Preserving natural dentition through endodontic retreatment
Featured Products Promotional FeaturesPosted by: Dental Design 23rd April 2023
When presented with a previously endodontically treated tooth which is failing, it’s important to consider all of the treatment options available to find an appropriate solution. In most cases, it is favourable to preserve as much of the patient’s natural dentition as possible, before considering more invasive treatment, or extraction. It is generally best to begin by considering nonsurgical options first, and if this is not appropriate for the case, move on to consider surgical treatment or extraction.[i] This will help you to preserve as much of the patient’s natural tooth as possible.
Why might an endodontically treated tooth fail?
When compared to teeth which have not been endodontically treated, teeth which have undergone root canal treatment have a lower long-term survival rate, and are more susceptible to breakage.[ii] Root canal treatment can preserve the natural tooth structure for around 8 to 10 years.[iii] This allows the patient to preserve the longevity of their natural dentition, removing only the infected tissue. However, if there is a failure during the first procedure, the tooth becomes re-infected, or a tooth or crown sustains a fracture, the tooth is likely to require further restorative treatment of some kind.
Before going forward with any treatment, it is important to consider all of the appropriate options – including the time required, the expense of treatment, prognosis of the tooth, and the impact of each treatment type on patient satisfaction.i These should be discussed with patients to ensure they understand the potential solutions and which you believe to be the best option. Patients should also understand that the survival of any root treated tooth is dependent on their oral hygiene, the amount of natural dentition remaining, and the biting forces on the tooth (as it will be more susceptible to fracture).iii
Endodontic retreatment as a conservative approach
When well executed, nonsurgical endodontic retreatment is often the ideal option for conservative restorative dentistry.i It requires minimal intervention, simply removing the existing filling material and restoring the tooth. This can provide patients with aesthetic and functional results while allowing them to avoid extraction – prolonging the life of their tooth. During nonsurgical endodontic retreatment, materials should be removed from the canals, and any issues within the tooth should be addressed during this time.i Retreatment is also useful as it provides an opportunity to identify any mechanical issues, any canals which were previously missed and any fractures – allowing clinicians to address these issues accordingly during treatment.i
When it comes to removing gutta-percha, there are several factors that should be taken into account which may influence the difficulty. These include the techniques used to fill the canals in the initial treatment, as well as the length and curvature of the root canals. Generally, it is recommended to remove filling material in stages, beginning with the coronal third, then middle, then apical third. This gradual technique helps to avoid irritation caused by dislodged material. It is important to decide on technique on a case-by-case basis however, as for some straighter canals, it may be appropriate to remove filling material in one motion using a single instrument. It may be useful to use preoperative imaging to help you to decide on your approach, it allows you to assess the size of canals – and be prepared to use a combination of approaches to enable you to achieve the best outcomes.i
Choosing the right tools
For best results, using a minimally invasive approach which allows you to preserve as much dental tissue as possible is preferable to maintain optimal strength and therefore longevity of the restoration. This requires the careful removal of existing gutta-percha, removing any infected tissue and meticulous cleaning of the root canals. In doing this, ensure you are using the appropriate instruments so as not to damage the tooth, or create steps in the canal while recontouring.
The HyFlex™ Remover from COLTENE as an essential instrument for successful endodontic retreatment. It mechanically removes gutta-percha material from the root canals, without the use of solvent and safely, thanks to the non-cutting tip which respects the root canal anatomy. The removal of filling material requires only one file, allowing you to proceed with canal re-shaping and retreatment. For best results complete root canal preparation using the HyFlex™ EDM shaping files, which are appropriate for use in all cases, including extremely curved canals.
It is important to plan endodontic retreatment considering a variety of treatment options. By assessing which methods are most appropriate for your patients and which would offer the best functionality. Nonsurgical endodontic retreatment offers the unique option to preserve patients’ teeth, enabling them to extend the life of their natural dentition, delaying any need for extraction. When performed with skill, and the use of quality equipment, endodontic treatment is a foundation of conservative restorative dentistry.
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
Author: Mark Allen, General Manager at COLTENE
[i] Ruddle, Clifford J. “Nonsurgical endodontic retreatment.” CDA Journal (2004): 1-14. https://static.theruddleshow.com/pdf-library/1607468884/114/NSRCTOverview_Jun2004.pdf
[ii] Mandil, Obada A., et al. “Modern versus traditional endodontic access cavity designs.” Journal of Pharmacy And Bioallied Sciences 14.5 (2022): 24.
https://www.jpbsonline.org/article.asp?issn=0975-7406;year=2022;volume=14;issue=5;spage=24;epage=27;aulast=Mandil
[iii] NHS. Root canal treatment – How is it performed. (Accessed 09.11.22) https://www.nhs.uk/conditions/root-canal-treatment/what-happens/
