EC Dental Science

Endodontic retreatment is most often necessary when the first root canal treatment fails to eradicate infection from the root canal system entirely. The essay herein elaborates on the primary reasons patients will require retreatment, including inadequate cleaning, inadequate root filling, procedural errors, and persistent infections. Success in retreatment remains challenging due to complex tooth anatomy and noncompliant microbial biofilms that are unresponsive to conventional treatment routines, typically posing additional health risks.

Current advancements in diagnostic and therapeutic technologies, such as cone-beam computed tomography (CBCT) and ultrasonic irrigation, have significantly improved accuracy and efficiency in managing complex cases. Advances in rotary instrumentation and the availability of biocompatible materials such as mineral trioxide aggregate (MTA) have also enabled more successful clinical outcomes.

While both nonsurgical and surgical retreatment are feasible, evidence suggests that nonsurgical retreatment has a better long-term success, even though both techniques have specific clinical indications. The paper concludes that adherence to evidence-based clinical guidelines and the employment of a patient-oriented approach are essential to optimizing retreatment outcomes.

Despite advancements in technology, limitations are present due to microbial resistance and root canal anatomy complexity. Therefore, research, innovation, and interdisciplinary collaboration are always necessary to continue the advancement of endodontic retreatment procedures and improve long-term prognosis, enabling the preservation of natural dentition.

 Keywords: Endodontic Re-treatment; Persistent Infections; Technological Advancements; Clinical Outcomes

1. Song M., et al. “Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery”. Journal of Endodontics11 (2011): 1516-1519.
2. Chércoles-Ruiz A., et al. “Endodontics, endodontic retreatment, and apical surgery versus tooth extraction and implant placement: a systematic review”. Journal of Endodontics5 (2017): 679-686.
3. Simon S and Wilhelm-J Pertot. “Clinical success in endodontic retreatment”. Quintessence International Editeur (2019).
4. Alghamdi F., et al. “Healing of periapical lesions after surgical endodontic retreatment: a systematic review”. Cureus2 (2020): e6916.
5. Fezai H and Al-Salehi S. “The relationship between endodontic case complexity and treatment outcomes”. Journal of Dentistry 85 (2019): 88-92.
6. Bierenkrant DE., et al. “The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontists”. International Endodontic Journal7 (2008): 561-570.
7. Ingle JI., et al. “Ingle's endodontics 6 (6^th edition)”. BC Decker (2008).
8. Gatewood RS. “Endodontic materials”. Dental Clinics of North America3 (2007): 695-712.
9. Nair PNR. “On the causes of persistent apical periodontitis: a review”. International Endodontic Journal4 (2006): 249-281.
10. Sjögren ULF., et al. “Factors affecting the long-term results of endodontic treatment”. Journal of Endodontics10 (1990): 498-504.
11. Siqueira Jr JF and Rôças IN. “Clinical implications and microbiology of bacterial persistence after treatment procedures”. Journal of Endodontics11 (2008): 1291-1301.
12. Peters OA. “Current challenges and concepts in the preparation of root canal systems: a review”. Journal of Endodontics 8 (2004): 559-567.
13. Gorni FG and Gagliani MM. “The outcome of endodontic retreatment: a 2-yr follow-up”. Journal of Endodontics1 (2004): 1-4.
14. Chong BS and Pitt Ford TR. “Root‐end filling materials: rationale and tissue response”. Endodontic Topics1 (2005): 114-130.
15. Patel S., et al. “Present status and future directions: vertical root fractures in root filled teeth”. International Endodontic Journal3 (2022): 804-826.
16. Kim S and Kratchman S. “Modern endodontic surgery concepts and practice: a review”. Journal of Endodontics7 (2006): 601-623.
17. Ng YL., et al. “A prospective study of the factors affecting outcomes of non‐surgical root canal treatment: part 2: tooth survival”. International Endodontic Journal7 (2011): 610-625.
18. Friedman S and Mor C. “The success of endodontic therapy—healing and functionality”. Journal of the California Dental Association6 (2004): 493-503.
19. Torabinejad M., et al. “Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review”. Journal of Endodontics7 (2009): 930-937.
20. de Chevigny C., et al. “Treatment outcome in endodontics: the Toronto study—phases 3 and 4: orthograde retreatment”. Journal of Endodontics 2 (2008): 131-137.
21. Setzer FC., et al. “Outcome of endodontic surgery: a meta-analysis of the literature—part 1: comparison of traditional root-end surgery and endodontic microsurgery”. Journal of Endodontics11 (2010): 1757-1765.
22. European Society of Endodontology. “Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology”. International Endodontic Journal12 (2006): 921-930.
23. Berman HL and Hargreaves KM. “Cohen's pathways of the pulp”. Twelfth Edition. Elsevier (2021).