The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
After reading this chapter, the student should be able to:
1. Understand the microbial etiology of apical
periodontitis.
2. Describe the routes of entry of microorganisms to the
pulp and periradicular tissues.
3. Recognize the different types of endodontic infections
and the main microbial species involved in each one.
4. Understand the bacterial diversity within infected root
canals.
5. Describe the factors involved with symptomatic
endodontic infections.
6. Understand the ecology of the endodontic microbiota
and the features of the endodontic ecosystem.
7. Discuss the role of microorganisms in the outcome of
endodontic treatment.
8. Understand the development and implications of
extraradicular infections.
Microbiology of Endodontic Infection.Mechanisms of MicrobialPathogenicity and Virulence Factors
Biofilm and Community-Based Microbial Pathogenesis
Biofilm and Bacterial Interactions
Biofilm Community Lifestyle
Quorum Sensing—Bacterial Intercommunication
Methods for Microbial Identification
Diversity of the Endodontic Microbiota
Primary Intraradicular Infection
Spatial Distribution of the Microbiota
Microbial Ecology and the Root Canal Ecosystem
Secondary/Persistent Infectionsand Treatment Failure
After reading this chapter, the student should be able to:
1. Understand the microbial etiology of apical
periodontitis.
2. Describe the routes of entry of microorganisms to the
pulp and periradicular tissues.
3. Recognize the different types of endodontic infections
and the main microbial species involved in each one.
4. Understand the bacterial diversity within infected root
canals.
5. Describe the factors involved with symptomatic
endodontic infections.
6. Understand the ecology of the endodontic microbiota
and the features of the endodontic ecosystem.
7. Discuss the role of microorganisms in the outcome of
endodontic treatment.
8. Understand the development and implications of
extraradicular infections.
Microbiology of Endodontic Infection.Mechanisms of MicrobialPathogenicity and Virulence Factors
Biofilm and Community-Based Microbial Pathogenesis
Biofilm and Bacterial Interactions
Biofilm Community Lifestyle
Quorum Sensing—Bacterial Intercommunication
Methods for Microbial Identification
Diversity of the Endodontic Microbiota
Primary Intraradicular Infection
Spatial Distribution of the Microbiota
Microbial Ecology and the Root Canal Ecosystem
Secondary/Persistent Infectionsand Treatment Failure
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
A detailed description about endo perio interrelationship, including introduction, development and etiology, historical aspects, definition, classification, diagnosis, differential diagnosis, management, special consideration in management,controversies prognosis, conclusion.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Endodontic microbiology /certified fixed orthodontic courses by Indian denta...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
A detailed description about endo perio interrelationship, including introduction, development and etiology, historical aspects, definition, classification, diagnosis, differential diagnosis, management, special consideration in management,controversies prognosis, conclusion.
Smear layer is a controversial topic in the field of operative dentistry and endodontics. This presentation includes composition, concepts, structure, advantages, disadvantages, and removal methods of smear layer.
Endodontic microbiology /certified fixed orthodontic courses by Indian denta...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Oral microbiology/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Springer Series on Biofilms: Vol. 9 - The Root Canal BiofilmLuis Chavez de Paz
The Root Canal Biofilm
Editors: Chávez de Paz, Luis E., Sedgley, Christine M., Kishen, Anil (Eds.)
Compiles all the basic information needed on root canal biofilms
Discusses the basic biology of root canal biofilms
One focus is on observational and experimental evidence of root canal microbial biofilms
Sheds some light on how infections caused by root canal biofilms are clinically treated and reviews the implementation of novel anti-biofilm approaches
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The presentation covers the whole aspect of Endodontic biofilm and its management in a clinical practice.
Right from definition to formation to its classification and its removal using various irrigants and techniques. Its microscopic structure. And role of E. Fecalis in biolfilm. Its also explains qurorom sensing very well
Symposium oral micro flora /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Similar to Endo microbiology/ dental implant courses (20)
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
2.Case Discussions
3.with hundreds of pictures.
4.Demo on Models
5.Demo on Patients
6. subtitles in your own language
12 months unlimited access and support @350 USD only.
