Nonsurgical Retreatment Research Articles

The effect of periapical lesion size on the success rate of different endodontic treatments: a systematic review and meta-analysis

This systematic review evaluated the effect of periapical lesion (PL) size on the success rate of different endodontic treatments, including root canal treatment (RCT), non-surgical retreatment (NSR), and apical surgery (AS). Cohorts and randomized controlled trials investigating the outcomes of endodontic treatment of permanent teeth with PL and its size were identified electronically through Web of Science, MEDLINE, Scopus, and Embase databases. Two reviewers independently conducted the study selection, data extraction, and critical appraisal process. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale and the 11-item Critical Appraisal Skills Program checklist for randomized controlled trials. The success rates of the endodontic treatments (small lesions and large lesions) were estimated using the rate ratios (RRs) with an associated 95% confidence interval (CI). Out of 44 included studies, 42 were cohort, and 2 were randomized controlled trials. Thirty-two studies had poor quality. For the meta-analysis, five studies in RCT, 4 in NSR, and 3 in AS were considered. The RR of the endodontic treatment success in PLs was 1.04 in RCT (95% CI, 0.99-1.07), 1.11 in NSR (95% CI, 0.99-1.24), and 1.06 in AS (95% CI, 0.97-1.16). Only sub-group analysis of long-term follow-up of RCT showed a significantly higher success rate in small lesions than in large lesions. Considering the quality of studies and variation in outcomes and size classification, our meta-analysis demonstrated that the PL size had no significant effect on the success rate of different endodontic treatments.

Rotary Systems for Root Canal Gutta-percha Removal: A Review

Gaining a predictable outcome in endodontics is complicated by handling an endodontically treated. Compared to primary root canal therapy, non-surgical endodontic retreatment typically entails the removal of previous root filling materials. This process may be necessary to enable access to contaminated canal space for recleaning and to remove obturation materials that may have been contaminated by marginal penetration of microorganisms and microbial toxins. The achievement of patency at the canal terminus and the extension of cleaning as close as possible to the apical terminus have been identified as healing prognostic criteria. Gutta-percha (GP) is the current mainstay material utilised as an endodontic filling material, capable of performing comprehensive, three-dimensional sealing of the treated root canal system in a highly effective manner with considerable physical durability. Interestingly, since its initial discovery in the 17th century, GP remains to this day the ideal obturation material used across, in essence, all dental clinics globally due to its material properties and versatility for use in conjunction with sealer compounds. The development of GP removal systems that can manage to remove GP in its entirety from root canals during non-surgical retreatment procedures is currently highly desirable for dental practices. This literature review investigated this current research niche and scrutinised two prevalently utilised rotary systems – Edgefile-XR and the XP-Endo shaper systems.

Effect of EDDY and manual dynamic activation techniques on postoperative pain in non-surgical retreatment: a randomized controlled trial

BackgroundDuring non-surgical retreatment process, the products such as dentin debris, root canal fillings, irrigation solutions, microorganisms and remaining pulp tissues can extrude to the apical area and can cause the postoperative pain and flare-up. Thus, the aim of this study was to evaluatethe effect of EDDY and manual dynamic activation (MDA) techniques on postoperative pain (PP) associated with retreatment.MethodsNinety patients scheduled for retreatment were treated at a single visit. Non-vital mandibular premolar teeth diagnosed with asymptomatic apical periodontitis were included in this study. The patients were divided into two groups (n = 45) on the basis of the need for additional irrigation activation procedures (EDDY and MDA). The patients’ post-treatment pain levels were asked to rate the intensity of their pain on a 10-point numerical rating scale (NRS) at the 12th, 24th, 48th, and 72nd h and 7 days.The data were analyzed using the chi-square and Wilcoxon signed-rank test was used for within-group comparisons and Mann Whitney U test was used to compare the groups by time period.ResultsThe difference in postoperative pain intensity between two groups was statistically significant at 12, 24, 48, and 72 h (p < 0.05). There was no significant difference at 7 days. Moreover, no statistically significant difference was found between the two groups in terms of gender and analgesic medication intake (p > 0.05). Pain intensity after the treatment was lesser in the MDA groupthanin the EDDY group at 12, 24, 48, and 72 h.ConclusionThis study could lead us to conclude that the two activation systems can be used during endodontic retreatment with no difference at PP 7 days later. However, a comparison of the groups indicated that the EDDY resulted in significantly more PP at 12, 24, 48, and 72 h.Trial registration ClinicalTrials.gov Identifier: NCT04726670.

