Advertisement

Light and electron microscopic studies of root canal flora and periapical lesions

  • Author Footnotes
    1 Dr. Nair is affiliated with the Department of Oral Structural Biology, Dental Institute, University of Zurich, Zurich, Switzerland.
    P.N. Ramachandran Nair
    Footnotes
    1 Dr. Nair is affiliated with the Department of Oral Structural Biology, Dental Institute, University of Zurich, Zurich, Switzerland.
    Search for articles by this author
  • Author Footnotes
    1 Dr. Nair is affiliated with the Department of Oral Structural Biology, Dental Institute, University of Zurich, Zurich, Switzerland.
      This paper is only available as a PDF. To read, Please Download here.
      This study elaborates on (a) the structure of the root canal flora in periapically affected human teeth; (b) the relationship of flora to the dentinal wall of the root canal; (c) morphological aspects of interaction among diverse groups of bacteria; and (d) the dynamic nature of inflammatory host response at the periapex. Spontaneous human periapical lesions (30 granulomas and 1 radicular cyst) obtained by tooth extraction were processed for light and electron microscopy. All 31 teeth showed bacteria in their root canals. The flora consisted of cocci, rods, filamentous organisms, and spirochetes. The rods often revealed Gram-negative walls. The bacterial flora formed clusters of “self-aggregating” colonies of one distinct type or “coaggregating” communities of several types. Electron microscopically a condensed bacterial layer could be identified on the dentinal wall of the root canal which when light microscopically visible, gave the palisade structure of bacterial plaques adhering to tooth surfaces. The endodontic flora was separated from the rest of the lesion by a dense wall of neutrophils (PMN's) or by an “epithelial plug” at the apical foramen. Five specimens revealed both intra- and extracellular bacteria within the body of the lesions. The membrane-delimited phagosomes containing bacteria showed interaction between phagocytic cells and bacteria. The presence of the “immunocoating” on the surface of certain phagocytosed bacteria strongly suggests that they were not contaminants but actual tissue invaders against which the host mounted a specific immune response at the periapex.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Harndt E.
        Histo-bakteriologische studies bei periodontitis chronika granulomatosa.
        Correspondenz-Blatt Zahnarztl. 1926; 50: 330-335
        • Harndt E
        Histo-bakteriologische studie bei periodontitis chronika granulomatosa.
        Correspondenz-Blatt Zahnarztl. 1926; 50: 365-370
        • Harndt E
        Histo-bakteriologische studie bei periodontitis chronika granulomatosa.
        Correspondenz-Blatt Zahnarztl. 1926; 50: 399-404
        • Harndt E
        Histo-bakteriologische studie bei periodontitis chronika granulomatosa.
        Correspondenz-Blatt Zahnarztl. 1926; 50: 426-432
        • Winkler KC
        • van Amerongen J
        Bacteriological results from 4000 root canal cultures.
        Oral Surg. 1959; 12: 857-875
        • Birch RH
        • Melville TH
        • Neubert EW
        A comparison of root-canal and apical lesion flora.
        Br Dent J. 1964; 116: 350-352
        • Winkler TF
        Review of the literature: a histologic study of bacteria in periapical pathosis.
        Pharmacol Ther Dent. 1975; 2: 157-181
        • Nair PNR
        • Schroeder HE
        Pathogenese periapikaler Läsionen (eine Literaturübersicht).
        Schweiz Mschr Zahnheilk. 1983; 93: 935-952
        • Weber R
        • Pesch KL
        Untersuchungen über die pathogenetische Bedeutung der Zahnwurzelgranulome für die orale Sepsis.
        Dtsch Mschr Zahnheilk. 1927; 45: 875-894
        • Boyle PE
        Intracellular bacteria in a dental granuloma.
        J Dent Res. 1934; 14: 297-301
        • Andreasen JO
        • Rud J
        A histobacteriologic study of dental and periapical structures after endodontic surgery.
        Int J Oral Surg. 1972; 1: 272-281
        • Winkler TF
        • Mitchel DF
        • Healey HJ
        A bacterial study of human periapical pathosis employing a modified Gram tissue stain.
