Calculus‐like deposit on the apical external root surface of teeth with post‐treatment apical periodontitis: report of two cases

Abstract

Biofilm on the external root surface has been implicated in the failure of apical periodontitis to heal, despite adequate root canal treatment. Calculus-like material was found, in two cases, on the root surface of teeth with post-treatment apical periodontitis, where the only communication externally was a sinus tract.

Histologic Investigation of Root Canal–treated Teeth with Apical Periodontitis: A Retrospective Study from Twenty-four Patients

“…In another tooth, a maxillary premolar with a long-lasting preoperative sinus tract, calculus-like material was found covering the root surface on the palatal aspect; numerous bacterial profiles were seen in the deepest part of this structure. This case has also been described elsewhere (23).…”

“…All these situations in which bacteria were visualized extraradicularly were clearly distinct from possible bacterial contamination that might occur during biopsy-taking procedures. Bacteria were present in large numbers in calculus-like deposits adhered to the external root surface (23), in an abscess cavity contiguous to apical ramifications clogged with bacteria (12), and in resorption lacunae, always faced with PMNs. At the same time, it was easy to distinguish between bacterial colonies actually located within the tissue and surrounded by a severe concentration of inflammatory cells (Fig.…”

One- versus Two-visit Endodontic Treatment of Teeth with Apical Periodontitis: A Histobacteriologic Study

“…Whether these remaining extraradicular biofilms can remain active after root canal treatment to the point of jeopardizing the treatment outcome cannot be answered by the present study. However, reports suggest that the presence of a biofilm on the external apical root surface might be implicated in the failure of apical periodontitis to heal (38,39).…”

Light activated disinfection: an alternative endodontic disinfection strategy

“…32,33 However, the presence of such mineralized matured endodontic biofilms may not be uncommon in vivo. 34,35 Data from Experiment 2 highlighted greater resistance of matured four-week-old biofilm bacteria to all tested disinfection methods. The improved LAD group showed considerable bacterial inactivation (96.7 per cent) when compared to LAD.…”