Int J Stomatol

Int J Stomatol ›› 2022, Vol. 49 ›› Issue (3): 283-289.doi: 10.7518/gjkq.2022047

• Microbiology • Previous Articles     Next Articles

Research status of the use of root canal and periapical microflora in refractory periapical periodontitis

Zhu Jiani1(),Su Qin2()   

  1. 1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China School of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral Diseases & Natio-nal Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodontics, West China Hospital of Stomato-logy, Sichuan University, Chengdu 610041, China
  • Received:2021-09-19 Revised:2021-12-30 Online:2022-05-01 Published:2022-05-09
  • Contact: Qin Su E-mail:1377691638@qq.com;1176629149@qq.com

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Abstract:

The pathogenic factors of refractory apical periodontitis include persistent intraradicular infection and extraradicular infection, both connectedly and differentially. With the development of modern molecular technology, it is found that the use of single sampling method and traditional bacterial detection methods makes it difficult to offer clear insight into all the bacterial species in the root canal. However, the combination of multiple sampling and detection methods can better improve the detection of species and populations of detected bacteria. Based on the review of literature on the intraradicular and extraradicular bacterial communities of refractory apical periodontitis in the last 10 years, this paper discus-ses the comparison of predominant microbial flora in and outside of the root canal of refractory apical periodontitis obtained by different sampling methods and detection techniques as well as the sources of infection microorganisms in refractory apical periodontitis.

Key words: refractory apical periodontitis, microflora, intraradicular infection, extraradicular infection

CLC Number: 

  • R 781.34+1

TrendMD: 

Tab　1

Comparison of the predominant microbial flora detected in and outside of the root canal of RAP"