The Effect of Different Irrigant Activation Methods on Postoperative Pain After Endodontic Retreatment

Aim: This study was designed to evaluate the effect of different irrigant activation methods on post operative pain after endodontic retreatment. Materials and Methods: seventy eight patients need non-surgical retreatment in mandibular first molar were involved in the study. The retreatment was performed in two visits, at first visit cases were randomly divided into three groups according to methods of irrigant activation after root canal retreatment with protaper next rotary ni-ti system. Group A (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) with manual dynamic agitation using master cone Group B (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) using ultrasonic machine (ultra-x) for 60 seconds. Group C (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) with NaviTip (29-gauge 27 mm) with double side tip. At second visit after one week, obturation was performed using modified single cone technique ans access cavity was filled with coronal restoration. After two visits root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48 72 hrs and one week post-obturation. Data were statistically analyzed with a significance level of P ≤0.05. Results: At 6,12,24 hrs., there was significant difference between the groups in pain intensity where control group C (Navitip with side vented needle) showed more pain scores than in the intervention groups (Ultra X and manual dynamic agitation). On the other hand, at 48, 72 hours and 7 days post- operative, there was no statistically significant difference in pain among tested groups. Conclusion: Agitation of the irrigation is reliable safe to clinican and effective as final step irrigation protocol with successful management of postoperative pain in retreatment cases. The intensity of postoperative pain decreased with time regardless of final irrigation protocol used.

Apicectomy of Upper Lateral Incisor with Symptomatic Persistent Cystic Lesion Previously Treated with Nonsurgical Retreatment

Endodontic failure caused by transportation, drilling, overfilling and failure to repair an injury apical sometimes lead to surgical therapy. With periapical surgery consisting of exposure of the apex, root resection and preparation of a cavity that is hermetically sealed, we will correct the persistent defects. The combination of this surgical technique with retrograde obturation provides high success rates. There are several widely used retrofilling materials, such as: IRM, Retroplast, SuperEBA or mineral trioxide aggregate (MTA) whick allow a retrograde sealing of the preparations. A case of a patient with recurrent apical lesion, describes the surgical technique of apicectomy and retrograde filling to preserve an upper lateral incisor with failed root canal retreatment and symptomatic persistent apical lesion.

Endodontic treatments on permanent teeth in pediatric patients aged 6–12 years old

The prevalence of carious lesions and traumatic injury in individuals between ages 6 and 12 is high. This study aimed to characterize pediatric patients aged 6–12 treated in the endodontic clinic and investigate the prevalence and patterns of their provided endodontic treatments. Clinical and radiographic records of patients (ages 6–12) referred to the postgraduate Endodontics clinic from June 2017 to June 2020 were reviewed. Demographics, pre-and post-operative conditions, type of endodontic treatment, and behavioral management were collected. A total of 6350 teeth from 6089 patients were treated in this period, and 425 teeth (6.7%) from 405 patients were included. Ages 9–11 were the most commonly treated age group. Significantly more lower molars (41.9%) and upper anterior teeth (36.7%) were treated ( P < 0.05). The majority of teeth were diagnosed with pulp necrosis (39.5%), and the most common periapical diagnosis was normal apical tissues (39.8%), then symptomatic apical periodontitis (38.8%). The most common etiological factor was caries (63.5%). Two hundred six teeth (48.5%) were treated with root canal therapy, 161 teeth (37.9%) with vital pulp therapy, 46 teeth (10.8%) with apexification or regenerative endodontic procedure, 12 teeth (2.8%) with non-surgical retreatment. A statistically high number of patients (87.8%) tolerated the endodontic procedures without any sedation ( P < 0.0001). Pediatric patients aged 6–12 compose around 7% of the population treated at the postgraduate Endodontics clinic, reflecting the high demand for endodontic treatment in a pediatric mixed dentition population.

The outcome of single-visit nonsurgical retreatment and patients’ perception of retreatment: a retrospective cohort study with 1-year follow-up

