Periapical Health Research Articles

Relationship between quality of root canal obturation and periapical lesion in elderly patients: a systematic review.

The aim of this study was to investigate the relationship between quality of root canal obturations and the presence/absence of periapical lesion in elderly patients. This was a systematic conducted by means analysing studies on the quality of root canal obturations and their relationship with periapical health in elderly patients. The methodological procedures were based on Cochrane. The inclusion criteria for selection of the titles were the following: (i) studies in humans; (ii) sample consisting of individuals aged 60years or older; (iii) intending criteria defined for the evaluation of quality of root canal obturations; (iv) intending criteria defined for the evaluation of periapical health; (v) determination of the relationship between quality of endodontic treatment and presence of periapical lesions; and (vi) articles published between 1st March 2003 and 1st March 2013. A total of 3161 potentially relevant studies were found in three databases chosen for the literature review, with 1669 being repeated and 395 duplicated. Therefore, the abstracts of 1097 studies were read. A total of 1022 studies were excluded, resulting in 75 articles for full analysis. However, no study could be included in the present literature review. There is no consensus on the relationship between the quality of root canal obturations and periapical health in older patients.

Apical periodontitis and the technical quality of root canal treatment in an adult sub-population in London.

To assess the prevalence of apical periodontitis (AP) and the technical quality of root canal treatment in an adult sub-population in London. Panoramic radiographs of 136 patients who attended a dental hospital were collected. The periapical health of teeth present was assessed radiographically and the presence or absence of AP noted. The technical quality of the root canal treatment was scored as adequate or inadequate, based on the European Society of Endodontology (2006) guidelines. A total of 3,396 teeth were assessed; AP was detected in 4.1% of the teeth. Forty-nine percent of patients had at least one tooth with radiographic evidence of AP. The percentage of root filled teeth with AP was 38.3%. AP was significantly more frequently found in root treated, compared with non-root treated, teeth (p <0.001). In 44.3% of the cases, the technical quality of the root canal filling was inadequate. AP was detected in 14% of adequately, compared with 68.6% of inadequately, root filled teeth. There is a significant negative correlation between the technical quality of root canal treatment and the presence of AP (p <0.001). There was a high prevalence of AP and poor technical quality root canal treatment; a strong association between AP and root filled teeth, and between the periapical health and the technical quality of the root canal treatment. The results are consistent with previous studies using similar methodology and re-confirmed that high technical quality root canal treatment is crucial to ensure a favourable treatment outcome.

Summary of: Apical periodontitis and the technical quality of root canal treatment in an adult sub-population in London.

Aim To assess the prevalence of apical periodontitis (AP) and the technical quality of root canal treatment in an adult sub-population in London. Methodology Panoramic radiographs of 136 patients who attended a dental hospital were collected. The periapical health of teeth present was assessed radiographically and the presence or absence of AP noted. The technical quality of the root canal treatment was scored as adequate or inadequate, based on the European Society of Endodontology (2006) guidelines. Results A total of 3,396 teeth were assessed; AP was detected in 4.1% of the teeth. Forty-nine percent of patients had at least one tooth with radiographic evidence of AP. The percentage of root filled teeth with AP was 38.3%. AP was significantly more frequently found in root treated, compared with non-root treated, teeth (p <0.001). In 44.3% of the cases, the technical quality of the root canal filling was inadequate. AP was detected in 14% of adequately, compared with 68.6% of inadequately, root filled teeth. There is a significant negative correlation between the technical quality of root canal treatment and the presence of AP (p <0.001). Conclusions There was a high prevalence of AP and poor technical quality root canal treatment; a strong association between AP and root filled teeth, and between the periapical health and the technical quality of the root canal treatment. The results are consistent with previous studies using similar methodology and re-confirmed that high technical quality root canal treatment is crucial to ensure a favourable treatment outcome.