取样方法检测方法研究者及年份检测结果
根管内：根管再治疗去除根管充填物后纸尖取样培养法Medina-Palacios等[5]，2021共鉴定出26种菌，粪肠球菌、链球菌、气球菌属和梭菌属最常见。88.5%兼性厌氧，11.5%严格厌氧
非培养法王娟等[11]，2014厚壁菌门、变形菌门、放线菌门、拟杆菌门、梭杆菌门和螺旋体门
张富华等[7]，2014共发现 15 种细菌，分属厚壁菌门、变形菌门、拟杆菌门、放线菌门。其中粪肠球菌、微小单胞菌最多
Sánchez-Sanhueza等[2]，2018细菌最丰富的家族是假单胞菌科。细菌数量最多的是变形菌门，其次是拟杆菌门
二者结合Endo等[14]，2013细菌培养中最常见的细菌为葡萄球菌、放线菌、孪生球菌、嗜血杆菌和肠球菌。PCR检出最多的菌种为微小单胞菌、变黑普雷沃氏菌、粪肠球菌和麻疹芽胞菌
Karygianni等[4]，2015在根管充填材料和根管标本中均检测到厚壁菌门、放线菌门和拟杆菌门。从根管感染后的根管中恢复了5个新类群（嗜盐梭菌、意大利肠球菌、酸丙酸杆菌、茶肠球菌、解糖肠球菌）
Zargar等[17]，2019粪肠球菌感染率最高，淡色普雷沃氏菌感染率最低
Dioguardi等[20]，2020粪肠球菌和牙龈卟啉单胞菌在根管治疗的所有阶段都被高度检测到
根管内：根尖手术切根尖后纸尖取样非培养法Bouillaguet等[3]，2018经过与未经过根管治疗的牙中：厚壁菌门、拟杆菌门、放线菌门、梭形菌门和协同菌门均超过90%。细胞核梭杆菌数量最多。经过根管治疗的牙中：放线菌门显著富集，粪肠球菌含量最高，显著高于未经根管治疗的牙
根尖外：拔牙或显微根尖手术中根尖或根尖周组织取样培养法Signoretti等[25]，2013根尖病变中G+菌存活率最高
非培养法周耀等[31]，2014口腔放线菌属（84.6%）、口腔丙酸菌属（61.5%）。包括兼性厌氧菌、专性厌氧菌和需氧菌
Ping等[16]，2015厚壁菌门、变形菌门、拟杆菌门、梭杆菌门、放线菌门、协同菌门和螺旋体
Zhang等[29]，2021根外感染细菌数量最多的是厚壁菌门。链球菌、巨型球菌、放线菌、丙酸杆菌、坦纳菌和奈瑟菌仅在根外生物膜组中检出。变形杆菌、柠檬酸杆菌和细小单胞菌仅在根尖周病变中检出
Pereira等[26]，2017在根端和根尖周标本中，有具核梭杆菌、害肺杆菌、福赛斯坦纳菌、伴放线放线杆菌、齿垢密螺旋体、中间普雷沃氏菌、牙龈卟啉单胞菌、粪肠球菌、牙髓卟啉单胞菌、变黑普雷沃氏菌
周焱等[30]，2019检测出9个菌门，厚壁菌门、变形菌门、拟杆菌门、未培养菌、具核梭杆菌、隐蔽小杆菌、纤细弯曲菌、轻型链球菌、血链球菌
二者结合秦彦涛等[27]，2016丙酸菌属和放线菌属。以兼性厌氧菌、专性厌氧菌、需氧菌为主
1 Dioguardi M, Quarta C, Alovisi M, et al. Microbial association with genus Actinomyces in primary and secondary endodontic lesions, review[J]. Antibiotics (Basel), 2020, 9(8): E433.
2 Sánchez-Sanhueza G, Bello-Toledo H, González-Rocha G, et al. Metagenomic study of bacterial microbiota in persistent endodontic infections using Next-generation sequencing[J]. Int Endod J, 2018, 51(12): 1336-1348.
3 Bouillaguet S, Manoil D, Girard M, et al. Root microbiota in primary and secondary apical periodontitis[J]. Front Microbiol, 2018, 9: 2374.
4 Karygianni L, Anderson AC, Tennert C, et al. Supplementary sampling of obturation materials enhan-ces microbial analysis of endodontic treatment fai-lures: a proof of principle study[J]. Clin Oral Investig, 2015, 19(2): 319-327.
5 Medina-Palacios SE, Vitales-Noyola M, López-Go-nzález E, et al. Root canal microorganisms and their antibiotic susceptibility in patients with persistent endodontic infections, with and without clinical symptoms[J]. Odontology, 2021, 109(3): 596-604.
6 Del Fabbro M, Samaranayake LP, Lolato A, et al. Analysis of the secondary endodontic lesions focu-sing on the extraradicular microorganisms: an overview[J]. J Investig Clin Dent, 2014, 5(4): 245-254.
7 张富华, 姚莉莉, 张建凤, 等. 根管充填失败后根管内微生物的分子生物学分析[J]. 牙体牙髓牙周病学杂志, 2014, 24(10): 586-591.
Zhang FH, Yao LL, Zhang JF, et al. Molecular identification of the microorganisms in well-filled-root canal associated with endodontic treatment failure[J]. Chin J Conserv Dent, 2014, 24(10): 586-591.
8 孙慧斌, 邓婧, 王云, 等. 根管治疗失败病例根管内微生物的分子生物学检测[J]. 实用口腔医学杂志, 2010, 26(1): 96-99.
Sun HB, Deng J, Wang Y, et al. A molecular biology study on the microorganism within teeth with failed root canal therapy[J]. J Pract Stomatol, 2010, 26(1): 96-99.
9 Barbosa-Ribeiro M, Arruda-Vasconcelos R, Mendes Louzada L, et al. Microbiological investigation in teeth with persistent/secondary endodontic infection in different stages of root canal retreatment[J]. Eur Endod J, 2020, 5(3): 219-225.
10 Cardoso FG, Chung A, Martinho FC, et al. Investigation of bacterial contents from persistent endodontic infection and evaluation of their inflammatory potential[J]. Braz Dent J, 2016, 27(4): 412-418.
11 王娟, 唐志娟, 李谨, 等. 根管治疗后伴或不伴根尖周炎患牙根管内微生物群落的比较分析[J]. 中华口腔医学杂志, 2014, 49(10): 607-613.
Wang J, Tang ZJ, Li J, et al. Comparison of the intra-radicular bacterial community structures of teeth with or without post-treatment periapical periodontitis[J]. Chin J Stomatol, 2014, 49(10): 607-613.
12 何洪旭, 王伦海, 冯冬菲, 等. 再感染根管的细菌学研究[J]. 中国保健营养, 2014(5): 2868.
He HX, Wang LH, Feng DF, et al. Bacteriological study of reinfected root canals[J]. China Health Care Nutr, 2014(5): 2868.
13 Anderson AC, Hellwig E, Vespermann R, et al. Comprehensive analysis of secondary dental root canal infections: a combination of culture and culture-independent approaches reveals new insights[J]. PLoS One, 2012, 7(11): e49576.
