Podcast
Questions and Answers
⭐️What percentage of root canals in UNTREATED teeth with primary apical periodontitis showed INTRAradicular biofilms?
⭐️What percentage of root canals in UNTREATED teeth with primary apical periodontitis showed INTRAradicular biofilms?
⭐️What was the prevalence of intraradicular biofilms observed in teeth with apical cysts?
⭐️What was the prevalence of intraradicular biofilms observed in teeth with apical cysts?
⭐️Which of the following conditions had the lowest prevalence associated with intraradicular biofilms?
⭐️Which of the following conditions had the lowest prevalence associated with intraradicular biofilms?
What role do epithelialized lesions play in relation to biofilms?
What role do epithelialized lesions play in relation to biofilms?
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What is the primary reason older apical periodontitis lesions are more likely to develop into cysts?
What is the primary reason older apical periodontitis lesions are more likely to develop into cysts?
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Which of the following best describes extraradicular biofilms in relation to apical periodontitis?
Which of the following best describes extraradicular biofilms in relation to apical periodontitis?
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According to Ricucci and Siqueira's criteria, which statement about the infection is accurate?
According to Ricucci and Siqueira's criteria, which statement about the infection is accurate?
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What is a characteristic of bacteria within the root canal during endodontic infections?
What is a characteristic of bacteria within the root canal during endodontic infections?
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Why are systemic antibiotics ineffective against intraradicular infections according to the provided information?
Why are systemic antibiotics ineffective against intraradicular infections according to the provided information?
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Which criterion indicates the difficulty of eradicating the infection in the context of biofilms?
Which criterion indicates the difficulty of eradicating the infection in the context of biofilms?
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What leads to a better outcome in endodontic treatment regarding microbial presence?
What leads to a better outcome in endodontic treatment regarding microbial presence?
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⭐️What factor contributes to the high prevalence of biofilms in cyst-associated lesions?
⭐️What factor contributes to the high prevalence of biofilms in cyst-associated lesions?
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Study Notes
Apical Periodontitis and Biofilms
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Apical periodontitis, also known as periapical periodontitis, is an inflammation of the tissues at the tip of the root of a tooth; it can be caused by bacteria.
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Biofilms are communities of bacteria living together and encased in a matrix of extracellular products.
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In a study by Ricucci and Siqueira, biofilms were present in approximately 80% of the root canals of teeth with apical periodontitis.
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This is a strong indication linking apical periodontitis to biofilms
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Biofilm morphology varies between individuals, including thickness, morphotypes, bacterial cells/extracellular matrix ratio.
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Bacteria in biofilms can invade dentinal tubules underneath the biofilm community.
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Biofilms are often seen in apical ramifications, lateral canals, and isthmuses, suggesting they can spread within the root canal system.
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Biofilms are significantly associated with epithelialized lesions, such as apical cysts and granulomas.
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Biofilms were found in 95% of teeth associated with apical cysts, 83% of teeth associated with abscesses, and 69.5% of teeth associated with granulomas.
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Biofilms are more frequent in root canals of teeth with large apical periodontitis lesions, which may be due to a longer time for bacteria to establish a mature biofilm community.
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This suggests that the size of the lesion may be related to the presence and nature of the biofilm.
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Extraradicular biofilms are infrequent, but when present they are associated with intraradicular biofilms and clinical symptoms.
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Bacteria in flocs (planktonic biofilms) may detach from biofilms or originate from cell aggregates in a fluid.
Criteria for Assessing Biofilm Involvement in Disease
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Biofilms fulfill several criteria that establish a causal link between biofilms and infection.
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These criteria include:
- Bacteria adhered to a surface.
- Bacteria forming clusters or microcolonies encased in an extracellular matrix.
- Infection confined to a specific site, with spread being a secondary event.
- Difficulty in eradicating infection with antibiotics, even though bacteria are susceptible to killing in their planktonic state.
- Ineffective host clearance evidenced by the location of bacterial colonies surrounded by inflammatory cells.
- Elimination or disruption of the biofilm structure leading to remission of the disease.
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Apical periodontitis fulfills four out of six criteria for biofilm involvement.
- Bacteria are adhered to dentinal root canal walls.
- Bacterial colonies are encased in an extracellular matrix.
- Endodontic biofilms are primarily confined to the root canal system.
- Biofilms are directly faced by inflammatory cells.
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Systemic antibiotics are often ineffective against intraradicular infections due to the location of bacteria in an avascular pulp necrotic space.
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The recognition of biofilms as the main mode of bacterial establishment in the root canal system strengthens the explanation for the lack of antibiotic effectiveness.
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Biofilms are frequently observed in canals of treated teeth with posttreatment apical periodontitis, suggesting a role in treatment failure.
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Teeth with successful treatment outcomes show no biofilm infection of the root canal.
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Canals with negative cultures at the time of filling have a better treatment outcome, suggesting a link between culture positivity and biofilm presence.
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