Endodontik Enfeksiyonların Mikrobiyolojisi ve Tanı Yöntemleri
Özet
Endodontik enfeksiyonlar, kök kanal sistemini kolonize eden ve çoğunlukla biyofilm organizasyonu gösteren polimikrobiyal topluluklar tarafından oluşturulmaktadır. Enfeksiyonun gelişiminde yalnızca mikroorganizmaların varlığı değil, aynı zamanda konak yanıtı, çevresel koşullar ve kök kanal sisteminin karmaşık anatomisi de belirleyici rol oynamaktadır. Bölümde primer, sekonder ve persistan endodontik enfeksiyonların mikrobiyolojik özellikleri ayrıntılı olarak açıklanmış; özellikle biyofilm yapısının mikroorganizmaların antimikrobiyal ajanlara ve konak savunmasına karşı direnç geliştirmesindeki önemi vurgulanmıştır. Ayrıca, kültür temelli yöntemlerden başlayarak PCR, FISH, DNA-DNA hibridizasyonu ve yeni nesil dizileme (NGS) gibi moleküler tekniklere kadar uzanan tanı yaklaşımları değerlendirilmiştir. Kültür yöntemlerinin kültüre edilemeyen mikroorganizmaları saptamadaki yetersizliği ve hedefe yönelik moleküler yöntemlerin sınırlılıkları belirtilirken, NGS teknolojilerinin endodontik mikrobiyomun daha geniş ve dinamik bir yapıya sahip olduğunu ortaya koyduğu ifade edilmiştir. Sonuç olarak, endodontik enfeksiyonların doğru anlaşılması ve etkili yönetimi için kültür temelli ve moleküler verilerin birlikte değerlendirilmesi gerektiği vurgulanmaktadır.
Endodontic infections are caused by polymicrobial communities that colonize the root canal system, most commonly in the form of biofilms. Their pathogenesis is influenced not only by the presence of specific microorganisms but also by ecological interactions among microbial species, host immune responses, and the complex microanatomy of the root canal system. Primary, secondary, and persistent endodontic infections differ in their microbial composition and clinical behavior, although clear distinctions are not always possible. Biofilm organization plays a critical role in microbial survival by increasing tolerance to antimicrobial agents and host defense mechanisms. Traditional culture-based methods have historically contributed to the identification of cultivable microorganisms, whereas targeted molecular approaches such as PCR, FISH, and DNA–DNA hybridization have improved detection sensitivity. However, both approaches have limitations in fully characterizing the endodontic microbiota. In this context, next-generation sequencing (NGS) has expanded current understanding by revealing a broader and more dynamic microbial diversity than previously recognized. Overall, accurate diagnosis and interpretation of endodontic infections require an integrated evaluation of culture-based, molecular, and sequencing-based data to better understand pathogenesis and support the development of more effective treatment strategies.
Referanslar
Duncan HF, Kirkevang LL, Peters OA, El‐Karim I, Krastl G, Del Fabbro M, et al. Treatment of pulpal and apical disease: the European Society of Endodontology (ESE) S3‐level clinical practice guideline. International Endodontic Journal. 2023;56:238-95.
Wong J, Manoil D, Näsman P, Belibasakis GN, Neelakantan P. Microbiological aspects of root canal infections and disinfection strategies: an update review on the current knowledge and challenges. Frontiers in Oral Health. 2021;2:672887.
Lin L, Huang GT. Pathobiology of apical periodontitis. Pathways of the pulp: Mosby; 2013.
Siqueira Jr JF, Silva WO, Romeiro K, Gominho LF, Alves FR, Rôças IN. Apical root canal microbiome associated with primary and posttreatment apical periodontitis: A systematic review. International Endodontic Journal. 2024;57(8):1043-58.
Prada I, Micó-Muñoz P, Giner-Lluesma T, Micó-Martínez P, Collado-Castellano N, Manzano-Saiz A. Influence of microbiology on endodontic failure. Literature review. Medicina oral, patologia oral y cirugia bucal. 2019;24(3):e364.
Hernández SR, Siqueira Jr JF, Voigt DD, Soimu G, Brasil SC, Provenzano JC, et al. Bacteriologic conditions of the apical root canal system of teeth with and without posttreatment apical periodontitis: a correlative multianalytical approach. Journal of Endodontics. 2024;50(2):154-63.
Zhu Y, Wang Y, Zhang S, Li J, Li X, Ying Y, et al. Association of polymicrobial interactions with dental caries development and prevention. Frontiers in microbiology. 2023;14:1162380.
Bjørndal L, Simon S, Tomson P, Duncan H. Management of deep caries and the exposed pulp. International endodontic journal. 2019;52(7):949-73.
