Zilong Deng, Binbin Lin, Fan Liu, Wanghong Zhao
Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
School of Stomatology, Southern Medical University, Guangzhou, China.
J Oral Microbiol. 2023 Mar 1;15(1):2184924. doi: 10.1080/20002297.2023.2184924. eCollection 2023.
Refractory apical periodontitis (RAP) is an oral infectious disease characterised by persistent inflammation, progressive alveolar bone destruction, and delayed bone healing. RAP has received increasing attention, because it cannot be cured after repeated root canal therapies. The aetiology of RAP is related to the complex interplay between the pathogen and its host. However, the exact pathogenesis of RAP remains unclarified and includes several factors, such as microorganism immunogenicity, host immunity and inflammation, and tissue destruction and repair. Enterococcus faecalis is the dominant pathogen involved in RAP, and has evolved multiple strategies to ensure survival, which cause persistent intraradicular and extraradicular infections.
To review the crucial role of E. faecalis in the pathogenesis of RAP, and open new avenues for prevention and treatment of RAP.
The PubMed and Web of Science databases were searched for pertinent publications, employing the search terms "Enterococcus faecalis", "refractory apical periodontitis", "persistent periapical periodontitis", "pathogenicity", "virulence", "biofilm formation", "dentine tubule", "immune cell", "macrophage", and "osteoblast".
Besides its high pathogenicity due to various virulence mechanisms, E. faecalis modulates the macrophage and osteoblast responses, including regulated cell death, cell polarisation, cell differentiation, and inflammatory response. An in-depth understanding of the multifaceted host cell responses modulated by E. faecalis will help to design potential future therapeutic strategies and overcome the challenges of sustained infection and delayed tissue healing in RAP.
难治性根尖周炎（RAP）是一种口腔感染性疾病，其特征为持续性炎症、进行性牙槽骨破坏和骨愈合延迟。RAP受到越来越多的关注，因为在反复进行根管治疗后仍无法治愈。RAP的病因与病原体及其宿主之间的复杂相互作用有关。然而，RAP的确切发病机制仍不明确，包括多种因素，如微生物免疫原性、宿主免疫与炎症以及组织破坏与修复。粪肠球菌是参与RAP的主要病原体，它已进化出多种生存策略，导致根管内和根管外持续感染。
综述粪肠球菌在RAP发病机制中的关键作用，为RAP的预防和治疗开辟新途径。
在PubMed和Web of Science数据库中检索相关出版物，检索词为“粪肠球菌”、“难治性根尖周炎”、“持续性根尖周炎”、“致病性”、“毒力”、“生物膜形成”、“牙本质小管”、“免疫细胞”、“巨噬细胞”和“成骨细胞”。
除了通过各种毒力机制具有高致病性外，粪肠球菌还调节巨噬细胞和成骨细胞反应，包括调控细胞死亡、细胞极化、细胞分化和炎症反应。深入了解粪肠球菌调节的多方面宿主细胞反应将有助于设计未来潜在的治疗策略，并克服RAP中持续感染和组织愈合延迟的挑战。
