Comparative Assessment of Gutta-Percha Removal Techniques for Endodontic Retreatment: Efficiency and Clinical Implications

Abstract

Background: Endodontic retreatment involves the removal of gutta-percha and sealer from root canals to address treatment failures and persistent infections. This study aimed to systematically evaluate and compare the effectiveness of different gutta-percha removal techniques.Methods: Sixty extracted human teeth with single canals were selected. The canals were initially treated, obturated with gutta-percha, and divided into six groups (n=10 each). Each group represented a distinct removal technique: rotary instrument-driven, Gates-Glidden drill-assisted, solvent-based dissolution, ultrasonic removal, heat-based softening, and a control group. Gutta-percha mass and canal wall cleanliness were assessed post-removal. Statistical analyses were performed using ANOVA and post hoc Tukey's HSD tests.Results: The solvent-based dissolution technique exhibited the most efficient removal, achieving the lowest mean remaining gutta-percha mass (0.89 ± 0.15 mg) and the highest canal wall cleanliness (95% ± 3%). The ultrasonic technique also showed effective removal capabilities with a mean remaining mass of 1.56 ± 0.22 mg and a cleanliness of 89% ± 4%. The rotary technique resulted in a mean mass of 2.47 ± 0.30 mg and cleanliness of 84% ± 5%. Gates-Glidden drill-assisted and heat-based techniques showed moderate performance with remaining masses of 3.18 ± 0.25 mg and 2.10 ± 0.20 mg, respectively, and cleanliness percentages of 78% ± 6% and 81% ± 5%. The control group had the highest remaining mass (9.88 ± 0.42 mg) and the lowest cleanliness (10% ± 2%), confirming the efficacy of the removal techniques.Conclusion: The solvent-based dissolution technique demonstrated superior efficacy in gutta-percha removal. Ultrasonic and rotary techniques were also effective choices. Clinicians should consider these findings when selecting gutta-percha removal methods for endodontic retreatment procedures.Keywords: Endodontic retreatment; Gutta-Percha removal; Canal wall cleanliness; Comparative efficacy; Removal techniques