Histological evaluation of the presence of bacteria in induced periapical lesions in monkeys.

In endodontic periapical lesions, both presence and location of bacteria are controversial. Various experimental techniques have produced differing results perhaps related to potential artifacts such as contamination during specimen recovery. Our objective was to examine for bacteria in uncontaminated, undisturbed periapical lesions in an animal model. Pulp necrosis was induced by exposing molars in nonhuman primates and closing the exposure after 1 week with amalgam. Lesions developed at 18 apices. After 7 months, block sections including tooth and surrounding tissues were removed, processed histologically, and Gram stained. Bacteria, primarily Gram positive, were consistently identified in necrotic tissue in canals. Two canals demonstrated bacterial masses to the apical foramen. No bacterial colonies, only intracellular microorganisms, were seen periapically. Inflammatory lesions seemed to resist the spread of bacteria, confining them to the canal space. Bacterial masses at the apical foramen could contaminate periapical tissues during surgery or extraction and give a false positive upon microbiological sampling.