Aim: To evaluate the outcome of single visit nonsurgical retreatment by clinical examination and PAI (Periapical Index) and, patients’ feedback regarding the nonsurgical retreatment after 1 year.&#x0D; Material and Method: 115 patients who previously had nonsurgical retreatment were recalled after 1 year and after dropouts, 84 patients were examined clinically and radiographical examinations were completed pre-and postoperatively using Periapical Index. Patients were also asked if they would still choose nonsurgical retreatment for teeth with previously failed root canal treatment.&#x0D; Results: The healing rate after 1 year was 88%. The tooth type did not influence the outcome (p=0.756). While the failure rate was lower in males (3.3%) than in females (16.7%), gender did not affect the outcome (p=0.088). 97.6% of patients had a positive approach to nonsurgical retreatment. There was a statistically significant relationship between treatment outcome and patients' feedback (p=0.013). There is a statistically significant positive correlation between postoperative VAS (Visual Analogue Scale) pain score and postoperative PAI score (p=0.002).&#x0D; Conclusion: Single-visit nonsurgical retreatment is a viable option for teeth where certain periapical diseases such as symptomatic apical abscess are excluded. Patients, who experienced successful nonsurgical retreatment, are eager to preserve their tooth with failed primary root canal treatment when nonsurgical retreatment option is available.

Postoperative Pain evaluation after single visit nonsurgical retreatment using a Bio ceramic sealer

Postoperative Pain evaluation after single visit nonsurgical retreatment using a Bio ceramic sealer

Comparison of Endodontic Failures between Nonsurgical Retreatment and Endodontic Surgery: Systematic Review and Meta-Analysis with Trial Sequential Analysis.

Background and Objectives: In the presence of a persistent endodontic lesion or endodontic failure, the alternative for the recovery of the dental element is endodontic retreatment or endodontic surgery, which consists in the surgical removal of the root apices with retrograde closure of the endodontium. The objective of this systematic review and meta-analysis was to provide an updated value of the Risk Ratio between the two types of treatment in order to offer to clinicians who propose a non-surgical endodontic retreatment or an endodontic surgery a direct comparison. Materials and Methods: The revision was performed according to PRISMA indications: three databases (PubMed, Scopus and Cochrane register) were consulted through the use of keywords relevant to the revision topic: surgical endodontic retreatment, endodontic retreatment, apicoectomy. This search produced 7568 records which, after eliminating duplicates and applying the inclusion and exclusion criteria, resulted in a total of seven included articles. The meta-analyses were conducted by applying fixed-effects models, given the low percentage of heterogeneity. In addition, trial sequency analysis (TSA) was performed for the analysis of the statistical power of the results and GRADE for the quality of the evidence. Results: The results of the meta-analyses’ data report an aggregate risk ratio (RR) between non-surgical endodontic retreatment and surgical endodontic retreatment of: 1.05 [0.74, 1.47] at one year of follow-up; RR 2.22 [1.45, 3.41] at two years of follow-up; an RR 1.08 [0.73 1.62] for a follow-up period of 3–4 years; and an RR 0.92 [0.53, 1.61] for a follow-up period of 8–10 years. Conclusions: The results of the present meta-analysis show that in the long term, the risk of failure is identical for the two groups, and there is only a slightly higher risk of failure for non-surgical endodontic retreatments, when only two years of follow-up are considered.

Present status and future directions: Surgical endodontics.

Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown and root resections, surgical perforation repair and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. Whilst nonsurgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.

Contribution of Endodontic Pathology to Persistent Orofacial Pain: A Case Report

Identifying the etiology and correct diagnoses for long-standing orofacial pain can be very challenging, especially in patients who have both odontogenic and nonodontogenic pain. This case report describes the successful management of a complex case of chronic orofacial pain in a patient with nonodontogenic chronic pain conditions and a maxillary molar tooth with persistent periapical pathology after endodontic treatment. The debilitating orofacial pain began after initial nonsurgical root canal treatment of the maxillary molar 3 years before presenting to our clinic. The initial clinical and radiographic assessment by our multidisciplinary team found that there were potentially both peripheral endodontic pathology and central pain mechanisms contributing to the long-standing pain. The diagnosis was shared with the patient's neurologist, who prescribed gabapentin, a centrally acting analgesic, and partial pain reduction was achieved. The odontogenic component of the orofacial pain was then addressed, by treating the persistent periapical infection and buccal bone fenestration of the roots of the maxillary molar. Treatments included both nonsurgical retreatment and surgical endodontic therapy (including root resection, root-end preparation, and retrofilling), and each significantly improved the patient's ongoing orofacial pain. After the successful endodontic treatments, the patient reported minimal pain and normal oral function. The case report highlights the importance of systematically treating endodontic pathology in a patient with long-standing orofacial pain, with both odontogenic and nonodontogenic components.

