References

Darcey J, Taylor C, Roudsari RV Modern endodontic principles. Part 3: preparation. Dent Update. 2015; 42:810-822 https://doi.org/10.12968/denu.2015.42.9.810
Bonsor SJ Disinfection of the root canal system: what should the protocol be?. Dent Update. 2021; 48:836-844 https://doi.org/10.12968/denu.2021.48.10.836
Burns LE, Kim J, Wu Y Outcomes of primary root canal therapy: an updated systematic review of longitudinal clinical studies published between 2003 and 2020. Int Endod J. 2022; 55:714-731 https://doi.org/10.1111/iej.13736
Kakehashi S, Stanley HR, Fitzgerald RJ The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol. 1965; 20:340-349 https://doi.org/10.1016/0030-4220(65)90166-0
Krmpotic M, Macan D, Skrlin J, Peric B A microbiological study of periapical lesions in single rooted teeth with open and closed root canal. Int J of Oral Sci and Dent Med. 2002; 36:375-379
Narayanan LL, Vaishnavi C Endodontic microbiology. J Conserv Dent. 2010; 13:233-239 https://doi.org/10.4103/0972-0707.73386
Teles AM, Manso MC, Loureiro S Microorganisms: the reason to perform endodontics. In: Mendez-Vilas A (eds). : Formatex; 2013
British Endodontic Society, Royal College of Surgeons. Guidelines for periradicular surgery. 2020. www.rcseng.ac.uk/-/media/files/rcs/fds/publications/periradicular_surgery_guidelines_2020.pdf (accessed November 2024)
Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006; 39:921-930 https://doi.org/10.1111/j.1365-2591.2006.01180.x
Nair PN On the causes of persistent apical periodontitis: a review. Int Endod J. 2006; 39:249-281 https://doi.org/10.1111/j.1365-2591.2006.01099.x
Segura-Egea JJ, Cabanillas-Balsera D, Martín-González J, Cintra LTA Impact of systemic health on treatment outcomes in endodontics. Int Endod J. 2023; 56:219-235 https://doi.org/10.1111/iej.13789
Ng YL, Mann V, Rahbaran S Outcome of primary root canal treatment: a systematic review of the literature – Part 2. Influence of clinical factors. Int Endod J. 2008; 41:6-31 https://doi.org/10.1111/j.1365-2591.2007.01323.x
Stankiewicz N, Wilson P The ferrule effect. Dent Update. 2008; 35:222-228 https://doi.org/10.12968/denu.2008.35.4.222
Ramachandra SS, Gupta VV, Woodford V, Malhotra N Isolated periodontal pockets: a clinical review. Dent Update. 2023; 50:618-624 https://doi.org/10.12968/denu.2023.50.7.618
McDonald A, Setchell D Developing a tooth restorability index. Dent Update. 2005; 32:343-348 https://doi.org/10.12968/denu.2005.32.6.343
Dawood A, Patel S The Dental Practicality Index – assessing the restorability of teeth. Br Dent J. 2017; 222:755-758 https://doi.org/10.1038/sj.bdj.2017.447
Patel S, Kanagasingam S, Mannocci F Cone beam computed tomography (CBCT) in endodontics. Dent Update. 2010; 37:373-379 https://doi.org/10.12968/denu.2010.37.6.373
Ordinola-Zapata R, Noblett WC, Perez-Ron A Present status and future directions of intracanal medicaments. Int Endod J. 2022; 55:613-636 https://doi.org/10.1111/iej.13731
Royal College of Surgeons of England. Restorative dentistry. Index of treatment need. Complexity assessment. www.rcseng.ac.uk/-/media/files/rcs/fds/publications/complexityassessment.pdf?la=en (accessed November 2024)
British Endodontic Society. Case assessment tool. https://britishendodonticsociety.org.uk/professionals/bes_case_assessment_tool.aspx (accessed November 2024)
Nair PN On the causes of persistent apical periodontitis: a review. Int Endod J. 2006; 39:249-281 https://doi.org/10.1111/j.1365-2591.2006.01099.x
Carrotte PV Current practice in endodontics: 3. Access is success, and rubber dam is easy. Dent Update. 2000; 27:436-440 https://doi.org/10.12968/denu.2000.27.9.436
Krasner P, Rankow HJ Anatomy of the pulp-chamber floor. J Endod. 2004; 30:5-16 https://doi.org/10.1097/00004770-200401000-00002
Bonsor SJ Disinfection of the root canal system: what should the protocol be?. Dent Update. 2021; 48:836-844 https://doi.org/10.12968/denu.2021.48.10.836
Lin PY, Huang SH, Chang HJ, Chi LY The effect of rubber dam usage on the survival rate of teeth receiving initial root canal treatment: a nationwide population-based study. J Endod. 2014; 40:1733-1737 https://doi.org/10.1016/j.joen.2014.07.007
Edwards D, Dowling N, Gemmell A, Bonsor SJ Re-endodontic treatment. part 2: How?. Dent Update. 2023; 50:740-748 https://doi.org/10.12968/denu.2023.50.9.740
Richardson N, Mordan NJ, Figueiredo JA Microflora in teeth associated with apical periodontitis: a methodological observational study comparing two protocols and three microscopy techniques. Int Endod J. 2009; 42:908-921 https://doi.org/10.1111/j.1365-2591.2009.01594.x
Ordinola-Zapata R, Noblett WC, Perez-Ron A Present status and future directions of intracanal medicaments. Int Endod J. 2022; 55:613-636 https://doi.org/10.1111/iej.13731
Chong BS, Pitt Ford TR The role of intracanal medication in root canal treatment. Int Endod J. 1992; 25:97-106 https://doi.org/10.1111/j.1365-2591.1992.tb00743.x
Ayon F, Vieyra J, Martinez V Non-surgical endodontic retreatment of extensive periapical lesion. International Dentistry. 2015; 9:28-33
Darcey J, Taylor C, Roudsari RV Modern endodontic planning part 2: access and strategy. Dent Update. 2015; 42:709-178 https://doi.org/10.12968/denu.2015.42.8.709
Mergoni G, Ganim M, Lodi G Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. 2022; 12 https://doi.org/10.1002/14651858.CD005296.pub4
Yen C, Pawar K Significance of apical patency in endodontics: a narrative review. Dentistry. 2021; 11
Ajina M, Billis G, Chong BS The effect of glide path preparation on root canal shaping procedures and outcomes. Eur Endod J. 2022; 7:92-105 https://doi.org/10.14744/eej.2022.97659
Darcey J, Roudsari RV, Jawad S Modern endodontic principles. Part 5: obturation. Dent Update. 2016; 43:114-126 https://doi.org/10.12968/denu.2016.43.2.114

