Abstract
Most periapical lesions resolve after root canal treatment of teeth with primary infections. Over the last decade there has been a renewed focus on post‐treatment apical periodontitis and its etiology. This review describes the microbiota associated with persistent post‐treatment infection, including microbial identification, ecology, and environmental selection. Compared with untreated teeth, the infection pattern in root canals with post‐treatment disease shifts to a resistant, mainly Gram‐positive community. The main challenge in root canal re‐treatment is access to the residual apical infection. Elimination of the microbial flora, or a dramatic reduction and sufficient ecological shift to allow host tissue healing, remains the biological goal.
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