Endodontic Infection Management and Treatment Strategies

Endodontic infection management centres on the eradication of microbial communities from the intricate root canal system, followed by effective sealing and restoration to prevent reinfection. The causative agents, often organised as biofilms within the main canal lumen, isthmuses and dentinal tubules, evoke inflammation of periapical tissues and may progress to apical periodontitis if left unchecked. Conventional chemomechanical preparation combines mechanical instrumentation with chemical irrigants—most notably sodium hypochlorite and ethylenediaminetetraacetic acid—to dissolve necrotic tissue, disrupt biofilms and neutralise endotoxins. Intracanal medicaments, such as chlorhexidine or calcium hydroxide, are employed between appointments to enhance disinfection and modulate host responses. Obturation techniques aim to hermetically seal the canal, utilising gutta-percha and biocompatible sealers that adapt to canal irregularities. Recent advances incorporate activation methods (e.g. sonic or ultrasonic agitation) to improve irrigant penetration and effectiveness. Emerging strategies explore nanomaterials and enzyme-mimetic catalysts to target recalcitrant biofilms while preserving periapical stem cell viability, thus merging antimicrobial therapy with regenerative potential. Integration of three-dimensional imaging and artificial intelligence promises to refine diagnosis, treatment planning and outcome assessment, underscoring a shift towards personalised endodontic care.

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Endodontic Infection Management and Treatment Strategies publication trend

The graph below shows the total number of articles in endodontic infection management and treatment strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Apical periodontitis: Inflammation of periradicular tissues caused by microbial invasion of the pulp and root canal system.

Biofilm: Structured community of microorganisms embedded in a self-produced matrix, adhering to canal walls and resisting antimicrobials.

Irrigant: Chemical solution used during instrumentation to dissolve tissue, disrupt biofilms and disinfect the canal.

Intracanal medicament: Antimicrobial agent placed between treatment sessions to enhance disinfection and modulate host response.

Nanozyme: Nanoparticle with enzyme-like catalytic properties, capable of generating reactive species to target biofilms.

References

1. Expert consensus on irrigation and intracanal medication in root canal therapy. International Journal of Oral Science (2024).
2. Ferumoxytol nanozymes effectively target chronic biofilm infections in apical periodontitis. Journal of Clinical Investigation (2024).
3. Application of Nanomaterials in Endodontics. BME Frontiers (2024).