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This narrative review considers the common clinical dilemma of choosing from non-surgical root canal re-treatment (NSRCreT), surgical root canal re-treatment or dental extraction. While orthograde root canal treatment is generally successful, cases with unresolved symptoms or persistent infection prompt the need for orthograde root canal re-treatment or surgical intervention. The latter involves microsurgery, reserved for suitable cases. Deciding on the appropriate treatment requires a holistic understanding of the patient, the existing dentition and specific tooth factors. This article discusses insights into decision-making, fostering optimal endodontic care and successful treatment outcomes.
CPD/Clinical Relevance: Knowledge of current recommendations regarding non-surgical root canal re-treatment, extraction or referral for apical surgery is useful knowledge.
Article
Endodontics has seen recent advances in equipment, materials and techniques for non-surgical and surgical approaches, resulting in improved outcomes and altering considerations for different treatment options. Selecting the appropriate treatment requires a comprehensive evaluation of the patient's clinical signs and symptoms, as well as considering the ‘bigger picture’, with factors including tooth anatomy, restorative status, periodontal condition, and systemic health all influencing decision-making. This article addresses a common clinical dilemma: determining when to consider non-surgical root canal re-treatment (NSRCreT); refer patients for endodontic surgery; or extract a tooth.
Root canal treatment is highly successful for managing peri-radicular pathologies related to an infected root canal system, with up to 96% of cases resolved with primary, non-surgical root canal treatment alone.1 However, there are cases where initial treatment fails to resolve symptoms or eliminate infection. This leaves practitioners with the decision to either perform non-surgical root canal re-treatment, extract the tooth or refer for surgical intervention. NSRCreT involves revisiting the root canal system to address persistent symptoms and eliminate residual infection. Where the cause of failure is clear, this may be achievable in a general practice setting, but may sometimes require more advanced clinical techniques.2,3
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