Impact of the quality of coronal restoration and root canal filling on the periapical health in adult Syrian subpopulation

The purpose of this study was to determine the status of periapical tissues of endodontically treated teeth according to coronal restorations and root canal fillings separately and in concomitant in adult Syrian subpopulation. Methods784 endodontically treated teeth from two hundred randomly selected Syrian adult patients were radiographically evaluated. According to predetermined criteria, the quality of coronal restorations and root canal filling of each tooth was scored as adequate or inadequate. The status of periapical tissues was also classified as healthy or diseased. Results were analyzed using Chi-squared test. ResultsAdequate coronal restorations were determined in 58.54% of cases which was accompanied with less periapical pathosis than that in teeth with inadequate restorations (p < 0.01). 14% of teeth were restored by posts which showed no significant impact on the periapical tissues health. 18.5% of endodontic treatments were evaluated as adequate with less number of periapical radiolucencies than that of inadequate root canal fillings (p < 0.01). Absence of periapical pathosis was 96.6% in cases with both adequate coronal restorations and root canals fillings. The rate was 88.5% in cases with only adequate root canals fillings, and about 70% in cases with only adequate coronal restorations. When the treatment was inadequate in both coronal and root canals fillings, success rate was only observed in 48.8%. ConclusionThe most important factor with regard to the periradicular tissue health is the quality of root canal filling without neglecting the influence of coronal restoration (regardless of its type). There is a high prevalence rate of periapical pathosis in Syrian subpopulation due to poor dental practice.

Impact of the quality of coronal restoration and root canal filling on the periapical health in adult syrian subpopulation.

Background:The purpose of this study was to determine the status of periapical tissues of endodontically treated teeth according to coronal restorations and root canal fillings separately and in concomitant in adult Syrian subpopulation.Methods:784 endodontically treated teeth from two hundred randomly selected Syrian adult patients were radiographically evaluated. According to predetermined criteria, the quality of coronal restorations and root canal filling of each tooth was scored as adequate or inadequate. The status of periapical tissues was also classified as healthy or diseased. Results were analyzed using Chi-squared test.Results:Adequate coronal restorations were determined in 58.54% of cases which was accompanied with less periapical pathosis than that in teeth with inadequate restorations (P < 0.01). 14% of teeth were restored by posts which showed no significant impact on the periapical tissues health. 18.5% of endodontic treatments were evaluated as adequate with less number of periapical radiolucencies than that of inadequate root canal fillings (P < 0.01). Absence of periapical pathosis was 96.6% in cases with both adequate coronal restorations and root canals fillings. The rate was 88.5% in cases with only adequate root canals fillings, and about 70% in cases with only adequate coronal restorations. When the treatment was inadequate in both coronal and root canals fillings, success rate was only observed in 48.8%.Conclusion:The most important factor with regard to the periradicular tissue health is the quality of root canal filling without neglecting the influence of coronal restoration (regardless of its type). There is a high prevalence rate of periapical pathosis in Syrian subpopulation due to poor dental practice.

Periapical Status and Quality of Root Canal Obturation in Elderly Population: A Systematic Review

The aim of this study was to investigate the relationship between root fillings and the presence of apical periodontitis in studies with samples containing elderly patients. The data were obtained by means of a systematic review of studies that evaluated the quality of root fillings and their relationship with periapical health. 1,376 potentially relevant articles were selected, of which 667 were repeated and 16 were duplicates. 693 abstracts were analyzed, with 608 of these being excluded and 85 selected for reading in full. Fourteen (14) articles were included, totaling data of 135,566 teeth. Of these, 13,704 (10.1%) had endodontic fillings, with 6,455 (47.1%) being considered adequate and 7,249 (52.9%) inadequate. Among the teeth with apical periodontitis, 2,084 (32.3%) had adequate endodontic fillings and 3,749 (51.6%) had inadequate fillings. There was a significant correlation between the quality of endodontic fillings considered adequate and lower frequency of apical periodontitis in elderly patients.

