{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:32:07Z","timestamp":1791923527803,"version":"4.3.4"},"reference-count":38,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100016549","name":"Universal","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016549","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"publisher","award":["424981\/2018\\u20131"],"award-info":[{"award-number":["424981\/2018\\u20131"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.jp","jendodon.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endodontics"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.joen.2025.07.015","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T23:11:17Z","timestamp":1753398677000},"page":"1549-1556","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"title":["Bacterial Viability in Persistent Apical Periodontitis: A Systematic Review"],"prefix":"10.1016","volume":"51","author":[{"given":"Diego","family":"Nascimento","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor Cavalcante","family":"Guedes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiza Meurer","family":"Brand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisiane","family":"Bernardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00falia Mergen","family":"Vasconcelos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Ant\u00f4nio Poli","family":"Figueiredo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda","family":"Visioli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Lazzaron","family":"Lamers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina Naomi","family":"Hashizume","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pantelis Varvaki","family":"Rados","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.joen.2025.07.015_bib1","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1590\/S0103-64402003000300008","article-title":"Distribution of CD8 and CD20 lymphocytes in chronic periapical inflammatory lesions","volume":"14","author":"Philippi","year":"2003","journal-title":"Braz Dent J"},{"key":"10.1016\/j.joen.2025.07.015_bib2","doi-asserted-by":"crossref","DOI":"10.1016\/j.archoralbio.2021.105055","article-title":"Analysis of microorganisms in periapical lesions: a systematic review and meta-analysis","volume":"124","author":"Bronzato","year":"2021","journal-title":"Arch Oral Biol"},{"key":"10.1016\/j.joen.2025.07.015_bib3","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.joen.2008.07.028","article-title":"Clinical implications and microbiology of bacterial persistence after treatment procedures","volume":"34","author":"Siqueira","year":"2008","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib4","doi-asserted-by":"crossref","first-page":"54","DOI":"10.14744\/eej.2020.42714","article-title":"Endodontic periapical lesion: an overview on the etiology, diagnosis and current treatment modalities","volume":"5","author":"Karamifar","year":"2020","journal-title":"Eur Endod J"},{"key":"10.1016\/j.joen.2025.07.015_bib5","series-title":"Oral Radiology: Principles and Interpretation","author":"White","year":"2014"},{"key":"10.1016\/j.joen.2025.07.015_bib6","series-title":"WHO Classification of Head and Neck Tumours","author":"El-Naggar","year":"2017"},{"key":"10.1016\/j.joen.2025.07.015_bib7","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1590\/S1806-83242012000300009","article-title":"A 10-year study of specimens submitted to oral pathology laboratory analysis: lesion occurrence and demographic features","volume":"26","author":"Mendez","year":"2012","journal-title":"Braz Oral Res"},{"key":"10.1016\/j.joen.2025.07.015_bib8","first-page":"73","article-title":"Do epithelial odontomes increase in size by their own tension?","volume":"19","author":"James","year":"1926","journal-title":"Proc R Soc Med"},{"key":"10.1016\/j.joen.2025.07.015_bib9","first-page":"681","article-title":"Experimental investigations into factors concerning the growth of cysts of the jaw","volume":"41","author":"Toller","year":"1948","journal-title":"Proc R Soc Med"},{"key":"10.1016\/j.joen.2025.07.015_bib10","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S0099-2399(80)80039-2","article-title":"Incidence of periapical cysts in relation to the root canal","volume":"6","author":"Simon","year":"1980","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib11","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.joen.2007.02.006","article-title":"Proliferation of epithelial cell rests, formation of apical cysts, and regression of apical cysts after periapical wound healing","volume":"33","author":"Lin","year":"2007","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib12","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.tripleo.2008.04.009","article-title":"Experimental evidence supports the abscess theory of development of radicular cysts","volume":"106","author":"Nair","year":"2008","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib13","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.joen.2015.08.036","article-title":"Radicular cyst: an update of the biological factors related to lining epithelium","volume":"41","author":"Bernardi","year":"2015","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib14","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.anaerobe.2017.06.016","article-title":"Microbial analysis of root canal and periradicular lesion associated to teeth with endodontic failure","volume":"48","author":"Pereira","year":"2017","journal-title":"Anaerobe"},{"key":"10.1016\/j.joen.2025.07.015_bib15","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-71029-3","article-title":"Accuracy for diagnosis of periapical cystic lesions","volume":"10","author":"Tsesis","year":"2020","journal-title":"Sci Rep"},{"key":"10.1016\/j.joen.2025.07.015_bib16","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/j.joen.2012.03.004","article-title":"Bacterial flora and extraradicular biofilm associated with the apical segment of teeth with post-treatment apical periodontitis","volume":"38","author":"Wang","year":"2012","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib17","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/j.joen.2013.06.018","article-title":"Investigation of cultivable bacteria isolated from longstanding retreatment-resistant lesions of teeth with apical periodontitis","volume":"39","author":"Signoretti","year":"2013","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib18","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.joen.2014.08.020","article-title":"Extraradicular infection as the cause of persistent symptoms: a case series","volume":"41","author":"Ricucci","year":"2015","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib19","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s40168-017-0285-3","article-title":"Schr\u00f6dinger's