A Review of Microbiologic Similarities of Refractory Periodontitis and Refractory Periapical Periodontitis

Treatment resistance cases in both endodontal and periodontal diseases are sometimes encountered in spite of a good treatment. These cases may be caused by microbial agents and / or inefficient host responses. The microbial factors need further investigation and host response in discussed in this section. Methods & Materials: Thirty two articles and two text were reviewed for this discussion. The main cause of innate and specific immune system involvement in refractory periapical periodontitis are microbial factors, where as in refractory periodontitis the bacterial factor is less prominent and cigarette smoking is considered the main factor with emotional stressors micronutient deficiency and herpesviruses being contributing factors.