Surgical vs Non-surgical Retreatment of Endodontic Cases - Factors, Influencing the Retreatment Choice

Abstract

Introduction: Endodontic retreatment describes a root canal procedure performed on a tooth that has previously had a root canal treatment. One of the main reasons for the failure of the initial treatment is bacterial contamination, leading to an inflammatory response characterized as apical periodontitis, granuloma, radicular cyst or abscess. The preservation of the tooth in such cases requires a retreatment, which can be performed non-surgical, surgical or combined. The aim or this work is to systemize the main indications for each treatment option by describing their advantages, disadvantages, as well as possible difficulties when performing it. Materials and Methods: We have studied numerous articles and publications, so that we can present the main factors influencing the different retreatment options. In order to visualize some of the main indications, requiring a retreatment, we are presenting a clinical case, which demonstrates a combined -surgical and non-surgical retreatment of an endodontically treated tooth. Results: When considering treatment for a tooth that has not healed successfully with root canal therapy there are some factors to pay attention to such as root canal system anatomy, root length, patency along the root canal, level of the lesion, structural integrity of the tooth, periodontal status and possibility of coronal reconstruction. All retreatment options present difficulties and possible risks which can lead to non-healing of the apical pathology, possible damaging of the tooth stability and even tooth loss. Conclusion: The longevity of an endodontically retreated tooth depends on the accuracy of the diagnosis, root canal irrigation, preparation, obturation and final restoration. Proper follow-ups, both clinical and radiographic, and thoughtful consideration of the retreatment option - surgical, non-surgical or combined can lead to long-term success and preservation of the tooth.