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
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
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
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
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
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
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
Management of Persistently Symptomatic Teeth in Primary Root Canal Treatment: Advice on Maximizing Successful Outcomes Menna Shykhon David Green Philip Lumley Dental Update 2025 51:11, 707-709.
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.
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