For Demo please visit :www.idalectures.com/preview/
For more details visit: www.idalectures.com
Please contact us for any clarifications:
idalectures@gmail.com
indiandentalacademy@gmail.com
Thanks & Regards
Indian Dental Academy
--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
2. Introduction
• Micro organisms cause virtually all pathoses
of the pulp and the perriadicular tissues. To
effectively treat endododontic infections,
clinicians must recognize the cause and
effect of microbial invasion of the dental pulp
space and surrounding periradicular tissues
• Although the vast majority of our knowledge
deals with bacteria, we are now aware of the
potential for endodontic disease to be
associated with fungi and viruses.
www.indiandentalacademy.com
3. History
• Louis Pasture1822-1895. laid the foundation of
microbiology in France
• In Germany Robert Koch (1843-1910) perfected
bacteriological techniques; Staining and obtaining
bacteria from culture media
• W.D. Miller in 1894, associated the presence of
bacteria with pulpal disease.
• 1939- Fish’s theory became the basis for root canal
treatment. He recognized four zones of infection
www.indiandentalacademy.com
4. Number of miroorganisms x virulence of miroorganism = severity of disease
resistance of host
• E.C rose 1909 –Theory of focal infection
• The true significance in endodontic disease was shown
in the classic study by Kakehashi et al in 1965.
• Hobson in 1965 first described this equation in
endodontic literature
www.indiandentalacademy.com
5. Terminologies
• Facultative bacteria can grow in the presence or
absence of oxygen.
• Obligate aerobes require oxygen for growth
possess both superoxide dismutase and catalase
enzymes and
• “Strict anaerobes” grow only in the absence of
oxygen but vary in their sensitivity to oxygen.
missing the enzymes superoxide dismustase and
catalase.
• Microaerophilic can grow in the presence of
oxygen but derive their most of energy from
anaerobic energy pathway.www.indiandentalacademy.com
6. Association of microbes in pulpal and
Periradicular diseases
• Establishment of bacteria or other organisms in a
living host takes place through the phenomenon
known as: colonization”.
• Normal flora is the result of permanent
colonization of microbes in a symbiotic
relationship.These organisms are considered
opportunistic pathogens if they gain access to
sterile area of the body such as the dental pulp or
periradicular tissues and produce disease.
www.indiandentalacademy.com
7. • Infectious disease (infection) results if organisms
damage the host and produce clinical signs and
symptoms.
• Pathogenicity is the capacity of organisms to
produce disease within a particular host.
• Virulence expresses the degree of pathogenicity in
a host under defined circumstances.
www.indiandentalacademy.com
8. Stages in development of an endodontic
infection include
1. Microbial invasion
2. Colonization
3. Multiplication
4. Pathogenic activity
www.indiandentalacademy.com
9. Microbial Invasion (Routes of
microoraganism Ingress)
Coronal Ingress:
1. Caries
2. Fracture – complete,
incomplete
3. Non fracture trauma
4. Anomalous tract
a.Dens invaginatus
b.Dens evaginatus
c. Palatogingival groove
5. Crown preparation and
leaking restoration
www.indiandentalacademy.com
11. Coronal Ingress
Caries; Caries is the most common portal of
entry and most frequent initial cause of pulp
inflammation.
Fractured Crown: In healthy vital pulp, the
penetration of bacteria in tissue is relatively
slow. It is less than 2mm after 2 weeks.A
necrotic pulp is rapidly invaded and colonized
by bacteria. www.indiandentalacademy.com
12. • Anomalous Tract: Anomalous tooth
development, of both the crown and the root,
accounts for pulp deaths usually by bacterial
invasion.
RADICULAR INGRESS
• Root caries - a less frequent occurrence, but
it remains a bacterial source of pulp irritation
www.indiandentalacademy.com
13. Retrogenic Infection – Periodontal Pocket
• Through the tubules, lateral or accessory canals,
furcation canals and apical foramina,
• The removal of cementum during periodontal
therapy exposes dentinal tubules to oral flora.
• Langeland et al found that changes in the pulp
occur when periodontal disease was present, but
pulpal necrosis occurs only if apical foramen was
involved.
• Periodontal Abscesswww.indiandentalacademy.com
14. Hematogenic infection:
• Anachoresis is a process which microbes
may be transported in the blood or lymph to
an area of inflammtion such as a tooth with
pulpitis , where they may establish an
infection.