Management of a Large Periapical Lesion Following Nonsurgical Retreatment and Low-level Laser Therapy: A Case Report

Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. Long-term success of root canal treatment(RCT) is dependent on sufficient and appropriate cleaning and shaping of the root canal system along with 3 dimensional obturation. This article aims to report a non-surgical and orthograde endodontic retreatment of mandibular right central incisor with a large radicular cyst progression related to endodontic origin in a 51-year-old male. The signs (sinus tract) and symptoms ceased after treatment. Bone formation Complete healing of the periradicular lesion was observed at the two-year follow-up examination. The appropriate diagnosis of periradicular lesion and the treatment of root canal system allowed complete healing of large lesions without endodontic surgery.

Retrievability of Calcium Silicate–based Root Canal Sealers During Retreatment: An Ex Vivo Study

IntroductionThe retrievability of calcium silicate–based sealers (CSSs) during nonsurgical retreatment has been equivocal. This study compared the retrievability of 3 different CSSs using 1 of 3 different solutions or no solution. MethodsA total of 130 extracted teeth with a straight canal were decoronated to a standardized root length. The canals were instrumented to 35/.04 and divided into 3 groups (BC: EndoSequence BC sealer; EBC: EdgeBioceramic; NEO: NeoSEALERFlo), and each group was further divided into 4 subgroups (6% sodium hypochlorite; 5% acetic acid; carbonated water; no solution). After sealer placement, each master gutta-percha cone was placed intentionally 2 mm short of the working length (WL) to ensure the apical 2 mm was filled only with sealer. After storage for 21 days at 37°C and 100% humidity, retreatment was performed until apical patency was obtained. The operator was blinded to the CSS and solution used. Data were analyzed using analysis of variance to compare apical patency rates and the mock chair-times. ResultsOverall success rates for apical patency in BC, EBC, and NEO were 63.64%, 69.77%, and 100%, respectively. There was significantly higher apical patency rate in NEO than BC and EBC. The chair-time for NEO was significantly shorter than BC (P < .05) and EBC sealer (P < .001). There was no significant difference in the chair-time between BC and EBC sealer groups. ConclusionBC, EBC, and NEO sealers in a straight canal were consistently retrievable when no solution was used. Compared with no solution, the retrievability of BC, EBC, and NEO decreased when solutions were used.

Nonsurgical Retreatment of Mandibular Incisors with Periapical Lesions –A Case Report

The case demonstrates successful, nonsurgical retreatment of mandibular, central, and lateral incisors. Acute exacerbation was noted on previously root-filled mandibular incisors with periapical lesions and endodontic retreatment was arranged. Thorough root canal cleaning and shaping were done using the step back technique with hand files and obturation was completed using gutta-percha and AH plus sealer using the passive lateral compaction technique. An 18-month follow-up showed complete osseous healing.

Endodontic retreatment: significance and a systematic review of te major protocols

Introduction: In the endodontic treatment scenario, despite the emergence of techniques and instruments that facilitate the treatment, there are still cases that require retreatment of the treated root canals. Non-surgical endodontic retreatment (NSER) can be performed in one or several visits. Endodontic pain has been the main reason for patient consultations after therapy and affects patient comfort. A condition for successful endodontic retreatment is proper cleaning of the root canals, therefore, special attention must be given to the technique used to remove the filling material, with the most commonly used cement, pastes, and gutta-percha cones. Objective: This systematic review aimed to evaluate the main protocols and techniques for endodontic retreatment. Methods: The present study was followed by a systematic literature review model. Clinical studies were included as case reports, retrospective, prospective and randomized trials with qualitative and/or quantitative analysis. The quality of the studies was based on the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: The results showed that cleaning and the presence of debris at a speed of 1500 rpm provided greater agility with a smaller number of fractured instruments. Furthermore, the dynamic navigation system enabled the minimally invasive removal of the fiber post with a high degree of precision, without unnecessary removal of the root structure. One visit NSER had lower postoperative pain than multiple visits only for 1 and 30 days. Ultrasonic tips should be considered a good option for endodontic retreatment, especially for cases of bioceramics. Finally, there is a predominance of E. faecalis and P. gingivalis in all phases of endodontic retreatment.

Intentional Replantation: an Approach to Save Hopeless Natural Teeth (A Case Report)

Introduction: Non-surgical endodontic retreatment and surgical endodontic therapy may not be practical for the treatment of endodontic diseases. Intentional replantation is considered as a procedure of last resort when nonsurgical or surgical endodontics is contraindicated. Case report: A 35 year- old female attended the endodontist office with pain and apical lesion in endodontically treated tooth ≠47. Access preparation for retreatment is a problem due to the posts and crown and surgical endodontic therapy was limited by anatomical features including nerve proximity and bone thickness. In addition, the patient could not afford to pay for non-surgical re-treatment or implant therapy Conclusion: This report demonstrates intentional replantation as a treatment that can be considered when other options such as endodontic retreatment or apical surgery are impossible.

