Pierre Machtou presents a review of the clinically relevant literature on apical seal versus coronal seal Apical seal versus coronal seal CPD

19 The biological basis of endodontics is well established and underlines the dominant role of bacteria in the initiation, development and persistence of periapical disease (Kakehashi S et al, 1965) or apical periodontitis (AP) according to the terminology currently in use. The aim of clinical procedures is to prevent or eliminate bacterial infection from the root canal system (Orstavik D, Pitt-Ford TR, 1998). For many years, inadequate obturation of the root canal was widely accepted as the cause of continuing endodontic infection (Figure 1). However, more recently attention has focused on the lack of effective sealing of the coronal restoration after endodontic treatment and the impact of this on the ultimate outcome. The current dilemma is based on ascertaining which of these two factors is the predominant cause of endodontic failure (Sritharan A, 2002) because the literature is abundant on each of these two issues and is dogged by controversy.