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Endodontide basarisiz kok kanal tedavisinin duzeltilme- si, tekrarlayan tedavi olarak tanimlanmaktadir. Kanal tedavisi uygulandiktan sonra gecmeyen agri veya semptom gelisen dislerde, mevcut kanal dolgusunun teknik olarak yetersiz oldugu durumlarda, ve iyiles- meyen periapikal radyolusensi varliginda tekrarlayan kok kanal tedavisi dusunulebilir. Dogru teshis konul- dugunda ve tum teknik imkânlar dikkatlice kullanil- diginda konservatif tekrarlayan tedavi, yuksek basari gosterebilmektedir. Tekrarlayan tedavi icin gelistirilmis bircok Ni-Ti alasimi iceren doner alet sistemi bulun- maktadir. Bu calismada Erciyes Universitesi Dis Hekim- ligi Fakultesine basvuran iki hastada ProTaper Univer- sal Retreatment Sistem ile yapilan tekrarlayan kok kanal tedavileri ve uc yillik takipleri sunulmus ve ba- sarili sonuclar elde edilmistir. Anahtar Kelimeler: ProTaper Universal Retreatment sistem, kanal tedavisi yenileme, guta perka ENDODONTIC RETREATMENT WITH PROTAPER UNIVERSAL RETREATMENT SYSTEM AND THREE-YEARS FOLLOW UP: TWO CASE REPORTS ABSTRACT Improvement of failed root canal treatment is defined as retreatment, in endodontics. Retreatment is applied to teeth with chronic pain and symptoms after root canal treatment, or when root canal filling is technically insufficient, and when there is non-healing periapical radiolucency. If diagnosis is right and all the techniques are used carefully, conservative retreat- ment will be successful. There are lots of Ni-Ti rotary systems developed for retreatment. This study presents the three years follow-up of the retreatment cases with ProTaper Universal Retreatment system conducted on two patients who applied to the Erciyes University, Faculty of Dentistry; and obtained successful results. Keywords: ProTaper Universal Retreatment system, retreatment, gutta percha

Bu vaka raporu ekstra bir kanal ve meziodistal fraktür hattına sahip üst birinci küçük azı dişinin başarılı bir kök kanal tedavisi yenilemesini sunmaktadır. Üst birinci küçük azı dişe kök kanal tedavisi yaptırmış olan 59 yaşında bayan hasta kliniğimize bu bölgesinden rahatsız olması ve ağız içi fistül nedeniyle başvurmuştur. Radyografik muayenesinde tespit ve tedavi edilememiş bir başka kök kanalından şüphelenilmiştir. Bu nedenle önceki kök kanal dolgusu söküldü (1 distobukkal kanal ve 1 palatinal kanal) ardından 2 bukkal ve 1 palatinal olmak üzere 3 kanala kök kanal dolgusu yapıldı. Tedavi sırasında kavitede meziodistal yönde seyreden fraktür hattı tespit edildi. Kanal dolgusu sonrasında kaviteye direk rezin restorasyon uygulandı. Devam eden takiplerde fistülün iyileştiği ve hastanın ağrılarının geçtiği görüldü. Hastanın 2 yıllık takibinde radyografik ve klinik açıdan asemptomatik olduğu izlendi. Başarılı bir endodontik tedavi için klinisyen kök kanalı morfolojik değişikliklerin farkında olmalıdır. Başarısız kök kanal tedavilerinde en önemli etkenlerden birisi fark edilemeyen ve tedavi edilemeyen ekstra kanallardır. Farklı açıdan alınan radyograflarla dişlerin kök yapılarının, sayılarının fark edilmesi ve fraktür hattının teşhis edilmesi tedavinin başarısı açısından önemlidir., This case report offers a successful root canal treatment of a maxillary right first premolar with an extra canal and a mesiodistal fracture line. A 59-year-old female was refered with intra oral sinus tract and lingering discomfort in relation to his maxillary right first premolar after the conventional root canal therapy. In radiographic examination suspected the presence of another undetected and untreated root canal. Therefore, after endodontic retreatment (one distobuccal canal and one palatinal canal), root canal treatment was performed to two buccals and a palatinal canal including three root canals. A meziodistal fracture line was detected during the treatment. After the endodontic retreatment direct resin restoration was applied to the cavity. The sinus tract was healed and the patient reported complete relief of pain. Clinical and radiographic examination of the patient found to be asymptomatic after 2 years recall period. For successful endodontic therapy, the clinician should be aware of the variations in the root canal morphology. The science of extra canal is important in endodontics as failure to locate and treat an extra canal(s) is one of the common causes for failure of root canal treatments. The number of the root canals, the root structure recognition and fracture lines are important for the success of treatment with radiographs taken from different angles.