        Oral Surg. 1972; 34: 109-116
        • Block RM
        • Bushell A
        • Rodrigues H
        • Langeland K
        A histopahologic, histobacteriologic, and radiographic study of periapical endodontic surgical specimens.
        Oral Surg. 1976; 42: 656-678
        • Langeland K
        • Block RM
        • Grossman LI
        A histopathologic study of 35 periapical endodontic surgical specimens.
        J Endodon. 1977; 3: 8-23
        • Spinner JR
        Vom Chemismus der Pulpengangrãn. Ein aktuelles Problem der konservierenden Zahnheilkunde.
        Zahnärztl Welt. 1947; 2: 305-313
        • Morse DR
        Immunologic aspects of pulpal-periapical diseases.
        A review. Oral Surg. 1977; 43: 436-451
        • Torabinejad M
        • Bakland LK
        Immunopathogenesis of chronic periapical lesions. A review.
        Oral Surg. 1978; 46: 685-699
        • Brown Jr, LR
        • Rudolph Jr, CE
        Isolation and identification of microorganisms from unexposed canals of pulp involved teeth.
        Oral Surg. 1957; 10: 1094-1099
        • Macdonald JB
        • Hare GC
        • Wood AWS
        The bacteriologic status of the pulp chambers in intact teeth found to be non-vital following trauma.
        Oral Surg. 1957; 10: 318-322
        • Crawford JJ
        • Shankle RJ
        Application of newer methods to study the importance of root canal and oral microbiota in endodontics.
        Oral Surg. 1961; 14: 1109-1123
        • Möller A.
        Microbiological examination of root canals and periapical tissues of human teeth [Thesis].
        Odontol Tidskr. 1966; 74: 1-9
        • Sundqvist G
        Bacteriological studies of necrotic pulps.
        in: Thesis. University of Umea, Umea1976
        • Dahlén G
        Studies on lipopolysaccharides from oral Gram-negative anaerobic bacteria in relation to apical periodontitis.
        Univerity of Göteborg, Göteborg, Sweden1980
        • Dahlén G
        • Bergenholtz G
        Endotoxic activity in teeth with necrotic pulps.
        J Dent Res. 1980; 59: 1033-1040
        • Möller AJR
        • Fabricius L
        • Dahlé G
        • Ohman AE
        • Heyden G
        Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys.
        Scand J Dent Res. 1981; 89: 475-484
        • Fabricius L
        Oral bacteria and apical periodontitis. An experimental study in monkeys.
        in: Thesis. University of Göteborg, Göteborg, Sweden1982
        • Fabricius L
        • Dahlén G
        • Holm SE
        • Möller AJR
        Influence of combinations of oral bacterial on periapical tissues of monkeys.
        Scand J Dent Res. 1982; 90: 200-206
        • Fabricius L
        • Dahlén G
        • Ohman AE
        • Möller AJR
        Predominat indigenous oral bacteria isolated from infected root canal after varied times of closure.
        Scand J Dent Res. 1982; 90: 134-144
        • Dahlén G
        • Fabricius L
        • Heyden G
        • Holm SE
        • Möller AJR
        Apical periodontitis induced by selected bacterial strains in root canals of immunized and nonimmunized monkeys.
        Scand J Dent Res. 1982; 90: 207-216
        • Dahlén G
        • Fabricius L
        • Holm SE
        • Möller AJR
        Circulating antibodies after experimental chronic infection in the root canal of teeth in monkeys.
        Scand J Dent Res. 1982; 90: 338-344
        • Lin L
        • Langeland k
        Light and electron microscopic study of teeth with carious pulp exposures.
        Oral Surg. 1981; 51: 292-316
        • Nair PNR
        • Schroeder HE
        Periapical actinomycosis.
        J Endodon. 1984; 10: 567-570
        • Karnovsky MJ
        A formaldehyde-glutaraldehyde fixative of high osmolarity for use in electron microscopy.
        J Cell Biol. 1965; 27: 137A-139A
        • Bennett HS
        • Luft JH
        S-collidine as a basis for buffering fixatives.
        J Biophys Biochem Cytol. 1959; 6: 113-114
        • Luft JH
        Improvements in epoxy resin embedding methods.
