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References

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Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol. 1984; 58:589-599 https://doi.org/10.1016/0030-4220(84)90085-9
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Ng YL, Mann V, Gulabivala K. Outcome of secondary root canal treatment: a systematic review of the literature. Int Endod J. 2008; 41:1026-1046 https://doi.org/10.1111/j.1365-2591.2008.01484.x
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Metzger ZV, Solomonov M, Kfir A. The role of mechanical instrumentation in the cleaning of root canals. Endod Topics. 2013; 29:87-109
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Re-endodontic Treatment. Part 2: How?

From Volume 50, Issue 9, October 2023 | Pages 740-748

Authors

David Edwards

BDS(Hons), MSc(RestDent), MFDS RCS(Ed), MFDTEd, PGDipRestDent RCS(Eng), PGDipConSed, PGCertMedEd, PGDipClinRes, FHEA

Newcastle Dental Hospital

Articles by David Edwards

Nisha Dowling

BDS MFDS RCS(Glas)

Newcastle Dental Hospital

Articles by Nisha Dowling

Email Nisha Dowling

A Gemmell

Practice Principal, Kingston Park Advanced Dentistry, Newcastle upon Tyne

Articles by A Gemmell

Stephen J Bonsor

BDS(Hons) MSc FHEA FDS RCPS(Glasg) FDFTEd FCGDent GDP

The Dental Practice, 21 Rubislaw Terrace, Aberdeen; Hon Senior Clinical Lecturer, Institute of Dentistry, University of Aberdeen; Online Tutor/Clinical Lecturer, University of Edinburgh, UK.

Articles by Stephen J Bonsor

Abstract

Where primary root canal treatment has failed, case selection is critical. If the reason for failure can be identified and overcome, then this is the main aim of re-treatment. The second of this two-part series discusses ways in which failed cases can be predictably re-treated, using a series of cases to illustrate key points.

CPD/Clinical Relevance: Root canal re-treatment can offer a predictable treatment option with awareness of common pitfalls..

Article

Part 1 of this series discussed potential reasons for endodontic failure and introduced the concept of assessing teeth to determine whether they should be considered for conventional root canal re-treatment, peri-radicular microsurgery or extraction.1 Part 2 now expands this discussion around pre-operative assessment and introduces techniques commonly used for re-endodontic treatment.

Where a decision is made to undertake non-surgical re-treatment, additional assessment is required. Case selection is essential to providing predictable treatment and obtaining informed consent, with appropriate discussion of risks and benefits. It is essential to ascertain why the root canal treatment (RCT) has failed,1 and whether this can be addressed by further treatment. The following questions should be considered.

Irrespective of technical shortfalls, anatomical complexities or iatrogenic errors, restorability of the tooth must be considered before investing clinician and patient time and resources. The dental practicality index (DPI)2 can be a useful tool to aid decisions regarding restorability and explaining these to patients. This assesses the structural integrity of the tooth, periodontal stability, endodontic need and other contextual factors, such as overall restorative needs, social, dental and medical factors. The DPI has been validated, being shown to predict the likely outcome of RCT.3 A first step may be the removal of existing restorations as part of the assessment of restorability, which may identify the reason for failure and critically, the restorability of the tooth. Caries, cracks and marginal breakdown are much more likely to be identified following restoration removal. For example, caries has been identified pre-operatively in 19.2% of teeth, whereas following restoration removal this increased to 86.1%.4 Furthermore, restoration removal will permit direct visualization of subgingival margins enabling a decision between extraction, marginal elevation5 or the ability to place an indirect restoration margin, as well as assessment of ferrule6 and better visualization of angulation for access.

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