SMILES
SPOTLIGHT
in the
Endodontic Retreatment Procedure
Conservative access to the pulp chamber through metal, porcelain, zirconia
and porcelain-fused-to-metal crowns is possible with the use of an endodontic microscope that enables advanced magnification and illumination. Metal
posts, cast posts, fiber posts, plastic or metal carriers and separated instruments are removed using ultrasonic and other micro-endodontic instruments.
Ledges and transportations from the previous treatment are overcome to
enable disinfection of the critical apical third of the canals. All endodontic
filling materials are removed and the canals are debrided and disinfected
using ultrasonic irrigation techniques. They are then obturated with gutta
percha using warm vertical condensation. The access cavity is restored
with composite and a new crown if necessary. Radiographic evidence of
healing is typically observed within 6 to 12 months of endodontic retreatment.
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Endodontic Retreatment and Apicoectomy
The success of endodontic treatment can vary from 86-97%. However,
for various reasons, endodontically treated teeth can get reinfected and
can become painful or diseased months or even years after treatment.
The leading causes of reinfection of endodontically treated teeth include:
1. Coronal microleakage – delayed placement of restoration and
crown; teeth not restored with crowns; open margins on crowns causing
salivary contamination of the root canals.
2. Complicated canal anatomy that went undetected in the initial
treatment.
3. New decay or fracture exposing the root canal filling material.
4. Fracture of the root that causes bacterial penetration into the canals.
Treatment Options
Whenever possible, it is best to save one’s natural teeth. The success
rate of endodontic retreatment ranges from 77-89%, because of
which there is substantial possibility that one may be able to save
one’s teeth from extraction even if the initial endodontic treatment
fails. The prognosis for retreatment increases exponentially when
there is an obvious cause for the failure of the initial treatment such
as the presence of missed canals or obturation that is short of the
apex. Endodontic-periodontic lesions in endodontically treated teeth
that may be commonly misdiagnosed as vertical root fractures can
also be successfully retreated.
Advances in technology are constantly changing the way root canal
treatment is performed. When using the latest technologies for
diagnosis and treatment such as cone beam computed tomography
and microscopes, high success rates for endodontic treatments and
retreatments are achievable.
18 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Pre-op x-ray: Two buccal
sinus tracts leading to the
mesial and distal root
apices of tooth #30, traced
with gutta percha cones
Immediate Post-op x-ray
after retreatment.
Pre-op x-ray: Evidence of missed
canals after initial endodontic treatment in tooth #18
Pre-op x-ray: Evidence of
missed canals after initial
endodontic treatment in
tooth #18
6 month Post-op x-ray:
Bone regeneration and
healing observed
Post-op x-ray: C-shaped canal;
Additional canals found and
obturated
Immediate post-op x-ray
after retreatment
6-month post-op
x-ray: Bone regeneration and healing
observed