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Microflora in teeth associated with apical periodontitis: a methodological observational study comparing two

N Richardson1, N J Mordan, J A P Figueiredo

  • 1Unit of Endodontology, Division of Restorative Dental Science, UCL Eastman Dental Institute, University College London, London WC1X 8LD, UK.

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This study compared two protocols for examining bacterial colonization in teeth with chronic apical periodontitis. Both methods revealed bacterial biofilms, with polymorphonuclear leukocytes (PMNs) present throughout the root canal, challenging previous assumptions.

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Area of Science:

  • Microbiology
  • Dental Science
  • Microscopy Techniques

Background:

  • Chronic apical periodontitis involves bacterial colonization within the root canal system.
  • Acute episodes (ap) complicate the understanding of intra-radicular bacterial presence and host response.
  • Advanced microscopy is crucial for visualizing these complex microbial communities.

Purpose of the Study:

  • To compare the Eastman Dental Institute (EDI) and Zurich protocols for examining bacterial colonization in teeth with chronic apical periodontitis with acute episodes (ap).
  • To evaluate the efficacy of light microscopy (LM), transmission electron microscopy (TEM), and scanning electron microscopy (SEM) in visualizing intra-radicular bacteria and host responses.
  • To characterize the distribution and morphology of bacteria and polymorphonuclear leukocytes (PMNs) within the root canal system.

Main Methods:

  • Nine root samples (seven teeth) were processed using either the EDI or Zurich protocol.
  • Roots were sectioned longitudinally, with one portion examined by SEM and the other by LM and TEM on transverse sections from apical, middle, and coronal thirds.
  • Bacterial presence, morphology, distribution, and host cells (PMNs) were systematically recorded.

Main Results:

  • The Zurich technique offered better root division, while the EDI approach yielded superior ultrastructural detail.
  • Bacteria were detected in eight of nine roots, forming biofilms on the canal surface with diverse morphotypes (rods, cocci, filaments, spirochaetes).
  • Bacteria were more prevalent apically on canal walls but more common coronally within dentinal tubules; PMNs were found throughout, particularly apically, often containing biofilms.

Conclusions:

  • Both EDI and Zurich protocols have distinct advantages and disadvantages for examining intra-radicular bacteria.
  • The combination of LM, TEM, and SEM provides complementary insights into bacterial colonization patterns.
  • Host inflammatory response (PMNs) is not confined to the apical region and can be present throughout the root canal, even in the coronal third.