Non-surgical management of maxillary first molars with five root canals

Aim: This case series reports the non-surgical management of five maxillary first molars with five root canals in different ethnic groups and geographic locations. Summary: Diagnosis and management of complex root canal anatomy, especially of the maxillary first molar, can be frustrating and challenging and also may increase the risk of failure if not managed with appropriate tools. In this case series the primary endodontic treatment of four, and a non-surgical retreatment of one maxillary first molar with five root canals treated by three different endodontists from India, Spain and Portugal has been described. None of the cases presented in the paper were performed without magnification and troughing of the pulp chamber floor using ultrasonic tips. Although, CBCT wasn’t used in all cases although it’s prudent use respecting the ALARA principle is highlighted in the paper. This paper also highlights the importance of anatomical variations in different ethnic groups with the maxillary first molar. Key learning points Operator should consider the ethnicity of the patient and thoroughly study pre-operative radiograph to carry out successful endodontic treatment. Use of magnification and ultrasonic tips is fundamental especially in treating unusual canal anatomies. The prudent use of CBCT should be performed respecting the ALARA principle in all given situations.

Iatrogenic complications arising from cleaning and shaping

Endodontic treatments tend to have very high successful rates in spite of the fact that they are quite an invasive, difficult procedure, especially in complex anatomies. As a consequence, retreatment has become a well-defined field of knowledge and expertise in endodontics, since most complications can be solved with proper surgical or nonsurgical retreatments. Failure to grasp the rationale behind cleaning and shaping concepts can increase the occurrence of needless complications, such as ledges. Extension of the access cavity to provide unobstructed access to the root canals, precurving and not forcing instruments, using NiTi files, using passive step-back and balanced force techniques, and instrumenting the canal to its full length will all help to prevent ledge formation. Initial negotiation and bypassing the ledge can be achieved using a small file with a distinct curve at the tip, whereas a slight rotation motion of the file combined with a picking motion can often help advance the instrument. Blockage, laceration, and foraminal damage are the most common results. Each alters the reliability of the procedure and must be prevented if one is to obtain the best possible prognosis for the patient.

Endodontic Treatment of a Mandibular Molar with Radix Paramolaris: A Case Report

Anatomical variations of the root canal system of mandibular molars are common and often present challenges for endodontic treatment. In some cases, an additional root is located in the distolingual, radix entomolaris (RE), or more rarely in the buccal, radix paramolaris (RP). This case report illustrates rare nonsurgical retreatment of the complex root canal morphology of a RP and demonstrates the utility of cone-beam computed tomography (CBCT) and 3D printing in managing such a case. Underscored is the need for clinicians to understand the possible variations of root canal morphology of mandibular molars and the role CBCT imaging can play in addition to periapical radiographs in order to successfully treat a tooth with radix paramolaris.

Management of apical periodontitis using WaveOne gold reciprocating files, single-cone endodontic approach: A case series

IntroductionThe endodontic treatment of apical periodontitis (AP) without surgical intervention presents a unique clinical challenge. This case series aimed to test the changes in size of periapical lesion scale and healing in post-treatment of AP by cone beam computed tomography (CBCT) using Waveobe Gold reciprocating file with single cone treatment approach. Presentation of casesA total of 20 patients with 20 teeth (9 M, six premolars, one canine, and four incisors) with AP underwent CBCT scanning before and after non-surgical root canal treatment (NSRCT) or non-surgical retreatment (NSReTx). Standardized root canal chemo-debridement and instrumentation with WaveOne Gold (WOG) reciprocating files was used. The canals were obturated using epoxy-based sealer (AH Plus) with a single WaveOne Gold conform fit gutta-percha cone technique. After one year, assessment with CBCT images showed that the success and healing rate using (AH Plus) with single cone technique was very high. DiscussionApical periodontitis is an inflammatory disease at the root end of teeth. Following NSRCT or NSReTx, evaluation of lesion size by radiograph has been essential to the evaluation of lesions post-operatively. In addition to the absence of symptoms, complete restitution of the lamina dura and periodontal ligament (PDL) space on post-operative radiograph has been considered the optimal outcome success. ConclusionsWithin the limitations of this study, NSRCT or NSReTx using reciprocating WaveOne Gold and single cone with AH plus sealer resulted in healing of AP as assessed by CBCT.