Management of Persistently Symptomatic Teeth in Primary Root Canal Treatment: Advice on Maximizing Successful Outcomes

From Volume 51, Issue 11, December 2024 | Pages 756-765

Authors

Menna Shykhon

BDS, MFDS (RCS Ed),Dental Core Trainee; Birmingham Dental Hospital

Articles by Menna Shykhon

Email Menna Shykhon

David Green

BDS (Hons) BSc (Hons) MSc (Res) MFDS RCS (Ed) MRD (Prostho) RCS (Eng) FDS (Rest)

BDS(Hons) BSc(Hons) MSc(Res) MFDS RCS (Ed) MRD Pros RCS (Eng) FDS (Rest Dent) RCS, Specialist in Prosthodontics, Consultant in Restorative Dentistry and Associate Professor in Restorative Dentistry; Birmingham Dental Hospital

Articles by David Green

Philip Lumley

BDS, MDentSci, PhD, FDS RCPS

BDS, FDSRCPS, MDentSc, PhD, FDS RCS, FDSRCS, Professor of Endodontology and Honorary Consultant in Restorative Dentistry; Birmingham Dental Hospital

Articles by Philip Lumley

Abstract

The aim of root canal treatment is chemo-mechanical debridement of the root canal system to promote healing. Root canal treatment is a predictable modality in the treatment of apical periodontitis; however, there are situations during primary root canal treatment where signs and symptoms persist despite repeated chemo-mechanical disinfection. This article highlights such situations and offers practical solutions on how to minimize them.

CPD/Clinical Relevance:

Understanding the possible causes of a persistently symptomatic tooth during treatment may allow for appropriate management.

Article

The aim of root canal treatment is chemo-mechanical debridement of the root canal system to promote apical healing. Root canal treatment has key sequential clinical stages, commencing by accessing the root canal system to locate the canals, while also ensuring all pulpal tissue is removed. The root canal is subsequently instrumented and shaped, with a variety of instruments including hand-files and rotary nickel–titanium (NiTi) files. Mechanical shaping of the root canal facilitates irrigation towards the apical region of the canals, while also allowing for more controlled and efficient obturation.1 Chemical disinfection with irrigants such as sodium hypochlorite may allow the microbial load to be reduced, facilitating the healing process and aiming to prevent further re-infection.2 The complete process of chemo-mechanical disinfection can be performed in a single visit, or over multiple visits, with placement of an intra-canal medicament between appointments.

Register now to continue reading

Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Up to 2 free articles per month
  • New content available