History of Endodontics aae/abe



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Black Pigmented Bacteria (BPB)


Bacteroides species – formerly Bacteroides melaninogenicus – 1980’s/90’s

Two genera (PP):

Porphyromonas (i.e.: P. gingivalis, endodontalis): Asaccharolytic BPBs



Prevotella (i.e.: P. intermedia, nigrescens, oris): Saccharoltyic BPBs
Sundqvist; VanWinklehoff – BPB (B. endodontalis/gingivalis) and AAA

Sundqvist – Saccharolytic Bacteria - Early Pulpal Infection (coronal); Asaccharolytic Bacteria – Late Pulpal Infection (apical)

Is HIV found in the root canal or apical lesion?


Glick – 1st to find HIV within the dental pulp

Torabinejad 1994 JOE – Found HIV in the periradicular lesion w/ PCR

Trope 1991 OOO – Found HIV in pulp tissue fibroblasts w/ DNA hybridization

Sabeti 2004 JOE – Found Herpes simplex, Epstein-Barr & Human Cytomegalovirus in periapical lesions (HSV, EBV, CMV). Large lesions showed higher levels.

Are certain bacteria taxa associated with symptoms?

YES


  1. Sundqvist 1976 – Classic study – Bacteroides melaninogenicus (BPBs) associated with acute symptoms (AAA)




  1. Griffee/Newton 1980– Black Pigmented Bacteroides (BPBs) are associated with pain, sinus tract and odor




  1. Van Winkelhoff 1985 – AAA: >90% contained Bacteroides species




  1. Yoshida 1987 – P. Magnus, Bacteroides in acute symptomatic cases




  1. Jacinto/Gomes 2003 – Specific Gram - anaerobes isolated from symptomatic cases (perc +, spontaneous pain, etc.), including BPBs (Por, Prev)




  1. Gomes 2006 – Fusobacterium alocis, T. forsythia (gram – anaerobic rods) & T. denticola (gram – anaerobic spirochete) associated with acute symptoms

Are certain bacteria taxa associated with symptoms?


NO

  1. Baumgartner 1999 – Culture/qPCR; 55% Root canal samples positive for BPBs, No significant relationship between specific BPB and signs/symptoms




  1. Siquiera/Rocas 2005 – qPCR; no relationship of BPB w/ symptoms




  1. Siqueira/Rocas 2009 – No strong evidence of any single species causing a specific sign or symptom of AP; more likely virulence factors/bacterial density/host resistance interactions




  1. Siqueira/Rocas 2013No single bacterial species can be implicated in pathogenesis of AP – limited to inferring Cause-and-Effect relationships; Different types and loads of the bacterial community (density/virulence factors) may be responsible for the specific pathophysiology of symp vs. asymp. cases. Bacterial community concept

Are more bacterial species found in symptomatic teeth?
YES

  1. Sundqvist 1975 - >6 species = pain, 5 or less = no pain (culture-dependent study, less specificity)




  1. Siqueira/Rocas 2004AAA cases: 12-18 taxa, AAP cases: 7-12 taxa (culture independent, qPCR study, detects VBNC taxa)




  1. Sakamoto/Siqueira 2006 – 16s rRNA PCR sequencing:

Symptomatic cases (AAA): 18 taxa, Asymptomatic cases (AAP): 12 taxa, AAA greater bacterial diversity


  1. Horiba – Higher levels of LPS endotoxin in symptomatic cases (along with lesions and exudate)

Are bacteria found in periapical lesions? Controversial

YES

Persistent AP (Surgical Biopsies):

  1. Saber/Simon 2012 – 7/13 persistent AP contained extraradicular infections upon surgical biopsy. All 7 were symptomatic.

