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Extraradicular infection: a methodological study.

P T Sunde¹, I Olsen, P O Lind

¹Department of Oral Biology, University of Oslo, Oslo, Norway.

Endodontics & Dental Traumatology

|February 24, 2001

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This study investigated bacterial presence in periapical lesions. Findings suggest bacteria in lesions predate sampling, with marginal incisions potentially introducing them from periodontal pockets.

Area of Science:

Endodontics
Microbiology
Oral Surgery

Background:

The presence and origin of bacteria in endodontic periapical lesions remain debated.
Sampling periapical bacteria is challenging due to potential contamination from oral microflora.

Purpose of the Study:

To determine if bacteria in periapical lesions are indigenous or introduced during sampling.
To compare bacterial contamination levels associated with marginal versus submarginal incision techniques.

Main Methods:

Bacterial samples were collected from mucosa, alveolar bone, and periapical lesions in 30 patients with root-filled teeth and radiolucencies.
Two incision techniques (marginal and submarginal) were employed after mucosal disinfection with chlorhexidine gluconate.
Samples were cultured anaerobically, and phenotypic profiling was performed using the API bioMérieux system.

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Main Results:

Despite disinfection, mucosal bacteria were detected in 80% of Group 1 (marginal incision) and 73% of Group 2 (submarginal incision) patients.
Alveolar bone and periapical lesion samples showed high bacterial growth rates (100% and 73% in Group 1; 20% and 67% in Group 2, respectively).
Phenotypic profiling indicated that sampling techniques prevented mucosal contamination of lesions, suggesting bacteria originated from periodontal pockets via bacteremia or translocation after marginal incision.

Conclusions:

Bacteria detected in periapical lesions appear to be present before sampling.
Marginal incision techniques may facilitate bacterial translocation from periodontal pockets to periapical tissues.
The study highlights the importance of meticulous sampling techniques to accurately assess periapical lesion microbiota.