Endodontic Treatments of Teeth with Necrotic Pulp and Apical Periodontitis - A Critical Analysis Jorge Paredes Vieyra * , Ricardo Machado, Francisco Javier Jiménez Enriquez and Fabian Ocampo Acosta Universidad Autónoma de Baja California, campus Tijuana, USA * Corresponding author: Jorge Paredes Vieyra, D.D.S., MsC, PhD, Professor, Universidad Autónoma de Baja California, campus Tijuana, USA, Tel: 6649797500; E- mail: jorgitoparedesvieyra@hotmail.com Received date: December 15, 2016; Accepted date: December 19, 2016; Published date: December 26, 2016 Copyright: © 2016 Vieyra JP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction he primary objective of root canal treatment is to eliminate microorganisms and pathologic debris from the root canal system [1] and to prevent its reinfection [2]. Bystrom and Sundqvist [3] reported that root canal systems are oten improperly cleaned and shaped. Bystrom and Sundqvist [3] cultured 15 teeth with necrotic pulps ater instrumentation accompanied with saline irrigation. hey reported a 100- to 1000- fold reduction in the bacterial counts. Chemomechanical preparation with supplemental irrigation devices promotes higher microbial reduction but is not able to render the canals bacteria-free [2]. One of the most challenging aspects of the endodontic therapy is the debridement and preparation of the apical third. Organic tissue remnants or dentinal debris in the apical third is a common event that can cause obstruction inside the canal anatomy. A patency ile is a lexible ile which will move passively through the terminus of a root canal without binding or enlarging the inal apical constriction [4]. A patency ile is set at a length 1 mm longer than the inal working length. According to Glossary of Endodontic terms 2003, apical patency is a form in which the apical third is maintained free of debris by recapitulation with a small ile through the apical constriction [5]. Knowing the anatomy of apical third minimizes the risk of loss of working length, reduces canal transportation and other accidents such as ledges, eases irrigation in the apical third of the canal, allows maintenance of the anatomy of the apical constriction, and improves the tactile sense of the clinician [6]. On the other hand, this method is not qualiied, arguing that foraminal patency inluence positively the movement of debris and aterward irritate the periodontal tissues without creating a better apical healing [7]. However, Alves et al. [8] establish that keeping foraminal patency did not reduce apical transportation or have an efect on loss of working length in calciied and curved root canals. Other researches detailed that keeping foraminal patency would not cause more postoperative events, providing it is satisfactorily made [7], and that its aids beat the possible damage it might cause [9] since it is proposed solely to prevent dentinal chips being compacted into the apical third and forming a plug that can interfere with maintaining WL [10]. hen, the aim of this paper is to perform a critical analysis about the impact of keeping apical patency on the original canal shape, apical transportation and loss of working length (WL) during preparation of curved root canals (more than 38°). Anatomical considerations he most classic example of this is the permanence of the binomial "Cleaning and Shaping" over all these years [11,12]. In addition, a factor unchangeable, but with high impact within the specialty remains the anatomy. he root canal anatomy has been studied since the studies of Kuttler [13] and remains exposed by the latest tools of clinical and laboratory analysis. Seen it, honestly, we do not believe that the anatomy has become more complex. What happens is that the technical and scientiic developments have shown us something closer to reality, mainly clinically [14]. Considering this point, the failure to obtain foraminal patency, even by experienced clinicians has always been and continues to be a reality. However, few studies on this factor were considered. Even so, the success rates within the specialty are quite high. General microbiological considerations An infectious phenomenon is the consequence of the relationship between microbial virulence, number and the host defenses. his concept combined with recent data on microbial community performance, quorum sensing procedures, and virulence controls can be applied to the understanding of the pathogenesis of apical periodontitis, as a result, can serve as a rationale for setting the goals clinicians should pursue during treatment [15]. Root canal treatment of teeth with irreversibly inlamed pulps is essentially a prophylactic treatment because the environment is usually free of microorganisms and the rationale is to treat in order to prevent a perirradicular disease. On the other hand, necrotic pulps the infection is established, and, as a consequence, endodontic procedures should focus not only on prevention of the introduction of new microorganisms into the root canal system but also on the reduction of those located therein. he success rate of the endodontic treatment will be focused on how efective the clinician is in accomplishing these goals [15-18]. here is a commom sence established that the foraminal patency should be responsible by a microbiological disorganization of the apical area. However, clinical reality shows that is not always possible execution of this maneuver and nor why these cases are doomed to failure. Impact of the bacterial persistence It is important to understand some aspects related to the signiicance of the bacterial permanence. Microbiological studies of ater treatment approaches involve some basic conditions: postoperative samples, post clinical samples and postobturation samples [2]. Investigation analysis about bacteria residual in the root canals ater chemo mechanical procedures or intracanal medication has the purpose to disclose the species that have the potential to inluence the treatment outcome. Bacteria detected in postmedication samples, in the most part of the time, survived to the intracanal procedures and medication with calcium hydroxide. Nevertheless, some microorganism may survive endodontic procedures, and their Otolaryngology: Open Access Vieyra et al., Otolaryngol (Sunnyvale) 2016, 6:6 DOI: 10.4172/2161-119X.1000281 Short Communication OMICS International Otolaryngol (Sunnyvale), an open access journal ISSN:2161-119X Volume 6 • Issue 6 • 1000281