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Bacterial biofilms are very prevalent in the apical root canals of teeth with primary and post-treatment apical periodontitis. These bacterial endodontic communities are often found adhered to or at least associated with the dentinal canal walls, with bacterial cells encased in an extracellular amorphous matrix and often facing host inflammatory cells. This pattern of bacterial community arrangement in the root canal system is consistent with the acceptable criteria for including apical periodontitis in the set of biofilm-mediated diseases. Whereas intraradicular biofilms are common in teeth with apical periodontitis lesions, extraradicular biofilms are found much less frequently and usually in association with symptoms. Morphological studies reveal that the structure of endodontic biofilms can vary from case to case and a unique pattern has not been established.