Periapical Health Related to the Quality of Coronal Restorations and Root Fillings in a Turkish Population

800x600 Objectives: The aim of the present study was to evaluate the quality of root canal treatments and coronal restorations investigating their influence on the periapical status of endodontically-treated teeth in a Turkish population based on radiographic examination. Materials and Methods: The study included 583 patients referred for routine dental care. A total of 1125 endodontically treated teeth were examined with panoramic radiographs. The quality of root canal fillings and coronal restorations were evaluated according to the criteria determined by Gunduz et al., which were slightly modified from those described by De Moor et al. Apical status was assessed by the Periapical Index (PAI) scores. Results: Out of 1125 endodontically treated teeth, 539 were classified as healthy and 586 as displaying apical periodontitis. Of these 539 subjects, 389 teeth had received quality endodontic treatment. Of 586 teeth with apical periodontitis, 500 had poor endodontic treatment. Four hundred and seventy-five teeth had adequate root canal fillings. Of these teeth, 389 were classified as healthy. Of the 666 teeth with adequate restoration, apical region was classified as healthy for 410 subjects. For the 388 teeth with both adequate coronal restorations and root canal fillings, the success rate was 85.3%. For the 372 teeth with both inadequate coronal restorations and root canal fillings, the success rate was 18.8%. Conclusions: The quality of root fillings in the population living in the back country of Turkey is in general below the acceptable standard and requires substantial improvement. Normal 0 21 false false false TR X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:Normal Tablo; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Calibri,sans-serif;}

Radiographic follow-up of periapical status after endodontic treatment of teeth with and without apical periodontitis

The aim was to assess objectively the rate of changes in periapical status after endodontic treatment in relation to preoperative radiographic status (Periapical Index Score, PAI) and to tooth type. Radiographic data from a total of 1,410 teeth in seven prospective clinical studies was pooled. The periapical status was evaluated blindly using the PAI scoring system. The longest follow-up period was 4 years; intervals between controls varied from 3 months to 1 year. Teeth with preoperative PAI score 1 maintained excellent periapical health throughout. Teeth with preoperative PAI score 2 showed some impairment in health over the first 6 months, but improved to approach 95 % healthy teeth at 2 years of observation. Teeth with PAI 3-5 at the start showed significant improvement at 3 months; 27 % were considered healthy (PAI 1 or 2) increasing to 41 % after 1 year. Improvement of periapical status was slower in PAI groups 4 and 5 compared with PAI 3 during the first year. After 2 years, improvement continued similarly in all preoperative PAI 3-5 groups of teeth. Upper lateral incisors showed the poorest healing rate. Healing of pre-existing periapical lesions is most pronounced from 3 months to 2 years. Teeth with initially healthy periapical structures predictably maintain good periapical health. Maxillary teeth, especially lateral incisors, showed poorer healing rates than mandibular teeth. Radiographic healing rates may vary among tooth groups within the dentition. Periapically healthy teeth that are root filled may not need postoperative controls.

Radiographic Assessment of the Technical Quality and Periapical Health of Root‐Filled Teeth Performed by General Practitioners in a Turkish Subpopulation

Aim. The aim of this study was to evaluate by means of radiographs the technical quality of root fillings performed by dental practitioners. Methods and Material. Standardized periapical radiographs were made on 484 patients who received endodontic treatment in private practice. A total of 831 endodontically treated teeth with 1448 roots were evaluated for technical quality of the root canal filling and the periapical status of the teeth. Also, the apical status of each root-filled tooth was assessed according to the length, density, and taper of root fillings, and the presence of apical transportation, broken root instruments, and overfilled sealer or gutta-percha material was recorded for each root canal. Results. Of the endodontically treated teeth 26.6% had healthy periapical tissues, while technically good endodontic treatment constituted 12.8%. Based on the treatment success, there was no significant difference between the tooth groups. Statistical analysis of the data did not demonstrate statistically significant differences between the various parameters that were evaluated (P < 0.05). Conclusions. Technical quality of root fillings in a population who received treatment in private practice was poor and was consistent with a low prevalence of apical health. The probable reasons for this failure are multifactorial and may be improved if the operators improve their skills with continuing postgraduate education programs.

