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<article xlink="http://www.w3.org/1999/xlink" dtd-version="1.0" article-type="dentistry" lang="en">
<front>
<journal-meta>
<journal-id journal-id-type="publisher">JOHS</journal-id>
<journal-id journal-id-type="nlm-ta">Journ of Health Scien</journal-id>
<journal-title-group>
<journal-title>Journal of HealthCare Sciences</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Journ of Health Scien</abbrev-journal-title>
</journal-title-group>
<issn pub-type="ppub">2231-2196</issn>
<issn pub-type="opub">0975-5241</issn>
<publisher>
<publisher-name>Radiance Research Academy</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">495</article-id>
<article-id pub-id-type="doi">http://dx.doi.org/10.52533/JOHS.2025.51230</article-id>
<article-id pub-id-type="doi-url"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Dentistry</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Microbial Resistance in Persistent Apical Periodontitis and Challenges in Eradication
</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Bafail</surname>
<given-names>Khaled Ahmed</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alhejaili</surname>
<given-names>Sami Musallam</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mohsinah</surname>
<given-names>Noaf Awad</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alshammari</surname>
<given-names>Omar Abdullah</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alrashidi</surname>
<given-names>Amal Musaad</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Aljeneede</surname>
<given-names>Dana Fahd</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alqahtani</surname>
<given-names>Sultan Saeed</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dayili</surname>
<given-names>Albaraa Abeid</given-names>
</name>
</contrib>
</contrib-group>
<pub-date pub-type="ppub">
<day>31</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>5</volume>
<issue>12</issue>
<fpage>946</fpage>
<lpage>951</lpage>
<permissions>
<copyright-statement>This article is copyright of Popeye Publishing, 2009</copyright-statement>
<copyright-year>2009</copyright-year>
<license license-type="open-access" href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract>
<p>Persistent apical periodontitis is a major cause of failure in root canal therapy, often resulting from the survival of resistant microorganisms within complex anatomical spaces of the root canal system. These infections are typically dominated by biofilm-forming pathogens such as Enterococcus faecalis and Candida albicans, which possess remarkable abilities to adapt, evade, and survive conventional disinfection methods. Their resistance is enhanced by multiple mechanisms, including biofilm formation, expression of virulence factors, horizontal gene transfer, efflux pumps, and the ability to enter dormant or viable but non-culturable states. These adaptations make them highly tolerant to commonly used irrigants like sodium hypochlorite and medicaments such as calcium hydroxide. The structural complexity of the root canal system further limits the penetration and effectiveness of chemical agents, allowing microbial communities to persist in areas inaccessible to mechanical instruments. Even with advanced irrigation techniques, such as ultrasonic activation and negative pressure systems, complete disinfection is rarely achieved. As a result, the focus has shifted toward novel antimicrobial strategies that may overcome these limitations. Approaches such as nanoparticle-based delivery systems, antimicrobial photodynamic therapy, cold atmospheric plasma, and bacteriophage therapy are under investigation for their ability to disrupt biofilms and target resistant organisms more effectively. These emerging methods offer targeted action with reduced cytotoxicity and improved penetration into microanatomical spaces. However, their clinical integration remains limited due to challenges in standardization, delivery mechanisms, and regulatory approval. Addressing microbial resistance in endodontics requires a multidisciplinary understanding of microbial behavior, biofilm biology, and canal anatomy. A shift toward more precise and biologically compatible disinfection methods may hold the key to improving the long-term success of root canal treatment in cases of persistent apical periodontitis.
</p>
</abstract>
<kwd-group>
<kwd>Persistent apical periodontitis</kwd>
<kwd> microbial resistance</kwd>
<kwd> biofilm</kwd>
<kwd> endodontic disinfection</kwd>
<kwd> novel antimicrobial therapies</kwd>
</kwd-group>
</article-meta>
</front>
</article>