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Abstract
This study intended to examine histologically root canal-treated teeth evincing apical
periodontitis lesions and correlate the findings with clinical observations. Specimens
were obtained from 24 patients (12 asymptomatic and 12 symptomatic) by extraction
or endodontic surgery and consisted of roots or root tips and the associated pathologic
lesion. Specimens were processed for histologic analysis, and serial sections were
evaluated. Findings were correlated with clinical observations according to the presence
or absence of symptoms. The mean period elapsed from treatment to specimen retrieval
in the asymptomatic group was 7.5 years, as compared with 2.2 years in the symptomatic
group. All specimens exhibited periradicular inflammation. Bacteria were visualized
in all cases, except for 1 specimen from the asymptomatic group in which a foreign
body reaction to overfilled material was the probable reason for emergent disease
in a previously vital case. Irrespective of the presence of symptoms, bacteria were
always located within the root canal system, although they were also observed in the
periradicular tissues in 1 asymptomatic and 4 symptomatic teeth. In general, intraradicular
bacterial colonization was heavier in symptomatic failed teeth. The present findings
support the role of intraradicular infections, usually in the form of biofilms, as
the primary cause of endodontic treatment failure.