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Extraradicular infection and apical mineralized biofilm: a systematic review of published case reports

2025-04-01Review article Open access
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dc.contributor.authorPérez, Alejandro R.
dc.contributor.authorRendón, Jaime
dc.contributor.authorOrtolani-Seltenerich, P. S.
dc.contributor.authorPérez-Ron, Yetzangel
dc.contributor.authorCardoso, Miguel
dc.contributor.authorNoites, Rita
dc.contributor.authorLoroño, Gaizka
dc.contributor.authorVieira, Gaya C. S.
dc.date.accessioned2025-08-13T14:28:54Z
dc.date.available2025-08-13T14:28:54Z
dc.date.issued2025-04-01
dc.description.abstractBackground/Objectives: Bacterial biofilms on root surfaces outside the apical foramen are linked to refractory apical periodontitis, as microorganisms can survive in extraradicular areas and cause persistent infections. This study aimed to precisely evaluate the relationship between extraradicular biofilm and persistent periapical periodontitis through an overview of case reports. Methods: A systematic search of PubMed, Web of Science, Scopus, Embase and ScienceDirect databases was conducted up to June 2023. Keywords included “extraradicular infection”, “wet canal”, “wet canals”, “extraradicular mineralized biofilms”, and “calculus-like deposit”. Only case reports meeting the inclusion criteria were analyzed. Results: Fifteen cases of extraradicular infection were identified, involving eight women and six men aged between 18 and 60 years. These cases included nine failed treatments confirmed through complementary methods such as histobacteriologic analysis, scanning electron microscopy (SEM), or polymerase chain reaction (PCR). Among these, four patients (six teeth) exhibited calculus-like deposits. Conclusions: Extraradicular biofilm is strongly associated with failed endodontic treatments, leading to persistent infections. A structured decision-making approach is essential. Before considering apical surgery, clinicians should prioritize intraradicular infection control through thorough irrigation, antimicrobial medicaments, and adjunctive disinfection techniques. When extraradicular biofilms or mineralized calculus are present, and symptoms persist after optimal intracanal disinfection, apical surgery should be performed.eng
dc.identifier.citationPérez, A. R., Rendón, J., Ortolani-Seltenerich, P. S., & Pérez-Ron, Y. et al. (2025). Extraradicular infection and apical mineralized biofilm: a systematic review of published case reports. Journal of Clinical Medicine, 14(7), Article 2335. https://doi.org/10.3390/jcm14072335
dc.identifier.doi10.3390/jcm14072335
dc.identifier.eid105002318911
dc.identifier.issn2077-0383
dc.identifier.othere77df282-a735-4f3a-9d2d-4de3e8ab136a
dc.identifier.pmcPMC11989643
dc.identifier.pmid40217783
dc.identifier.urihttp://hdl.handle.net/10400.14/54546
dc.identifier.wos001463581000001
dc.language.isoeng
dc.peerreviewedyes
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectExtraradicular biofilm
dc.subjectExtraradicular infection
dc.subjectLike-calculus deposit
dc.subjectSinus tract
dc.subjectWet canals
dc.titleExtraradicular infection and apical mineralized biofilm: a systematic review of published case reportseng
dc.typereview article
dspace.entity.typePublication
oaire.citation.issue7
oaire.citation.titleJournal of Clinical Medicine
oaire.citation.volume14
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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