A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health

To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.

The effect of the gap between the post restoration and the remaining root canal filling on the periradicular status in a Turkish subpopulation

The aim of this study was to evaluate whether the gap between the post restoration and the remaining root canal filling had an impact on the periapical health of endodontically treated teeth in a Turkish subpopulation. Digital panoramic radiographs, evaluated for this cross-sectional study, were randomly selected from files of patients who attended to Yeditepe University, Faculty of Dentistry, between June 2007 and December 2008. The total number of teeth with endodontic posts and crowns was 407. Two observers assessed the radiographs and evaluated the quality of root canal filling and the gap between the root canal filling and the post restoration. Periapical status of the teeth was assessed by the Periapical Index (PAI) scores. Only the teeth with a minimum of 5 mm apical root canal filling that was classified as "good endodontic treatment" were included in the study. Teeth that had no root canal filling, poor endodontic treatment, or less than 5 mm remaining root canal filling beyond post restoration were not assessed. Chi-square test was used for statistical analysis and significance level was established at 5%. In cases with good endodontic treatment, there were 207 teeth that had no gap between the remaining root canal filling and the post restoration. In this group, 135 (65%) teeth had healthy periapex and 72 (35%) teeth showed signs of apical periodontitis. There were 81 teeth that had a gap between the remaining root canal filling and the post restoration. Of these teeth, 69 (85%) had periapical pathosis; however, only 12 (15%) teeth had healthy periapex. Statistical analysis revealed that the success rate of good endodontic treatment was significantly affected by the gap between the post restoration and remaining root canal filling (P < .001).

Periapical Status and Quality of Root canal Fillings and Coronal Restorations in Iranian Population.

This cross-sectional survey determined the dental prevalence of apical periodontitis (AP) in selected Iranian population, and evaluated the influence of the quality of root canal treatment (RCT) and their coronal restorations (CR) on the periapical status. A total of 1064 panoramic radiographies were evaluated by two observers during 2009. The quality of RCT i.e. length/density of root fillings and CR in addition to periapical status of endodontically treated teeth were recorded. Their interrelationship was analyzed by Chi-squared, logistic regression and Spearman's rho statistics. Hosmer and Lemeshow tests were used for assessing fitness of logistic regression model and one sample k-s test was used for evaluating of normality of the data. Our results showed that 527 teeth (52%) of the endodontically treated teeth presented with AP radiographically. The percentages of teeth which fulfilled the criteria of an acceptable RCT or CR radiographically were 42.3 and 62.5 respectively. Incidence of AP among teeth with acceptable RCT (29.1%) was significantly lower than those suffering from unacceptable RCT (68.8%) (P<0.001). Moreover, adequate CR demonstrated a significantly better periapical status (58.6%) compared to teeth with inadequate CR (30.3%) (P<0.001). The incidence of AP ranged from 25.6% (good qualities) to 79.5% (bad qualities) (P<0.001). Cases with both unacceptable RCT/CR were 11 times more likely to have AP than cases with acceptable RCT/CR. The quality of RCT and CR were found to impact the periapical health of endodontically treated teeth. There are a significant high number of technically unacceptable endodontic and restorative treatments in Iran; therefore considerable efforts are needed to improve the standards of endodontic and restorative treatments.

