574

P A R T II THE ADVANCED SCIENCE OF ENDODONTICS

Dialister invisus Bacteroidetes clone X083 Pseudoramibacter alactolyticus Porphyromonas endodontalis Treponema denticola Dialister pneumosintes Filifactor alocis Tannerella forsythia Treponema parvum Prevotella baroniae Treponema socranskii Prevotella multisaccharivorax Treponema lecithinolyticum Treponema maltophilum Catonella morbi Enterococcus faecalis Veillonella parvula Olsenella uli Synergistes clone BA121 Porphyromonas gingivalis Campylobacter rectus Propionibacterium propionicum Synergistes clone BH017 Streptococcus species Parvimonas micra Synergistes clone W090 Campylobacter gracilis Granulicatella adiacens Treponema vincentii Fusobacterium nucleatum Eikenella corrodens Treponema medium Treponema pectinovorum Actinomyces israelii Centipeda periodontii Prevotella nigrescens Prevotella intermedia 0 25 50 Percent 75 100

FIG. 15-12 Prevalence of bacteria detected in primary infections of teeth with chronic apical periodontitis. Data from the authors studies using a taxon-specic nested-polymerase chain reaction protocol. (From references 207, 211, 250, and 253.)

location and others shared by the two locations, showing great differences in prevalence.143 The factors that can lead to differences in the composition of the endodontic microbiota and the impact of these differences on therapy, particularly in abscessed cases requiring systemic antibiotic therapy, remain elusive.

Spatial Distribution of the Microbiota Anatomy of Infection

Knowledge of microbial location and organization within the root canal system assumes special importance to understand-

ing the disease process and establishing effective antimicrobial therapeutic strategies. Most of the knowledge of the structure of the endodontic microbiota comes from morphologic studies,161,167,227,257 but these do not usually provide information about bacterial identity and numbers. Consequently, it is not possible to delineate the role of the visualized bacteria in the disease process. Because every bacterial cell observed in the root canal system might be an endodontic pathogen, ndings from morphologic studies should be used to understand the topography of the root canal infection and establish thera-