• Anachoresis of bacteria from the vessels of
the gingival sulcus by Saglic et al,
• From a systemic transient bacteremia
www.indiandentalacademy.com
15. Reaction of Pulp to Bacteria
The dynamics of the pulpal reaction is related to
• Virulence of the bacteria
• Host response,
• Amount of pulpal circulation
• Degree of drainage.
www.indiandentalacademy.com
16. Microorganisms associated with
endodontic disease
• Kakehashi et al in 1965. found that no pathologic
changes occurred in the exposed pulps or periadicular
tissue in germ free rats. Thus, the presence of absence
of microbial flora was the major determinant for the
destruction or healing of exposed rodent pulps.
• In humans, Once the pulp becomes necrotic, it becomes
a reservoir for microorganism, microbial byproduct and
microbial breakdown products.
www.indiandentalacademy.com
17. Structure of Endodontic flora
• Of the more than 350 species of bacteria
recognized as normal flora, only relatively small
group are commonly isolated from infected pulp
cavities.
• Most of the bacteria in an endodontic infection are
“strict anaerobes”.
• Prior to 1970, very few strains of strict anaerobes
were isolated and identified because of inadequate
anaerobic culturing methods.
www.indiandentalacademy.com
18. • The number of bacterial species in root canals may
vary from 1 to more than 12 and the number of
bacterial cells colony forming units (CFU) recovered
between < 102
to > 108
.
• A correlation seems to exist between the size of
periapical lesion and the number of bacterial species
cells(CFU)
• Teeth with large lesion usually harbor more bacterial
species and have a higher density of bacteria in their
root canals than teeth with small lesions.
www.indiandentalacademy.com
19. Conditions conducive to Growth of
Bacteria in Necrotic Dental Pulp
• Nutritional factors
• Influence of oxygen
• Bacterial interrelationsnips
• Bacteriocins
• Coaggregation
www.indiandentalacademy.com
20. Nutrition
• Tissue fluid and the breakdown products of
necrotic pulp rich with polypeptides and amino
acids, essential for growth of the bacteria.
• Inflammatory exudates containing serum and
blood factors
• Conditions in the root canal which permit the
growth of anaerobic bacteria capable of
fermenting amino acids and peptides.
www.indiandentalacademy.com
21. Influence of oxygen
• Extremely low availability of oxygen in infected
root canals.
• When direct oral exposure, the oxygen level
remain low, particularly in the apical portions of
the canal where low oxidation reduction potential
is produced for growth of facultative bacteria
• These bacteria initially colonize the pulpal
chamber, but due to the resulting low oxidation
reduction potential, growth of obligate anaerobic
bacteria will be favored.
www.indiandentalacademy.com
22. • Bacterial interrelationsnips
Bacteria can be commensal or antagonistic.Some
metabolites (eg: ammonia) may be either a
nutrition or a toxin depending on the concentration.
• Bacteriocins
Antibiotic like proteins produced by one species of
bacteria to inhibit another species of bacteria.
• Coaggregation
A “symbiotic relationship” that may lead to an
increase in virulence by the organisms in that
ecosystem.
www.indiandentalacademy.com
23. Virulence factors
• Bacterial fimbriae are important for attachment to surfaces
and to other bacteria.
• Capsules; significant resistance factor enabling bacteria
to avoid phagocytosis..
• LPS are found on the surface of gram- negative bacteria
and have biologic effects that induce periradicular pathosis.
When LPS is released from the outer membrane of gram –
negative bacteria, it is called endotoxin.
• Endotoxin activate complement and bone resorption.
Enzymes collagenase seems to be associated with the
spread of cellulites.
www.indiandentalacademy.com
24. • Fungi in the form of yeasts were proven to be
present in the root canal system. fungal
species Candida albicans was found to be the
commonest.
• Extracellular vesicles are formed form the
outer membrane of gram – ve bacteria and
may contain enzymes or other toxic agents.
involved in haemagglutination, hemolytic,
bacterial adhesion and proteolytic action on
host tissues.
www.indiandentalacademy.com
25. COMPOSITION OF THE MICROBIOTA
• Morphologic forms:Studied using Dark field
and phase contrast microscopy
• Cocci, rods, filaments, spirochetes have all
been identified in infected root canals.
www.indiandentalacademy.com
26. Association of Bacteria with
Periaradicualr infections:
• Bacterial byproducts alone are capable of
causing periradicular pathosis.