WITHDRAWN: Clinical Evaluation of Restoration Quality in Studies Assessing the Influence of the Coronal Seal on Periapical Health

WITHDRAWN: Clinical Evaluation of Restoration Quality in Studies Assessing the Influence of the Coronal Seal on Periapical Health

Periapical health related to the type of coronal restorations and quality of root canal fillings in a Turkish subpopulation

The purpose of this study was to evaluate the relationship between the quality of root canal fillings and type of permanent coronal restorations and their association with the periapical status in a Turkish subpopulation. There were 1268 endodontically treated teeth from 280 panoramic radiographs that were evaluated. Two observers assessed the radiographs using an x-ray viewer with 2 times magnification. Teeth were classified according to the type of restorations. The quality of root canal fillings were evaluated according to the criteria determined by Tronstad et al. Apical status was assessed by the Periapical Index scores (PAI) proposed by Ørstavik et al. Chi-square test was used for statistical analysis. There were 59.5% of endodontically treated teeth that showed healthy periapex. Teeth with good endodontic treatment showed statistically significant high healthy periapex rates regardless of the type of the restoration. In addition, the evaluation of the entire material also showed that the roots with posts had significantly more periapical pathosis than roots without posts (P = .001). It can be concluded that, although the quality of the root canal filling plays a key role in the outcome of endodontic therapy, the type of restoration can also be a contributing factor in the treatment outcome.

Management of an unerupted dilacerated maxillary central incisor: a case report

A case with a dilacerated maxillary permanent central incisor, treated with forced eruption technique is illustrated and the results of the 4-year follow up are presented. After the successful eruption of the tooth, the root development was completed and the root canal was obliterated. The 4-year follow-up results revealed the tooth to be still functional and the radiographic evaluation showed that the periodontal and periapical tissues were intact and healthy. In conclusion, the impacted dilacerated incisor diagnosed in the early mixed dentition should be treated with the aid of orthodontic traction. The long-term follow up showed that once the tooth is placed in the occlusion properly, it may function well esthetically and preserve its periodontal and periapical health.

Er:Yag laser irradiation of the microbiological apical biofilm

One problem in cases of healing-resistant periapical lesions is to eradicate the contamination at the periapical area. This contamination is due to the microbiological biofilm formed by microorganisms and their subproducts lodged in apical third of the root, on both cementum and dentin surface. Paraendodontic surgery consists of the mechanical removal of harmful agents to promote healing and periapical health. The purpose of this study was to assess the results of Er:YAG laser irradiation on the apical root third of newly extracted teeth to eliminate microbial contamination on root apex surface. Apical irradiation was performed with an Er:YAG laser device using an experimental contact tip, at 100 mJ, 10 Hz, 1 W, 39 J/cm(2), 3 times on the target area. SEM analysis showed the elimination of part of the irradiated cementum and the formation of small roughened without exposing the subjacent dentin. Vaporization of the remaining periodontal tissue and removal of microbiological apical biofilm (MAB) were also observed on the irradiated areas. Under the tested conditions and based on the findings of this study, Er:YAG laser may be considered effective for removal of microbiological apical biofilm.

Socio-economic risk indicators for apical periodontitis

Objective. The aim of this study was to reveal possible socio-economic risk indicators for apical periodontitis. Material and Methods. In 1992–93 a representative sample of women in Göteborg, Sweden, aged 38–84 years, participated in a medical and dental survey (n=981) which included dental and medical examinations and dental radiographic examination (OP). The dependent variable was apical periodontitis (AP = 0, AP > 0). The independent variables were age, number of teeth, number of restored teeth, number of root-filled teeth, number of teeth with carious lesions, satisfactory masticatory function, and dental esthetics as crude measures of self-reported dental health, dental anxiety, time elapsed since last visit to a dental office, regular dental visiting habits, smoking, alcohol habits, and marital status. A subjective evaluation of economy, health and life situation (acceptable or poor) was accounted for as socio-economic variables. The oldest age group, women born 1908, and edentulous individuals were omitted, leaving 844 subjects for analysis. Statistical analysis included multivariate logistic regression, chi-squared test, and independent t-test for comparison of group characteristics (AP = 0 vs AP > 0). Results. For socio-economic variables there was a significant association between acceptable health and apical periodontitis (OR = 1.72 (CI = 1.09–2.70)). For oral-related variables, root-filled teeth (OR = 1.17 (CI = 1.10–1.23)) and teeth with carious lesions (OR = 1.48 (CI = 1.19–1.85)) were predictive of apical periodontitis. Conclusions. In the present study, socio-economic variables and dental visiting habits did not appear to have obvious implications for periapical health, whereas root-filled teeth and carious lesions were associated with apical periodontitis.