  2. Gatti/Socransky 2000 – DNA/DNA hybrid., Persistent AP (refractory) cases; Attempted to discount sample contamination during sx biopsy

  3. Tronstad/Sunde; Tronstad/Barnett– Extrarad Biofilms, Persistent cases

Sinus Tracts/CAA:

  1. Haapasalo - Microbial presence within Sinus tracts (CAA)

  2. Weiger 1995Culture study, Sinus tracts contain bacteria; 9/12 sinus tracts contain species also found in the canal

AAA:

  1. Oguntebi/Langeland; Siqueira culture; PCR, AAA contain bacteria (commonly accepted)

  2. Siqueira/Rocas 2013 – Review of AAA, mixed obligate anaerobic infection – bacterial community as a pathogen concept

Are bacteria found in periapical lesions? Controversial
NO

  1. Walton – Inflammation resists spread of bacteria, confined to root

  2. Nair – Bacteria confined to root, except:

    1. Abscesses

    2. Therapy resistant cases – actinomyces (israeli)

    3. Infected cysts

  3. Holland – Bacteria are present when pushed out during RCT

  4. Langeland

  5. Siqueira/Rocas Only in Abscesses & Actinomycosis cases

  6. Ricucci/Siqueira – Extraradicular biofilms 6%, typically planktonic bacteria in form of abscess with PMNs


Sjogren – isolated P. propionicum extraradicularly

Waltimo – no candida in AP and is resistant to Ca(OH)2

Discuss bacterial flora in Acute Apical Abscess

  1. Oguntebi/Langeland 1982 - Abscesses aspirated/cultured – Mixed gram +/- facultative and obligate anaerobic flora; Most common: Fusobacterium nucleatum, Streptococcus mitis

  2. Baumgartner 2004 – Periradicular abscesses are polymicrobial infections with organisms similar to those found in infected root canals

  3. Siqueira/Rocas 2006 - # bacterial species: Acute Abscess (12-18) > Chronic AP (7-12); Mixed flora and dominated by Anaerobic bacteria

  4. Santos/Siqueira 2011 – Pyrosequencing, Most abundant phyla:

    1. Symptomatic Infections: Firmicutes (Dialister, Strep, Filifactor), Fusobacteria, Bacteroidetes (P, P, T)

    2. Asymptomatic Infections: Firmicutes, Bacteroidetes, Actinobacteria

  5. Siqueira/Rocas 2013AAA: Mixed anaerobic infection, Great Diversity

Gram -: BPBs (Prevotella, Porphyromonas), Fusobacterium nucleatum, Treponema, Tannerella forsythia, Dialister invisus

Gram +: Peptostreptococci (Parvimonas), Streptococcus anginosus, Actinomyces

Bacteremia from RCT


  1. Baumgartner 1976 – Bacteremias & NSRCT: evaluated vital/necrotic cases; instrumentation & obturation; overinstrumentation of necrotic cases

    1. Total incidence: 3.3% (1/30)overinstrumentation of necrotic tooth

    2. No bacteremia if instrumentation/obturation confined w/in canal




  1. Debilian/Tronstad 1995 - ~25% even when instrument is confined to canal




  1. Pallasch - Endo tx is the least likely dental procedure to produce bacteremia




  1. Baumgartner 1977 – Bacteremias & Endo Surgery:

    1. Flap reflection: 83%

    2. Periapical curretage: 33%

    3. Simple Tooth Extraction: 100%

    4. Transient nature of bacteremias (83%-33% during surgery)

Periodontal vs. Endodontic Bacterial Profiles


  1. Trope/Tronstad/Rosenberg 1988Darkfield microscopy, Endodontic vs. Periodontal abscesses: Coccoid cells: Endo > Perio, Spirochetes: Perio > Endo; Spirochete (i.e.: Treponema) ranges: Perio abscesses 30-60%, Endo abscesses 0-10%




  1. Socransky 1998RED Complex (PTT) = P. gingivalis, Tanerella forsythia, and Treponema denticola, Periodontal pathogenic complex (13,000 plaque samples)




  1. Socransky 2005 – Periodontal microbial etiology review
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