• Infection beyond the apex depends on the
number and virulence of the organisms, host
resistance, and anatomic structures
associated with the infection
www.indiandentalacademy.com
27. • The microorganisms identified in periradicular
infections( abscesses ) of endodonntic origin are similar to
bacteria isolated form the root canal system.
• In mixed culture with F. Nucleatum, the BPB Prevoltella
intermedia and Porphyromanas gingivalis were significantly
more abscessogenic than F. nucleatum in pure culture.
• Prophyromonas gingivalis has been shown to produce
severe rapidly spreading abscess while prevotella
intermedius and Prophyromonas endodontalis cause
localized abscesses.
• P. gingivalis has also been shown to express “collagenase”
as a potential “ virulence factor”
www.indiandentalacademy.com
28. • Whether asymptomatic chronic apical
periodontitis lesions (periapical granulomas) are
sterile has been controversial since the beginning
of 1900s
• study by Nair; Species of Actinomyces and
Proprinibacterium have been shown to be able to
persist inflammatory tissue
• Actinomyces israelli is a spices of bacteria
isolated from periapical tissues that does not
always respond to conventional endodontic
therapy.
www.indiandentalacademy.com
29. • sodium, hypochlorite and calcium hydroxide have been
shown to be highly effective in killing A. israelli
• endodontic surgery apparently is an effective way to
remove A. israelli from the periapex and seems to provide
a high success rate without antibiotics
• Studies identified the presence of fungi .Waltimo et al
showed that strains of Candida albicans which required
incubation with a saturated solution of calcium hydroxide
for about 16 hours kill 99.9% of the fungi.
www.indiandentalacademy.com
30. • In 1989 Michael Glick and other examine
dental pulp tissue from a patient with (AIDS)
to determine the presence of human
immunodeficiency virus (HIV).
• Ebstein Bar viruses have also been isolated
in other cases.
www.indiandentalacademy.com
31. • several species have been implicated with some
clinical signs and symptoms.
BPB (Black Pigmented Bacterodies)
Peptostrptococcus, Peptococcus
Eubacterium, Fustobacterium
Actinomyces.
Recent Taxonomic changes for previous
Bacteroides species; ‘Goran Sundquist’
Three saccharolytic species of BPB have been
reclassified into a separate genus named
Porphyromonas.
Six species of saccharolytic BPB have been
reclassified into a separate genus named
Prevotella. www.indiandentalacademy.com
32. • Porphyromonas gingivalis has been shown
to produce severe rapidly spreading abscess
• Prevotella intermedias and prophyrmonas
endodontalis cause localized abscesses.
• Prevotella intermedia was found in both
Symptomatic and asymptomatic infections
• In 1992, isolates previously thought to be, P.
intermedia ar now known as P. nigrescens
• P. nigrescens is actually the BPB most
commonly isolated from both root canals and
Periradicular abscesses of endodontic origin.
www.indiandentalacademy.com
33. Factors responsible for non responsive
Endodontic cases
• Faulty temporary seal
• Additional canals
• canal configuration
• Inaccurate length determination
• Incomplete canal disinfection
• Fractures
• Refractory failure
• Post space failure
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34. • Endodontically treated teeth requiring
“retreatment” show prevalence of
facultative bacteria, especially
streptococcus faecalis, instead of strict
anaerobes.
• In Teeth with persisting periapical
lesions flora differs from that of
untreated necrotic dental pulps.
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35. • The microbial flora detected in root- filled
canals would be characterized as “
monoinfections of predominantly gram-
positive microorganisms”, with approximately
equal proportions of facultative and obligate
anerobes.
• This differs from that seen in infections of the
untreated canal, which have a polymicrobial
flora with approximately equal proportion of
gram- negative and gram positive bacteria
and are dominated by obligate anerobes.
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36. • Enterococus faecalis highly resistant to the
medicaments used during treatment
• one of the few micro organisms that has been shown
in vitro to resist the antibacterial effect of calcium
hydroxide.
• survive the antibacterial treatment, and persist after
obturation.
• in low numbers can usually be eliminated, once
established in the root canal it is difficult to eradicate.
• Have an ability to survive in root canals as single
organism without the support of other bacteria.
• usually enters the canal “ during treatment
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37. • Bacteria can also prevent the healing of
periapical lesions by establishing
themselves in periapial tissue.
• A Israeli and Propionibacterium propionicum,
have the ability to establish extraradicular
infections.