microbes: tools for distinguishing the living from the dead in microbial ecosystems","volume":"5","author":"Emerson","year":"2017","journal-title":"Microbiome"},{"key":"10.1016\/j.joen.2025.07.015_bib20","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2021.798367","article-title":"Microbial communities in the extraradicular and intraradicular infections associated with persistent apical periodontitis","volume":"11","author":"Sun","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"10.1016\/j.joen.2025.07.015_bib21","doi-asserted-by":"crossref","first-page":"6313","DOI":"10.1128\/AEM.05262-11","article-title":"PCR amplification-independent methods for detection of microbial communities by the high-density microarray PhyloChip","volume":"77","author":"DeAngelis","year":"2011","journal-title":"Appl Environ Microbiol"},{"key":"10.1016\/j.joen.2025.07.015_bib22","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1093\/embo-reports\/kve182","article-title":"A matter of bacterial life and death","volume":"2","author":"Bogosian","year":"2001","journal-title":"EMBO Rep"},{"key":"10.1016\/j.joen.2025.07.015_bib23","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/j.1600-9657.1987.tb00549.x","article-title":"Extraradicular endodontic infections","volume":"3","author":"Tronstad","year":"1987","journal-title":"Endod Dent Traumatol"},{"key":"10.1016\/j.joen.2025.07.015_bib24","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1034\/j.1600-9657.2000.016002084.x","article-title":"Extraradicular infection: a methodological study","volume":"16","author":"Sunde","year":"2000","journal-title":"Endod Dent Traumatol"},{"key":"10.1016\/j.joen.2025.07.015_bib25","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.pdpdt.2015.06.002","article-title":"Effects of antimicrobial photodynamic therapy and surgical endodontic treatment on the bacterial load reduction and periapical lesion healing. Three years follow up","volume":"12","author":"Garcez","year":"2015","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"10.1016\/j.joen.2025.07.015_bib26","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1016\/j.tripleo.2009.12.051","article-title":"Surgical endodontic treatment of refractory periapical periodontitis with extraradicular biofilm","volume":"110","author":"Su","year":"2010","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib27","series-title":"JBI Manual for Evidence Synthesis","article-title":"Chapter 7: systematic reviews of etiology and risk","author":"Moola","year":"2020"},{"key":"10.1016\/j.joen.2025.07.015_bib28","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/edt.12508","article-title":"Prevalence of dentofacial injuries among combat sports practitioners: a systematic review and meta-analysis","volume":"36","author":"Polmann","year":"2020","journal-title":"Dent Traumatol"},{"key":"10.1016\/j.joen.2025.07.015_bib29","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1016\/j.joen.2012.06.037","article-title":"Bacterial flora of dental periradicular lesions analyzed by the 454-pyrosequencing technology","volume":"38","author":"Saber","year":"2012","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib30","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/S0099-2399(06)81409-3","article-title":"A bacteriological and histological evaluation of 58 periapical lesions","volume":"18","author":"Wayman","year":"1992","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib31","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.joen.2009.04.010","article-title":"Molecular analysis of persistent periradicular lesions and root ends reveals a diverse microbial profile","volume":"35","author":"Subramanian","year":"2009","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib32","doi-asserted-by":"crossref","first-page":"3513","DOI":"10.1128\/aem.59.10.3513-3515.1993","article-title":"Polymerase chain reaction detection of nonviable bacterial pathogens","volume":"59","author":"Josephson","year":"1993","journal-title":"Appl Environ Microbiol"},{"key":"10.1016\/j.joen.2025.07.015_bib33","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1111\/iej.12361","article-title":"Microbial community in persistent apical periodontitis: a 16S rRNA gene clone library analysis","volume":"48","author":"Zakaria","year":"2015","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2025.07.015_bib34","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/00004770-200210000-00001","article-title":"Participation of bacterial biofilms in refractory and chronic periapical periodontitis","volume":"28","author":"Noiri","year":"2002","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2025.07.015_bib35","doi-asserted-by":"crossref","first-page":"8738","DOI":"10.1128\/AEM.71.12.8738-8743.2005","article-title":"Identification and localization of extraradicular biofilm-forming bacteria associated with refractory endodontic pathogens","volume":"71","author":"Noguchi","year":"2005","journal-title":"Appl Environ Microbiol"},{"key":"10.1016\/j.joen.2025.07.015_bib36","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1111\/j.1365-2591.2006.01099.x","article-title":"On the causes of persistent apical periodontitis: a review","volume":"39","author":"Nair","year":"2006","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2025.07.015_bib37","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1038\/sj.bdj.2014.200","article-title":"Causes and management of post-treatment apical periodontitis","volume":"216","author":"Siqueira","year":"2014","journal-title":"Br Dent J"},{"key":"10.1016\/j.joen.2025.07.015_bib38","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.joen.2016.09.002","article-title":"Stem cell marker expression in persistent apical periodontitis","volume":"43","author":"Estrela","year":"2017","journal-title":"J Endod"}],"container-title":["Journal of Endodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S009923992500442X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S009923992500442X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:13:03Z","timestamp":1772849583000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S009923992500442X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":38,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["S009923992500442X"],"URL":"https:\/\/doi.org\/10.1016\/j.joen.2025.07.015","relation":{},"ISSN":["0099-2399"],"issn-type":[{"value":"0099-2399","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Bacterial Viability in Persistent Apical Periodontitis: A Systematic Review","name":"articletitle","label":"Article Title"},{"value":"Journal of Endodontics","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.joen.2025.07.015","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 American Association of Endodontists.","name":"copyright","label":"Copyright"}]}}