Large Bacterial Floc Causing an Independent Extraradicular Infection and Posttreatment Apical Periodontitis: A Case Report.

This article describes a case of large persistent posttreatment apical periodontitis associated with 2 maxillary incisors, which was successfully managed by periradicular surgery. Histobacteriologic analysis revealed that the lesion was a granuloma that contained in its body a very large actinomycoticlike colony surrounded by accumulations of polymorphonuclear leukocytes and showing no direct communication with the root canal systems from both teeth. One incisor had no evidence of persistent intraradicular infection, whereas the other exhibited some residual dentinal tubule infection in the apical canal, which may have not significantly contributed to persistent inflammation given the organization and agglomeration of inflammatory cells around the large extraradicular bacterial colony. Findings showed that the main cause of persistent disease was the extraradicular infection in the form of a large bacterial floc, apparently independent of an intraradicular infection and as such only solved by surgery.

Extraradicular infection as the cause of persistent symptoms: a case series.

INTRODUCTION: This article describes 3 cases that presented persistent symptoms after appropriate endodontic treatment. Histopathologic and histobacteriologic investigation were conducted for determination of the cause. METHODS: Three cases are reported that presented with persistent symptoms after endodontic retreatment (cases 1 and 2) or treatment (case 3). Periapical surgery was indicated and performed in these cases. The biopsy specimens, consisting of root apices and the apical periodontitis lesions, were subjected to histopathologic and histobacteriologic analyses. RESULTS: Case 1 was an apical cyst with necrotic debris, heavily colonized by ramifying bacteria, in the lumen. No bacteria were found in the apical root canal system. Case 2 was a granuloma displaying numerous bacterial aggregations through the inflammatory tissue. Infection was also present in the dentinal tubules at the apical root canal. Case 3 was a cyst with bacterial colonies floating in its lumen; bacterial biofilms were also seen on the external apical root surface, filling a large lateral canal and other apical ramifications, and between layers of cementum detached from the root surface. No bacteria were detected in the main root canal. CONCLUSIONS: Different forms of extraradicular infection were associated with symptoms in these cases, leading to short-term endodontic failure only solved by periapical surgery.

Comparison of the mechanical properties of rotary instruments made of conventional nickel-titanium wire, M-wire, or nickel-titanium alloy in R-phase.

INTRODUCTION: This study compared the mechanical properties of endodontic instruments made of conventional nickel-titanium (NiTi) wire (K(3) and Revo-S SU), M-Wire (ProFile Vortex), or NiTi alloy in R-phase (K(3)XF). METHODS: The test instruments were subjected to mechanical tests to evaluate resistance to bending (flexibility), cyclic fatigue, and torsional load in clockwise rotation. Data were statistically evaluated by the analysis of variance test and the Student-Newman-Keuls test for multiple comparisons. RESULTS: In the bending resistance test, flexibility decreased in the following order: K(3)XF > Revo-S SU > ProFile Vortex > K(3). The ranking in the fatigue resistance test was the following: K(3)XF > K(3) > ProFile Vortex > Revo-S SU. In the torsional assay, the angular deflection at failure decreased in the following order: K(3)XF > Revo-S SU > K(3) > ProFile Vortex. For the maximum torque values, the ranking was K(3) > K(3)XF > ProFile Vortex > Revo-S SU. CONCLUSIONS: The results showed that the K(3)XF instrument, which is made of NiTi alloy in R-phase, had the overall best performance in terms of flexibility, angular deflection at failure, and cyclic fatigue resistance. In addition to the alloy from which the instrument is manufactured, the design and dimensions are important determinants of the mechanical performance of endodontic instruments.

Dentinal tubule infection as the cause of recurrent disease and late endodontic treatment failure: a case report.

INTRODUCTION: This article describes a case of recurrent post-treatment apical periodontitis and late failure after endodontic retreatment performed in a single visit. METHODS: The patient presented with a tooth exhibiting inadequate endodontic treatment and a large periradicular lesion that extended laterally to the root. Retreatment was performed in a single visit and involved chemomechanical preparation using 5.25% NaOCl as the irrigant and root canal obturation by Schilder's vertical compaction technique. A large lateral canal was radiographically revealed after obturation. After 2 years, the lesion was no longer radiographically discernible, a condition that was confirmed 9 years after retreatment procedures. Nonetheless, after 12 years, radiographs revealed recurrent disease. Apical surgery was performed, and the root apex, including the area of the large lateral canal, was resected with care to maintain the lesion attached to it. The biopsy specimen was subjected to histopathologic and histobacteriologic analyses. RESULTS: Longitudinal sections of the apical root specimen revealed a heavy dentinal tubule infection surrounding the area of the lateral canal. Bacteria were not found in any other area of the specimen. No other possible reason for the inflammatory periradicular lesion, such as root fracture, coronal leakage, or foreign-body reaction, was evident. CONCLUSIONS: A persistent intraradicular infection caused by bacteria located within dentinal tubules is the most reasonable explanation for resurgence of the apical periodontitis lesion. This case report stresses the importance of attaining proper disinfection of the root canal system for a predictable long-term outcome of the treatment.