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Cholesterol as an aetiological agent in endodontic failures--a review
1Department of Oral Structural Biology, Centre for Dental & Oral Medicine, University of Zurich, Plattenstrasse 11, CH-8028 Zurich, Switzerland.
Summary
Cholesterol crystals in apical periodontitis lesions hinder healing after root canal treatment. Surgical intervention is recommended for persistent lesions, as re-treatment alone may not remove these external irritants.
Area of Science:
- Endodontology
- Oral Pathology
- Inflammation Biology
Background:
- Cholesterol clefts are common in apical periodontitis.
- A recent hypothesis links cholesterol crystals to persistent lesions post-endodontic treatment.
Purpose of the Study:
- To explain the biological basis for cholesterol crystal accumulation.
- To review clinical and experimental data on cholesterol crystals impacting periapical healing.
- To support the role of cholesterol crystals in non-resolving apical periodontitis.
Main Methods:
- Literature review of clinical and experimental data.
- Biological explanation of cellular inability to eliminate cholesterol crystals.
- Consolidation of evidence regarding cholesterol crystal impact on periapical tissues.
Main Results:
- Massive accumulation of cholesterol crystals in inflamed periapical tissues can impede healing after root canal treatment.
- Cholesterol crystals and other etiological agents causing treatment failure often reside outside the root canal system.
Conclusions:
- Re-treatment alone is unlikely to resolve persistent apical periodontitis lesions caused by external factors like cholesterol crystals.
- Apical surgery is indicated for effective management of such challenging cases.