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Bacterial Viability in Persistent Apical Periodontitis: A Systematic Review.

D Nascimento1, I C Guedes1, L M Brand1

  • 1Basic Research Center, Dentistry School, UFRGS, Porto Alegre, Brazil.

Journal of Endodontics
|July 27, 2025
PubMed
Summary
This summary is machine-generated.

Viable microorganisms are present in persistent apical periodontitis, a condition often unresponsive to treatment. This systematic review confirms bacterial presence, though their exact location remains unclear.

Keywords:
Apical periodontitisRNA-based methodsbacterial viabilitycell culturepersistent apical inflammatory lesion

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Area of Science:

  • Endodontics
  • Microbiology
  • Oral Pathology

Background:

  • Apical inflammatory lesions stem from microbial infections.
  • Persistence of these lesions despite treatment is not fully understood.
  • This review focuses on viable microorganisms in persistent apical periodontitis.

Purpose of the Study:

  • To systematically review evidence on viable microorganisms in persistent apical periodontitis.
  • To analyze the role of microbial presence in treatment-resistant apical lesions.

Main Methods:

  • Comprehensive literature search across multiple databases (MEDLINE/PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, CAPES, grey literature).
  • Inclusion limited to studies obtaining periapical tissue samples during apical surgery.
  • Quality assessment of included studies using Joanna Briggs Institute Checklist.

Main Results:

  • Four studies were selected from 522 initial results.
  • Viable microorganisms were detected in persistent apical periodontitis.
  • Bacterial viability confirmed by cell culture (1 study) and RNA-based methods (3 studies).
  • RNA-based studies showed methodological heterogeneity.
  • Diverse microbial populations characterize these infections.

Conclusions:

  • Evidence supports the presence of viable bacteria in persistent apical periodontitis.
  • The precise location of bacteria (within lesion, intra-radicular, or extra-radicular) requires further investigation.
  • Understanding microbial location is crucial for explaining lesion persistence.