W, Zheng Q, Tan X , et al. Comparison of mineral trioxide aggregate and iRoot BP plus root repair material as root-end filling materials in endodontic microsurgery: a prospective randomized controlled study[J]. J Endod, 2017,43(1):1-6.
doi: 10.1016/S0099-2399(17)30115-2
[37] Wang ZH, Zhang MM, Wang J , et al. Outcomes of endodontic microsurgery using a microscope and mineral trioxide aggregate: a prospective cohort study[J]. J Endod, 2017,43(5):694-698.
doi: 10.1016/j.joen.2016.12.015 pmid: 28292605
[1] 李红 侯本祥. 持续性根尖周炎根外生物膜的研究进展[J]. 国际口腔医学杂志, 2013, 40(6): 754-757.
[2] 古丽莎,凌均棨,. 根管生物膜及其临床控制的研究进展[J]. 国际口腔医学杂志, 2006, 33(05): 349-351.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 张新春. 桩冠修复与无髓牙的保护[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 王昆润. 长期单侧鼻呼吸对头颅发育有不利影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[3] 彭国光. 颈淋巴清扫术中颈交感神经干的解剖变异[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 杨凯. 淋巴化疗的药物运载系统及其应用现状[J]. 国际口腔医学杂志, 1999, 26(05): .
[5] 康非吾. 种植义齿下部结构生物力学研究进展[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 柴枫. 可摘局部义齿用Co-Cr合金的激光焊接[J]. 国际口腔医学杂志, 1999, 26(04): .
[7] 孟姝,吴亚菲,杨禾. 伴放线放线杆菌产生的细胞致死膨胀毒素及其与牙周病的关系[J]. 国际口腔医学杂志, 2005, 32(06): 458 -460 .
[8] 费晓露,丁一,徐屹. 牙周可疑致病菌对口腔黏膜上皮的粘附和侵入[J]. 国际口腔医学杂志, 2005, 32(06): 452 -454 .
[9] 赵兴福,黄晓晶. 变形链球菌蛋白组学研究进展[J]. 国际口腔医学杂志, 2008, 35(S1): .
[10] 庞莉苹,姚江武. 抛光和上釉对陶瓷表面粗糙度、挠曲强度及磨损性能的影响[J]. 国际口腔医学杂志, 2008, 35(S1): .