14 Endo MS, Ferraz CCR, Zaia AA, et al. Quantitative and qualitative analysis of microorganisms in root-filled teeth with persistent infection: monitoring of the endodontic retreatment[J]. Eur J Dent, 2013, 7(3): 302-309.
15 Barbosa-Ribeiro M, Arruda-Vasconcelos R, Louzada LM, et al. Microbiological analysis of endodontically treated teeth with apical periodontitis before and after endodontic retreatment[J]. Clin Oral Investig, 2021, 25(4): 2017-2027.
16 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.
17 Zargar N, Marashi MA, Ashraf H, et al. Identification of microorganisms in persistent/secondary endo-dontic infections with respect to clinical and radiographic findings: bacterial culture and molecular detection[J]. Iran J Microbiol, 2019, 11(2): 120-128.
18 Barbosa-Ribeiro M, De-Jesus-Soares A, Zaia AA, et al. Antimicrobial susceptibility and characterization of virulence genes of Enterococcus faecalis isolates from teeth with failure of the endodontic treatment[J]. J Endod, 2016, 42(7): 1022-1028.
19 Alghamdi F, Shakir M. The influence of enterococcus faecalis as a dental root canal pathogen on en-dodontic treatment: a systematic review[J]. Cureus, 2020, 12(3): e7257.
20 Dioguardi M, Crincoli V, Laino L, et al. Prevalence of bacteria of genus actinomyces in persistent extraradicular lesions-systematic review[J]. J Clin Med, 2020, 9(2): E457.
21 Chow AT, Quah SY, Bergenholtz G, et al. Bacterial species associated with persistent apical periodon- titis exert differential effects on osteogenic differen-tiation[J]. Int Endod J, 2019, 52(2): 201-210.
22 Zhang CJ, Du JR, Peng ZX. Correlation between Enterococcus faecalis and persistent intraradicular infection compared with primary intraradicular infection: a systematic review[J]. J Endod, 2015, 41(8): 1207-1213.
23 Wu MK, Dummer PM, Wesselink PR. Consequen-ces of and strategies to deal with residual post-treatment root canal infection[J]. Int Endod J, 2006, 39(5): 343-356.
24 Sakko M, Tjäderhane L, Rautemaa-Richardson R. Microbiology of root canal infections[J]. Prim Dent J, 2016, 5(2): 84-89.
25 Signoretti FG, Gomes BP, Montagner F, et al. Investigation of cultivable bacteria isolated from longstanding retreatment-resistant lesions of teeth with apical periodontitis[J]. J Endod, 2013, 39(10): 1240-1244.
26 Pereira RS, Rodrigues VAA, Furtado WT, et al. Microbial analysis of root canal and periradicular lesion associated to teeth with endodontic failure[J]. Anaerobe, 2017, 48: 12-18.
27 秦彦涛, 马琰, 吴佩玲. 持续性根尖周炎根管外菌群分析[J]. 现代仪器与医疗, 2016, 22(3): 43-44, 48.
Qin YT, Ma Y, Wu PL. Analysis of bacteria flora outside the root canal of persistent periapical inflammation[J]. Mod Instrum Med Treat, 2016, 22(3): 43-44, 48.
28 Wang J, Jiang YT, Chen W, et al. Bacterial flora and extraradicular biofilm associated with the apical segment of teeth with post-treatment apical periodontitis[J]. J Endod, 2012, 38(7): 954-959.
29 Zhang C, Yang Z, Hou B. Diverse bacterial profile in extraradicular biofilms and periradicular lesions associated with persistent apical periodontitis[J]. Int Endod J, 2021, 54(9): 1425-1433.
30 周焱, 赵焕英, 蔡爽, 等. 未经治疗与根管治疗失败的乳牙慢性根尖周炎菌群的对比研究[J]. 北京口腔医学, 2019, 27(4): 191-195.
Zhou Y, Zhao HY, Cai S, et al. Comparison of bacterial compositions in primary and persistent apical periodontitis of deciduous teeth[J]. Beijing J Stomatol, 2019, 27(4): 191-195.
31 周耀, 王娟. 持续性根尖周炎根尖区微生物群落多样性分析[J]. 口腔生物医学, 2014, 5(3): 120-124.
Zhou Y, Wang J. Bacterial flora associated with the apical segment of teeth with persistent periapical periodontitis[J]. Oral Biomed, 2014, 5(3): 120-124.
32 Ricucci D, Loghin S, Gonçalves LS, et al. Histobacteriologic conditions of the apical root canal system and periapical tissues in teeth associated with sinus tracts[J]. J Endod, 2018, 44(3): 405-413.
33 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.
34 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.
35 Aw V. Discuss the role of microorganisms in the aetiology and pathogenesis of periapical disease[J]. Aust Endod J, 2016, 42(2): 53-59.
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