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38. Bateriologic Examination
Microbiological identification techniques
• Anaerobic culturing
• Indirect immunofluoresene; Porphyromonas &
Prevotella
• Sodium dodecyl sulfate polyacrylamide gel phoresis
(SDS-PAGE) Prevotella nigrescens from Prevotella
intermedia
• Polymerase chain ration- DNA method applies
genetic code analysis
• DNA analysis with biochemical enzyme analysiswww.indiandentalacademy.com
39. Culture media
• single organism is sufficient for growth in culture medium
and maximum ten microorganisms are needed.
• Brain heart infusion broth, Trypticase dexrose broth ,serum
dextrose broth were not suitable for anaerobic organisms.
Addition of small amount of agar, serum,blood or ascitic fluid
facilitate their growth.
• Trypticase soy agar broth with 0.1% agar
• Thioglycolate and glucose ascits broth
• Viability medium for growth
• Stuart’s transport mediumwww.indiandentalacademy.com
40. Steps in taking a culture
1. Wipe away residual
antibiotic or antiseptic
from surface of root
canal
2. Insert the absorbent
point and let remain in the
root anal for atleast 1
minute
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41. 3. Tip of the absorbent
point is will be moist
when removed from the
canal
4. Flame the lip of
the culture tube
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42. 5. Drop the absorbent
point into the culture
tube and replace the
cap.
Anaerobic culturing
•Requires special equipment in temperature controlled
oxygen free environment
•Meticulous care must be taken to prevent contact of
the specimen with atmospheric oxygen.
• canal orifice must b flushed with nitrogen gas during
sampling to maintain Anaerobiosis.
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43. Periradicular sample
• Insert the sterile needle of leur lock syringe
into periradicular space
• Aspirate fluid
• Eject any air inside the syringe barrel
immediately
• Insert the needle through the rubber septum
stopper of anaport vial and eject the fluid
• Vial should be transported to anaerobic
culture depot with in 4 hours after taking a
sample
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44. Root canal sample
• Aseptically prepare an ass cavity into the pulp
chamber.
• Inject few drops of prereduced anaerobicaly
sterilized medium (chopped meat glucose
broth) into the chamber.
• Pump the medium into the root anal with
sterile endodontic file.
• Aspirate fluid with leur lock syringe into
periradicular space.
• eject any air inside the syringe barrel
immediately.
• transported to anaerobic culture depot with in
4 hours after taking a sample.
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45. Culture reversal
• Negative culture become positive by the time
of obturation.
• Advised to allow more than 48 hours between
taking culture and obturation(96 or more
hours)
• Culture tube should be reexamined
immidiately before obturating a canal so that
no evidence of growth is present.
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46. Root canal debridement and intracanal
medication
Crown down technique with rotary instruments
and abundant irrigation.
• Debris is not extruded apically
• Enlarges coronal portion of canal to allow
large reservoir for irrigants
• Sodium hypochlorite(.5%-5.25%)
• Sodium hypochlorite an EDTA(15%) is more
effective.
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47. Intracanal asepsis
Calcium hydroxide-
• mixed with saline or glycerin
• Carried with amalgam carrier in pulp
chamber.
• Carried down in the canal using plugger,
lentulospiral.
• Can be removed easily in next appointment.
Calcium hydroxide and sodium hypochlorite
(increases ability of NaOcl)
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48. • Good temporary coronal seal-3-4mm thick
• Camphorated choloroxylenol-liquid medication(ED84)- new
root canal medicament ,effective for two days.
Infection control
• Patient screening
• Presonal protection
• Equipment asepsis
• Instrument sterilization
• Surface disinfection
• Aseptic technique
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49. Endodontic Flareups
Is a true complication characterized by development of
pain swelling or both, which commences with in few
hours or days after root canal preparation.
Require an unscheduled visit for emergency treatment
Microbial mechanisms in inductuion of flare up
• Apical extrusion of infected debris
• Changes in endodontic microbiota or in
enviornmental conditions
• Secondary infections
• Increase of the oxidation reduction potential.
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50. Preventive measures
• Selection of instrumentation technique.
• Completion of chemomechanical procedure
in single visit.
• Use of antimicrobial intracanal medication
between appointments.
• Not leaving teeth open for drainage.
• Maintain aseptic chain during intra canal
procedure
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