mgdu-2026-02-10_03_06_33-fate-of-tissue-in-lat-canal.pdf
mgdu-2026-02-10_03_06_33-fate-of-tissue-in-lat-canal.pdf
Fate of the Tissue in Lateral Canals and Apical Ramifications in Response to Pathologic Conditions and Treatment Procedures
Abstract
Abstract
Introduction: This article reviews and reports on the histopathologic and histobacteriologic status of the tissue in lateral canals and apical ramifications in diverse clinical conditions as well as in response to endodontic treatment. Methods: In total, serial sections from four hundred ninety-three human tooth specimens obtained by extraction or apical surgery were screened for the presence of lateral canals and apical ramifications. Results: Lateral canals and apical ramifications were observed in about seventy-five percent of the teeth. In clinically vital teeth, vital tissue was consistently found in lateral canals and apical ramifications. In teeth with periodontal disease, the whole pulp became necrotic only when the subgingival biofilm reached the main apical foramen. In teeth with pulp exposure by caries, the tissue in lateral canals and apical ramifications remained vital as far as the pulp tissue in the main canal did so. When pulp necrosis reached the level of the lateral canals and apical ramifications, the tissue therein was either partially or completely necrotic. Chemomechanical preparation partially removed necrotic tissue from the entrance of lateral canals and apical ramifications, whereas the adjacent tissue remained inflamed, sometimes infected, and associated with periradicular disease. Vital tissue in lateral canals and apical ramifications was not removed by preparation. In cases in which lateral canals appeared radiographically "filled," they were actually not obturated, and the remaining tissue in the ramification was inflamed and enmeshed with the filling material. Conclusions: Overall, the belief that lateral canals must be injected with filling material to enhance treatment outcome was not supported by literature review or by our histopathologic observations. It appears that strategies other than finding a technique that better squeezes sealer or gutta-percha within lateral canals and apical ramifications should be pursued to effectively disinfect these regions.