        J Biophys Biochem Cytol. 1961; 9: 409-414
        • Schroeder HE
        • Rossinsky K
        • Müller W
        An established routine method for differential staining of epoxy-embedded tissue sections.
        Microsc Acta. 1980; 83: 111-116
        • Reynolds ES
        The use of lead citrate at high pH as an electron-opaque stain in electron microscopy.
        J Cell Biol. 1963; 17: 208-212
        • Fraska JM
        • Parks VR
        A routine technique for double staining ultrathin sections using uranyl and leadsalts.
        J Cell Biol. 1965; 25: 157-161
        • Thilo B
        • Baehni P
        • Holz J
        • Baume LJ
        Distribution des bactéries dans les parties coronaire et apicale de dents à pulpe nécrosée.
        Rev Mens Suisse Odonto-Stomatol. 1983; 93: 335-350
        • Kornman KS
        • Holt SC
        Physiological and ultrastructural characterization of a new Bacteroides species (Bacteroides capillus) isolated from severe localized periodontitis.
        J Periodont Res. 1981; 16: 542-555
        • Ranta H
        • Lounatmaa K
        • Haapasalo M
        • Ranta K
        Isolation and ultrastructure of Bacteroides sp. with external cell wall layer (S-layer) in periapical ostitis.
        Scand J Dent res. 1983; 91: 458-464
        • Emery DL
        • Clark BL
        • Stewart DJ
        Analysis of the outer membrane proteins of Bacteroides nodosus, the causal organism of ovine footrot.
        Vet Microbiol. 1984; 9: 155-168
        • Houte van J
        Bacterial adherence in the mouth.
        Rev Infect Dis. 1983; 5: S659-S669
        • Gibbons RJ
        • Houte van J
        On the formation of dental plaques.
        J Periodontol. 1973; 44: 347-360
        • Cisar J
        Coaggregation reactions between oral bacteria: studies of specific cell to cell adherence mediated by microbial lectins.
        in: Genco R Mergenhagen SE Host-parasite interactions in periodontal diseases. American Society of Microbiology, Washington, DC1982: 121-131
        • Kolenbrander PE
        • Andersen RN
        • Holdeman LV
        Coaggregation of oral Bacteroides species with other bacteria: central role in coaggregation bridges and competitions.
        Infect Immun. 1985; 48: 741-746
        • Schroeder HE
        • Hirzel HC
        A method of studying dental plaque morphology.
        Helv Odontol Acta. 1969; 13: 22-27
        • Schoreder HE
        • De Boever J
        The structure of microbial dental plaque.
        in: McHugh WD Dental plaque. Churchill-Livingston, Edinburg/London1970: 49-75
        • Nair PNR
        • Schroeder HE
        Epithelial attachment at diseased human tooth-apex.
        J Periodont Res. 1985; 20: 293-300
        • Malassez ML
        Sur le Role Débris Epithéliaux Paradentaires.
        in: Masson G. Travaux de I-année 1885, Laboratoire d-histologie du collège de France, Paris. Librairie de l-académie de Médecine, 1885: 21-121
        • Sonnabend E
        • Oh CS
        Zur Frage des Epithels im apicalen Granulationsgewebe (Granulom) menschlicher Zähne.
        Dtsch Zahnarzti Z. 1966; 21: 627-643
        • Griffin Jr, FM
        • Griffin JA
        • Leider JE
        • Silverstein SC
        Studies on the mechanism of phagocytosis. I. Requirements for circumferential attachment of particle-bound ligands to specific receptors on the macrophage plasma membrane.
        J Exp Med. 1975; 142: 1263-1282
        • Root RK
        • Cohen MS
        The microbicidal mechanisms of human neutrophils and eosinophils.
        Rev Infect Dis. 1981; 3: 565-598
        • Lai C
        • Listgarten M
        • Rosan B
        Serology of Streptococcus sanguis: Localization of antigens with unlabeled antisera.
        Infect Immun. 1973; 8: 475-481
        • Baehni P
        • Listgarten MA
        • Taichman NS
        • McArthur WP
        Electron microscopic study of the interaction of oral microorganisms with polymorphonuclear leucocytes.
        Arch Oral Biol. 1977; 22: 685-692