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References

Ng Y-L, Mann V, Rahbaran S, Lewsey J, Gulabivala K Outcome of primary root canal treatment: systematic review of the literature – Part 1. Effects of study characteristics on probability of success. Int Endod J. 2007; 40:(12)921-939
Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006; 39:921-930
Ørstavik D Time-course and risk analyses of the development and healing of chronic apical periodontitis in man. Int Endod J. 1996; 29:(3)150-155
Nair P On the causes of persistent apical periodontitis: a review. Int Endod J. 2006; 39:(4)249-281
Byström A, Happonen R-P, Sjögren U, Sundqvist G Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis. Dent Traumatol. 1987; 3:(2)58-63
Siqueira JF, Rôças IN Present status and future directions in endodontic microbiology. Endod Topics. 2014; 30:(1)3-22
Ramachandran Nair P, Pajarola G, Schroeder HE Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81:(1)93-102
Hancock H, Sigurdsson A, Trope M, Moiseiwitsch J Bacteria isolated after unsuccessful endodontic treatment in a North American population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91:(5)579-586
Tronstad L, Barnett F, Riso K, Slots J Extraradicular endodontic infections. Endod Dent Traumatol. 1987; 3:(2)86-90
Ng Y-L, Mann V, Rahbaran S, Lewsey J, Gulabivala K Outcome of primary root canal treatment: systematic review of the literature – Part 2. Influence of clinical factors. Int Endod J. 2008; 41:(1)6-31
Gorni FG, Gagliani MM The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004; 30:(1)1-4
De Deus QD, Horizonte B Frequency, location, and direction of the lateral, secondary, and accessory canals. J Endod. 1975; 1:(11)361-366
Bandlish R, McDonald A, Setchell D Assessment of the amount of remaining coronal dentine in root-treated teeth. J Dent. 2006; 34:699-708
Abbott P Incidence of root fractures and methods used for post removal. Int Endod J. 2002; 35:(1)63-67
Ng YL, Gulabivala K, Mann V A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 1 periapical health. Int Endod J. 2011; 44:583-609
Andreasen JO, Munksgaard EC, Bakland LK Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA. Dent Traumatol. 2006; 22:(3)154-156
Murray PE, Garcia-Godoy F, Hargreaves KM Regenerative endodontics: a review of current status and a call for action. J Endod. 2007; 33:(4)377-390
Darcey J, Qualtrough A Resorption: part 1. Pathology, classification and aetiology. Br Dent J. 2013; 214:(9)439-451
Tabiat-Pour S, Roberts A, Harrison R, Chapple I Restorative planning for hemisection surgery: a technique report. Perio Practice Today. 2007; 4:(3)215-219
Guidelines on CBCT for Dental and Maxillofacial Radiology.
Velvart P, Ebner-Zimmermann U, Pierre Ebner J Papilla healing following sulcular full thickness flap in endodontic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98:(3)365-369
Velvart P Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery. Int Endod J. 2002; 35:(5)453-460
Rubinstein RA, Kim S Short-term observation of the results of endodontic surgery with the use of a surgical operation microscope and Super-EBA as root-end filling material. J Endod. 1999; 25:(1)43-48
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Modern endodontic principles part 6: managing complex situations

From Volume 43, Issue 3, April 2016 | Pages 218-232

Authors

Carly Taylor

BDS, MSc, MFGDP, FHEA

Clinical Lecturer/Honorary Specialty Registrar in Restorative Dentistry, Dental School, University of Manchester

Articles by Carly Taylor

Reza Vahid Roudsari

DDS, MFDS, MSc, PGCert(OMFS)

Clinical Lecturer/Honorary Specialty Registrar in Restorative Dentistry, Dental School, University of Manchester

Articles by Reza Vahid Roudsari

Sarra Jawad

BDS, BSc, MFDS

Specialty Registrar/Honorary Clinical Lecturer in Restorative Dentistry, University Dental Hospital of Manchester

Articles by Sarra Jawad

James Darcey

BDS, MSc, MDPH, MFGDP, MEndo, FDS(Rest Dent)

Consultant and Honorary Clinical Lecturer in Restorative Dentistry, University Dental Hospital of Manchester

Articles by James Darcey

Alison Qualtrough

BChD, MSc, PhD, FDS MRD, BChD, MSc, PhD, FDS, MRD (RCS Edin)

University Dental Hospital of Manchester

Articles by Alison Qualtrough

Abstract

Clinicians are often faced with endodontic cases that are significantly more challenging than the primary root canal treatment of mature adult teeth. This paper outlines some of the common treatment modalities which can be employed in situations in which either primary treatment has failed, or there is iatrogenic damage or unusual anatomy.

CPD/Clinical Relevance: This paper will provide the reader with advice and techniques for undertaking orthograde endodontic retreatment, hemisection, endodontic surgery and management of teeth with incompletely formed roots.

Article

Primary endodontic treatment is not always successful.1 Teeth which are no longer painful but, after root canal treatment, have a persisting periapical radiolucency or draining sinus may be considered to have ‘survived’. When there is persistent periapical disease and symptoms, treatment is said to be at best unfavourable and at worst to have failed. However, when teeth become symptomatic the clinician must consider intervention, be it via root canal treatment or extraction.

It is essential to consider the time that has elapsed since the root canal treatment was undertaken; healing takes time. Though the ESE recommends monitoring for 4 years,2 evidence suggests that healing will most likely occur within two years of treatment.3 Serial radiographs are essential and patients must be counselled that a treatment may not have failed, especially if a lesion persists but has diminished in size.

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