Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after "one-visit" endodontic treatment.
OBJECTIVE
To assess the in vivo intracanal microbial status of apical root canal system of mesial roots of human mandibular first molars with primary apical periodontitis immediately after one-visit endodontic treatment. The residual intracanal infection was confirmed by correlative light and transmission electron microscopy.


METHODS
Sixteen diseased mesial roots of mandibular first molars were treated endodontically, each in one visit. Mesio-buccal canals were instrumented using stainless steel hand files and mesio-lingual canals with a nickel-titanium rotary system. The canals were irrigated with 5.25% sodium hypochlorite (NaOCl) during the instrumentation procedures, rinsed with 10 mL of 17% ethylenediamine tetraacetic acid (EDTA), and obturated with gutta-percha and zinc oxide eugenol cement. Thereafter, the apical portion of the root of each tooth was removed by flap-surgery. The specimens were fixed, decalcified, subdivided in horizontal plane, embedded in plastic, processed, and evaluated by correlative light and transmission electron microscopy.


RESULTS
Fourteen of the 16 endodontically treated teeth revealed residual intracanal infection after instrumentation, antimicrobial irrigation, and obturation. The microbes were located in inaccessible recesses and diverticula of instrumented main canals, the intercanal isthmus, and accessory canals, mostly as biofilms.


CONCLUSIONS
The results show (1) the anatomical complexity of the root canal system of mandibular first molar roots and (2) the organization of the flora as biofilms in inaccessible areas of the canal system that cannot be removed by contemporary instruments and irrigation alone in one-visit treatment. These findings demonstrate the importance of stringent application of all nonantibiotic chemo-mechanical measures to treat teeth with infected and necrotic root canals so as to disrupt the biofilms and reduce the intraradicular microbial load to the lowest possible level so as to expect a highly favorable long-term prognosis of the root canal treatment.
Nair
P N R
PN
Institute of Oral Biology, Center of Dental & Oral Medicine, University of Zurich, Zurich, Switzerland. nair@zzmk.unizh.ch
Henry
Stéphane
S
Cano
Victor
V
Vera
Jorge
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001047:Apicoectomy; D018441:Biofilms; D003786:Dental Pulp Cavity / Q000382:microbiology*; D004492:Edetic Acid / Q000627:therapeutic use; D005260:Female; D006171:Gutta-Percha / Q000627:therapeutic use; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D008963:Molar / Q000382:microbiology*; D010485:Periapical Periodontitis / Q000382:microbiology*; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D012388:Root Canal Irrigants / Q000627:therapeutic use; D018915:Root Canal Preparation / Q000295:instrumentation; D012390:Root Canal Therapy; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D019227:Tooth Apex / Q000382:microbiology*; D015035:Zinc Oxide-Eugenol Cement / Q000627:therapeutic use
D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D015035:Zinc Oxide-Eugenol Cement; D006171:Gutta-Percha; D004492:Edetic Acid; D012973:Sodium Hypochlorite