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Endodontic surgery. Part 2: surgical root canal re-treatment

From Volume 49, Issue 11, December 2022 | Pages 880-887

Authors

Robert Smith

BDS, MSc, MFDS RCS, MFDTEd, BDS, MSc, MEndoRCS, MFDS RCS, FDTFEd

Enhanced Practitioner, Defence Primary Healthcare (Dental), Defence Centre for Rehabilitative Dentistry

Articles by Robert Smith

Email Robert Smith

Graeme Bryce

BDS, MSc, MEndoRCS, MRD RCPSG, FDS (Rest Dent), FFDT, BDS, MSc, MEndoRCS, MRD RCPSG, FDS (Rest Dent), FDTFEd

Consultant in Restorative Dentistry, Centre for Restorative Dentistry, Defence Primary Health Care (Dental), Evelyn Woods Road, Aldershot, GU11 2LS

Articles by Graeme Bryce

Geoffrey St George

BDS, DGDP (UK), MSc, FDS RCS, FDS (Rest Dent)

Consultant in Restorative Dentistry

Articles by Geoffrey St George

Poonam Kalsi

BDS (Hons), MSc, MJDF RCS, FDS (Rest Dent)

Consultant in Restorative Dentistry, Guy's and St Thomas' NHS Foundation Trust, London

Articles by Poonam Kalsi

Abstract

Surgical root canal re-treatment (SRCReT), or root-end surgery, is the most commonly undertaken surgical endodontic technique. Approaches to SRCReT differ, with a variety of different protocols described and varied success rates reported. In the second part of this two-part series, the current scientific literature is examined and clinical examples are given to offer guidance for the optimal protocol for SRCReT.

CPD/Clinical Relevance: SRCReT is a procedure which may facilitate the treatment of disease of endodontic origin which is not amenable to management with orthograde non-surgical root canal treatment.

Article

In Part 1 of this series, a general overview of endodontic surgery was discussed. The second article evaluates the optimal way to perform SRCReT, the commonest endodontic surgical procedure, which is a long-established method of treatment for apical periodontitis when conventional root canal treatment (RCT) has failed and non-surgical root canal re-treatment (NSRCReT) is impractical.1 As discussed in Part 1, SRCReT success rates are reported to range between 37% to over 90%1–5 with a number of general and local factors responsible for this wide variation. A strict surgical protocol improves the prognosis of treatment.4,6 Guidelines for the provision of SRCReT (American Association of Endodontists, British Endodontic Society Quality Guidelines, Royal College of Surgeons of England) are generic and do not adequately detail or illustrate their proposed approaches. This article uses published scientific literature to produce a protocol for SRCReT, with inferences drawn that can be applied to other endodontic surgical techniques.

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