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Endodontic retreatment can be a challenging task that can result in many complications if not approached cautiously. Many of these difficulties revolve around regaining access to the pulp chamber through extensive coronal restorations and removing residual root filling material, the commonest being gutta-percha (GP), from within obturated canals. This can often be an untidy, time consuming process that places teeth at a greater risk of iatrogenic injury and inhibits the operator achieving the necessary chemical disinfection required to eliminate the persistent apical disease. Therefore the following article aims to aid practitioners, particularly those who are unfamiliar, with accessing and removing GP from endodontically treated teeth. The outlined systematic approach is accessible in general practice, where the vast majority of endodontic treatment is conducted, requires basic equipment and with the correct experience can be applied to both straight and curved canals. By overcoming this initial stage of retreatment, subsequent chemical disinfection, which is critical to success, can be carried out to a higher standard reducing risks of re-infection.

IntroductionIntentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth in select cases. This case series demonstrates the use of IR as an alternative treatment approach to both orthograde and surgical endodontic retreatment. The indications, contraindications, benefits and risks of IR are discussed, and the clinical procedure is outlined.

Objective: To review the evidence on the most appropriate management of failed endodontic treatment.Data Sources: Appropriate articles were selected from the international literature.Results: There was good evidence that conventional endodontic treatment is associated with a successful outcome in a significant proportion of cases. The results of surgical treatment are more difficult to interpret since account should be made of the status of the existing root filling. However, there is evidence of an increased success rate with a satisfactory orthograde root filling.Conclusions: It is difficult to make direct comparisons from cited studies to advance a clear argument in support of one treatment modality. However, it is judged that a conventional endodontic retreatment approach is the most appropriate in the first instance, providing access to the root canal is possible. This does not preclude a subsequent surgical approach. Teeth that are permanently restored soon after retreatment are more successful than those which are not. There are significant challenges in setting up prospective research studies to directly address the problem of the failed root filing