Extraradicular Infection as the Cause of Persistent Symptoms: A Case Series
Extraradicular Infection as the Cause of Persistent Symptoms: A Case Series
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DOI：
10.1016/j.joen.2014.08.020
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发表时间：
2015-02-01
影响因子：
4.2
通讯作者：
Rocas, Isabela N.
中科院分区：
文献类型：
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作者：
Ricucci, Domenico;Siqueira, Jose F., Jr.;Rocas, Isabela N.
前言：本文描述了3例在适当的根管治疗后出现持续性症状的病例。组织病理学和组织细菌学检查以确定病因。方法：报告3例经再治疗(1例和2例)或治疗(3例)后出现持续症状的病例。这些病例均进行了根尖周手术。活检标本包括根尖和根尖周炎病变，进行组织病理学和组织细菌学分析。结果：病例1为根尖囊肿，腔内有大量分枝杆菌定植，有坏死性碎片。在根管系统中未发现细菌。例2为肉芽肿，炎性组织内有大量细菌聚集。根尖根管的牙本质小管也有感染。例3为囊肿腔内漂浮的细菌菌落；根尖外表面也可见细菌生物膜，充填较大的侧根管和其他根尖分支，以及从根面脱落的牙骨质之间。主根管内未检出细菌。结论：在这些病例中，不同形式的根管外感染与症状有关，导致短期的根管失败只能通过根尖周围手术来解决。
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 endodontit 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 shortterm endodontic failure only solved by periapical surgery.