A comparative analysis of periapical health based on historic and current data

To compare periapical health using samples from prehistoric and historic periods until the present day, and to emphasize the major risk indicators for apical periodontitis (AP). A comparative survey to assess periapical health was performed on five samples (525 individuals) drawn from different periods of history within the time frame 2000 BC to 2000 AD. Twenty-one binary risk indicators for AP were retained for a logistic regression model. The probability of a diseased tooth was defined from a two-level response variable based on the periapical index (PAI). An individual regression model was computed with partial least squares (PLS) regression model, based on the individual mean values of the nine retained risk indicators. Condensing osteitis, tooth wear, caries, root fillings and the presence of inadequate root fillings were associated with the PAI levels. The maxillary molars and recent time periods (contemporaneous and seventeenth century) were also risk indicators for the pathological condition. The PLS regression for individuals demonstrated correlations between risk factors. This multidimensional analysis indicated that the mean PAI was correlated mainly with caries and condensing osteitis. Condensing osteitis was more frequent in the mandibular than in the maxillary bone (P=0.001), and correlated with tooth wear in ancient periods. This comparative analysis demonstrated a significantly higher prevalence of AP in the contemporary period. The most important risk indicators for that period were the presence of inadequate root fillings, carious lesions and condensing osteitis.

A 24‐year follow‐up of root filled teeth and periapical health amongst middle aged and elderly women in Göteborg, Sweden

To describe the endodontic status amongst middle-aged and elderly women longitudinally and cross-sectionally over 24 years. A random sample of 1462 women 38, 46, 50, 54 and 60 years old, living in Göteborg, Sweden, were sampled in 1968 for medical and dental examinations with a participation rate of 90.1%. The same women were re-examined in 1980 and 1992 together with new 38- and 50-year-old women. The dental examination consisted of questionnaires, clinical and panoramic radiological survey (OPG). The number of teeth, number of root filled teeth (RF) and number of teeth with periapical radiolucencies (PA) were registered. The RF and PA ratios were calculated. Cross-sectional data were analysed by means of anova and longitudinal data by a general linear model for repeated measures. Sample prevalences were compared and statistical inferences were made with the chi-squared test. In all analysis, the confidence interval (CI) regarded mean difference between groups (95% CI). The RF and PA ratio decreased over time as well as the frequency of edentulous subjects. Cross-sectional analysis revealed a minor increase in frequency of RF and PA and loss of teeth with age. Longitudinally, loss of teeth was evident in all cohorts. In addition, there was a trend of lower number of teeth with PA, and the RF ratio increased with age. The prevalence of periapical disease did not increase with age, probably as a result of root canal treatment and extractions. Data showed that the prevalence of RF teeth and teeth with PA decreased for comparable age cohorts during the 24-year follow-up.

Endodontic retreatment strategies used by general dental practitioners

Purpose Root-filled teeth with persistant periapical radiolucencies are often classified as endodontic failures. Studies have shown that general dental practitioners (GDP) do not consistantly suggest retreatment of “failures.” The “Praxis Concept” (PC) theory hypothesizes that dentists conceive periapical health and disease as different states on a continuum. This study examined endodontic retreatment concepts among 157 GDPs from Värmland, Sweden. Study design In 6 simulated cases the periapical condition, quality of root filling and presence of a root canal–retained post were systematically varied. Five options were offered: no therapy, wait and see, nonsurgical retreatment, surgical retreatment, and extraction. Results The investigation showed large interindividual variation in retreatment behavior among the GDPs. Only 9 dentists (6%) where found to repeatedly suggest retreatment of endodontic failures. A majority of GDPs (79%) performed in accordance with PC. Conclusions The data indicate that several retreatment decision rules are used by Swedish GDPs, but PC-derived strategies attract the majority.