{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:59:29Z","timestamp":1793732369637,"version":"4.6.1"},"reference-count":67,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Bacterial biofilms on root surfaces outside the apical foramen are linked to refractory apical periodontitis, as microorganisms can survive in extraradicular areas and cause persistent infections. This study aimed to precisely evaluate the relationship between extraradicular biofilm and persistent periapical periodontitis through an overview of case reports. Methods: A systematic search of PubMed, Web of Science, Scopus, Embase and ScienceDirect databases was conducted up to June 2023. Keywords included \u201cextraradicular infection\u201d, \u201cwet canal\u201d, \u201cwet canals\u201d, \u201cextraradicular mineralized biofilms\u201d, and \u201ccalculus-like deposit\u201d. Only case reports meeting the inclusion criteria were analyzed. Results: Fifteen cases of extraradicular infection were identified, involving eight women and six men aged between 18 and 60 years. These cases included nine failed treatments confirmed through complementary methods such as histobacteriologic analysis, scanning electron microscopy (SEM), or polymerase chain reaction (PCR). Among these, four patients (six teeth) exhibited calculus-like deposits. Conclusions: Extraradicular biofilm is strongly associated with failed endodontic treatments, leading to persistent infections. A structured decision-making approach is essential. Before considering apical surgery, clinicians should prioritize intraradicular infection control through thorough irrigation, antimicrobial medicaments, and adjunctive disinfection techniques. When extraradicular biofilms or mineralized calculus are present, and symptoms persist after optimal intracanal disinfection, apical surgery should be performed.<\/jats:p>","DOI":"10.3390\/jcm14072335","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T02:50:16Z","timestamp":1743389416000},"page":"2335","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Extraradicular Infection and Apical Mineralized Biofilm: A Systematic Review of Published Case Reports"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6925-5939","authenticated-orcid":false,"given":"Alejandro R.","family":"P\u00e9rez","sequence":"first","affiliation":[{"name":"Department of Endodontics, Rey Juan Carlos University, Alcorc\u00f3n, 28922 Madrid, Spain"},{"name":"Private Practice, Villa Nova de Gaya, 4400-239 Porto, Portugal"},{"name":"Surpreendente Research Group, Villa Nova de Gaia, 4400-239 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Rend\u00f3n","sequence":"additional","affiliation":[{"name":"POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medell\u00edn 050026, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0983-7945","authenticated-orcid":false,"given":"P. S.","family":"Ortolani-Seltenerich","sequence":"additional","affiliation":[{"name":"Department of Dental Pathology and Therapeutics, Faculty of Dentistry, UCAM, 30107 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yetzangel","family":"P\u00e9rez-Ron","sequence":"additional","affiliation":[{"name":"Surpreendente Research Group, Villa Nova de Gaia, 4400-239 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Centre for Interdisciplinary Research in Health, Faculty of Dental Medicine, Universidade Cat\u00f3lica Portuguesa, 3504-505 Viseu, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2329-5071","authenticated-orcid":false,"given":"Rita","family":"Noites","sequence":"additional","affiliation":[{"name":"Centre for Interdisciplinary Research in Health, Faculty of Dental Medicine, Universidade Cat\u00f3lica Portuguesa, 3504-505 Viseu, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4228-3729","authenticated-orcid":false,"given":"Gaizka","family":"Loro\u00f1o","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Endodontics, Department of Dentistry, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaya C. 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