Siqueira Jr JF. Endodontic infections: concepts, paradigms, and perspectives. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2002;94(3):281-93.
Siqueira Jr J, Rôças I. Exploiting molecular methods to explore endodontic infections: part 2—redefining the endodontic microbiota. Journal of endodontics. 2005;31(7):488-98.
JC B. Bacteria in the apical 5mm of infected root canal. J Endod. 1991;17:380-3.
de Oliveira JCM, Siqueira Jr JF, Alves GB, Hirata Jr R, Andrade AF. Detection of Porphyromonas endodontalis in infected root canals by 16S rRNA gene-directed polymerase chain reaction. Journal of endodontics. 2000;26(12):729-32.
Rôças IN, Siqueira Jr JF, Santos KR, Coelho AM, de Janeiro R. “Red complex”(Bacteroides forsythus, Porphyromonas gingivalis, and Treponema denticola) in endodontic infections: a molecular approach. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2001;91(4):468-71.
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Parsek MR, Singh PK. Bacterial biofilms: an emerging link to disease pathogenesis. Annual Reviews in Microbiology. 2003;57(1):677-701.
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Referanslar
Duncan HF, Kirkevang LL, Peters OA, El‐Karim I, Krastl G, Del Fabbro M, et al. Treatment of pulpal and apical disease: the European Society of Endodontology (ESE) S3‐level clinical practice guideline. International Endodontic Journal. 2023;56:238-95.
Wong J, Manoil D, Näsman P, Belibasakis GN, Neelakantan P. Microbiological aspects of root canal infections and disinfection strategies: an update review on the current knowledge and challenges. Frontiers in Oral Health. 2021;2:672887.
Lin L, Huang GT. Pathobiology of apical periodontitis. Pathways of the pulp: Mosby; 2013.
Siqueira Jr JF, Silva WO, Romeiro K, Gominho LF, Alves FR, Rôças IN. Apical root canal microbiome associated with primary and posttreatment apical periodontitis: A systematic review. International Endodontic Journal. 2024;57(8):1043-58.
Prada I, Micó-Muñoz P, Giner-Lluesma T, Micó-Martínez P, Collado-Castellano N, Manzano-Saiz A. Influence of microbiology on endodontic failure. Literature review. Medicina oral, patologia oral y cirugia bucal. 2019;24(3):e364.
Hernández SR, Siqueira Jr JF, Voigt DD, Soimu G, Brasil SC, Provenzano JC, et al. Bacteriologic conditions of the apical root canal system of teeth with and without posttreatment apical periodontitis: a correlative multianalytical approach. Journal of Endodontics. 2024;50(2):154-63.
Zhu Y, Wang Y, Zhang S, Li J, Li X, Ying Y, et al. Association of polymicrobial interactions with dental caries development and prevention. Frontiers in microbiology. 2023;14:1162380.
Bjørndal L, Simon S, Tomson P, Duncan H. Management of deep caries and the exposed pulp. International endodontic journal. 2019;52(7):949-73.
Siqueira Jr JF. Endodontic infections: concepts, paradigms, and perspectives. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2002;94(3):281-93.
Siqueira Jr J, Rôças I. Exploiting molecular methods to explore endodontic infections: part 2—redefining the endodontic microbiota. Journal of endodontics. 2005;31(7):488-98.
JC B. Bacteria in the apical 5mm of infected root canal. J Endod. 1991;17:380-3.
de Oliveira JCM, Siqueira Jr JF, Alves GB, Hirata Jr R, Andrade AF. Detection of Porphyromonas endodontalis in infected root canals by 16S rRNA gene-directed polymerase chain reaction. Journal of endodontics. 2000;26(12):729-32.
Rôças IN, Siqueira Jr JF, Santos KR, Coelho AM, de Janeiro R. “Red complex”(Bacteroides forsythus, Porphyromonas gingivalis, and Treponema denticola) in endodontic infections: a molecular approach. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2001;91(4):468-71.
Siqueira Jr JF, Rôças IN, Souto R, de Uzeda M, Colombo AP. Microbiological evaluation of acute periradicular abscesses by DNA-DNA hybridization. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2001;92(4):451-7.
Sundqvist G. Bacteriological studies of necrotic dental pulps: Umeå University; 1976.
Gomes B, Lilley J, Drucker D. Clinical significance of dental root canal microflora. Journal of dentistry. 1996;24(1-2):47-55.
Haapasalo M, Ranta H, Ranta K, Shah H. Black-pigmented Bacteroides spp. in human apical periodontitis. Infection and Immunity. 1986;53(1):149-53.
