Sakko Marjut, Tjäderhane Leo, Rautemaa-Richardson Riina
Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Prim Dent J. 2016 May 1;5(2):84-89. doi: 10.1308/205016816819304231.
Inflammatory reaction in the periapical tissues is induced by microbial infection in the root canal system. The aim of root canal treatment is to preserve healthy periapical tissues or to provide healing of them in restorable teeth, which have sufficient periodontal support. The amount of microbial cells in the root canal system and their virulence as well as host responses influence on the degree of periapical inflammation and symptoms. Microbial biofilm formation is typically seen on root canal walls but some microbial species are able to invade the dentine tubules to varying depth. In prolonged and complicated infections, or in case of risk of systemic spread of infection, root canal sampling for microbiological diagnostics is recommended. Anaerobic gram-negative rods are commonly isolated organisms in primary infections. In post-treatment disease, the microflora is dominated by facultatively anaerobic gram-positive cocci and rods such as Streptococcus, Enterococcus, Peptostreptococcus and Actinomyces species. Instrumentation, disinfection and interappointment medication in strict aseptic conditions are essential steps for eradication of microbial species from the infected root canal system. During past decades, Enterococcus faecalis and Candida albicans have been commonly associated organisms in treatment-resistant infections. Novel microbial detection methods are giving increasing knowledge about microbial species associated with endodontic infections and their roles in them.
根尖周组织中的炎症反应是由根管系统中的微生物感染引起的。根管治疗的目的是在具有足够牙周支持的可修复牙齿中保存健康的根尖周组织或使其愈合。根管系统中微生物细胞的数量及其毒力以及宿主反应会影响根尖周炎症的程度和症状。微生物生物膜通常可见于根管壁，但一些微生物种类能够侵入牙本质小管至不同深度。在长期和复杂的感染中，或在有感染全身扩散风险的情况下，建议进行根管取样以进行微生物诊断。厌氧革兰氏阴性杆菌是原发性感染中常见的分离菌。在治疗后疾病中，微生物群以兼性厌氧革兰氏阳性球菌和杆菌为主，如链球菌、肠球菌、消化链球菌和放线菌属。在严格的无菌条件下进行器械操作、消毒和复诊间用药是从感染的根管系统中根除微生物种类的关键步骤。在过去几十年中，粪肠球菌和白色念珠菌一直是治疗抵抗性感染中常见的相关微生物。新型微生物检测方法使人们对与牙髓感染相关的微生物种类及其在其中的作用有了越来越多的了解。