Finlay BB, Falkow S. Common themes in microbial pathogenicity. Microbiological reviews. 1989;53(2):210-30.
Kolenbrander P. Environmental sensing mechanisms and virulence factors of bacterial pathogen. Topley and Wilson's Microbiology and Microbial Infections. 1998;2:307-26.
Siqueira Jr JF, Rôças IN, Oliveira JCM, Santos KR. Molecular detection of black-pigmented bacteria in infections of endodontic origin. Journal of endodontics. 2001;27(9):563-6.
Siqueira Jr JF, Rôças IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. Journal of endodontics. 2008;34(11):1291-301. e3.
Hong B-Y, Lee T-K, Lim S-M, Chang SW, Park J, Han SH, et al. Microbial analysis in primary and persistent endodontic infections by using pyrosequencing. Journal of endodontics. 2013;39(9):1136-40.
Chugal N, Wang J-K, Wang R, He X, Kang M, Li J, et al. Molecular characterization of the microbial flora residing at the apical portion of infected root canals of human teeth. Journal of endodontics. 2011;37(10):1359-64.
Sundqvist G, Figdor D, Persson S, Sjögren U. Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1998;85(1):86-93.
Chávez De Paz L, Dahlén G, Molander A, Möller Å, Bergenholtz G. Bacteria recovered from teeth with apical periodontitis after antimicrobial endodontic treatment. International endodontic journal. 2003;36(7):500-8.
Siqueira Jr JF, Alves FR, Rôças IN. Pyrosequencing analysis of the apical root canal microbiota. Journal of Endodontics. 2011;37(11):1499-503.
Anderson AC, Al-Ahmad A, Elamin F, Jonas D, Mirghani Y, Schilhabel M, et al. Comparison of the bacterial composition and structure in symptomatic and asymptomatic endodontic infections associated with root-filled teeth using pyrosequencing. PloS one. 2013;8(12):e84960.
Santos AL, Siqueira Jr JF, Rocas IN, Jesus EC, Rosado AS, Tiedje JM. Comparing the bacterial diversity of acute and chronic dental root canal infections. Plos one. 2011;6(11):e28088.
Tennert C, Fuhrmann M, Wittmer A, Karygianni L, Altenburger MJ, Pelz K, et al. New bacterial composition in primary and persistent/secondary endodontic infections with respect to clinical and radiographic findings. Journal of endodontics. 2014;40(5):670-7.
Costerton JW. The biofilm primer: Springer; 2007.
Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clinical microbiology reviews. 2002;15(2):167-93.
Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial biofilm: a review on formation, infection, antibiotic resistance, control measures, and innovative treatment. Microorganisms. 2023;11(6):1614.
Chen L, Ren Z, Zhou X, Zeng J, Zou J, Li Y. Inhibition of Streptococcus mutans biofilm formation, extracellular polysaccharide production, and virulence by an oxazole derivative. Applied microbiology and biotechnology. 2016;100(2):857-67.
Chałas R, Wójcik-Chęcińska I, Woźniak MJ, Grzonka J, Święszkowski W, Kurzydłowski KJ. Dental plaque as a biofilm-a risk in oral cavity and methods to prevent. Postepy higieny i medycyny doswiadczalnej (Online). 2015;69:1140-8.
Foschi F, Cavrini F, Montebugnoli L, Stashenko P, Sambri V, Prati C. Detection of bacteria in endodontic samples by polymerase chain reaction assays and association with defined clinical signs in Italian patients. Oral microbiology and immunology. 2005;20(5):289-95.
Flemming H-C, Wingender J. The biofilm matrix. Nature reviews microbiology. 2010;8(9):623-33.
Hall‐Stoodley L, Stoodley P. Evolving concepts in biofilm infections. Cellular microbiology. 2009;11(7):1034-43.
Parsek MR, Singh PK. Bacterial biofilms: an emerging link to disease pathogenesis. Annual Reviews in Microbiology. 2003;57(1):677-701.
Molven O, Olsen I, Kerekes K. Scanning electron microscopy of bacteria in the apical part of root canals in permanent teeth with periapical lesions. Dental Traumatology. 1991;7(5):226-9.
Ricucci D, Siqueira Jr JF. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. Journal of endodontics. 2010;36(8):1277-88.
Sen B, Piskin B, Demirci T. Observation of bacteria and fungi in infected root canals and dentinal tubules by SEM. Dental Traumatology. 1995;11(1):6-9.
Sjögren U, Figdor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. International endodontic journal. 1997;30(5):297-306.
Waltimo T, Trope M, Haapasalo M, Ørstavik D. Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing. Journal of endodontics. 2005;31(12):863-6.
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