64 SUMMARY The purpose of this study was to compare the efficiencies of various gutta percha solvents during endodontic retreatment. The solvents evaluated were chloroform, methyl chloroform, halothane and eucalyptol. In this study, 65 sound upper incisors and canines which were extracted for the periodontal reasons were used. The teeth were stored in 10% formalin solution until use. The root canals of the teeth were cleaned and shaped by step- back method and filled with lateral condensation technique, using AH26 as sealer. After the access cavities were filled temporarily, the teeth were stored in physiological saline solution at 37°C for 3 weeks. 60 teeth, from the total of 65 were divided into 4 subgroups each containing 15 teeth. The remaining 5 teeth were used as control. After the temporary filling materials were removed, the coronal 2 mm of canals were enlarged with Gates-Glidden burs and two drops of solvent was placed in the canals. When gutta-percha was softened, it was removed by the help of H-files. This procedure was repeatedly performed all through the entire working length. Reinstrumentation was carried on until there was no further evidence of gutta percha remained on the instrument. The crowns of the teeth were removed and the roots were splitted into two halves longitudinally in the vestibulopalatinal direction. The root halves were photographed and the images on the photos were copied onto tracing paper. The remaining gutta-percha and canal outlines were traced. The canal area and remaining gutta-percha area in the coronal, middle and apical thirds were measured using Image Analizer.65 The results were statistically analyzed by analysis of One-way variance, Kruskal-Wallis and Mann-Whitney U tests. No significant difference overall among the 4 experimental groups (4 solvents) were found in the area of remaining gutta percha (p>0.05). However, chloroform was found to be more efficient in the apical third when compared with eucalyptol. The results of this study suggest that eucalyptol, which was also found to be an efficient solvent in this study and does not have risks on human health as others do, seems to be the best choice to be used in retreatment procedures. 64 SUMMARY The purpose of this study was to compare the efficiencies of various gutta percha solvents during endodontic retreatment. The solvents evaluated were chloroform, methyl chloroform, halothane and eucalyptol. In this study, 65 sound upper incisors and canines which were extracted for the periodontal reasons were used. The teeth were stored in 10% formalin solution until use. The root canals of the teeth were cleaned and shaped by step- back method and filled with lateral condensation technique, using AH26 as sealer. After the access cavities were filled temporarily, the teeth were stored in physiological saline solution at 37°C for 3 weeks. 60 teeth, from the total of 65 were divided into 4 subgroups each containing 15 teeth. The remaining 5 teeth were used as control. After the temporary filling materials were removed, the coronal 2 mm of canals were enlarged with Gates-Glidden burs and two drops of solvent was placed in the canals. When gutta-percha was softened, it was removed by the help of H-files. This procedure was repeatedly performed all through the entire working length. Reinstrumentation was carried on until there was no further evidence of gutta percha remained on the instrument. The crowns of the teeth were removed and the roots were splitted into two halves longitudinally in the vestibulopalatinal direction. The root halves were photographed and the images on the photos were copied onto tracing paper. The remaining gutta-percha and canal outlines were traced. The canal area and remaining gutta-percha area in the coronal, middle and apical thirds were measured using Image Analizer.65 The results were statistically analyzed by analysis of One-way variance, Kruskal-Wallis and Mann-Whitney U tests. No significant difference overall among the 4 experimental groups (4 solvents) were found in the area of remaining gutta percha (p>0.05). However, chloroform was found to be more efficient in the apical third when compared with eucalyptol. The results of this study suggest that eucalyptol, which was also found to be an efficient solvent in this study and does not have risks on human health as others do, seems to be the best choice to be used in retreatment procedures. 74

Bu çalışmada iki farklı döner alet sistemi kullanılarak yapılan kanal tedavisi yenilenmesi işleminde, Er:Yag lazer ile aktive irigasyonun etkinliğinin çekilmiş dişlerde in vitro olarak incelenmesi amaçlandı. Çekilmiş alt çene premolar dişlerin kronları uzaklaştırılıp ProTaper Universal (Dentsply Maillefer, Ballaigues, İsviçre) F3 numaralı eğeye kadar genişletildi ve ardından ProTaper Universal F3 gütaperka ve AH Plus (Dentsply De Trey GmbH, Konstanz, Almanya) kanal patı ile dolduruldu. Örneklerin yarısına ProTaper Retreatment (Dentsply Maillefer, Ballaigues, İsviçre), diğer yarısına da Mtwo Retreatment(VDW, Münih, Almanya) kanal yenileme kitleri ile kanal dolgusu uzaklaştırma işlemi uygulandı. Her iki gruptaki örneklerin yarısına konvansiyonel irrigasyon, kalan yarısına da PIPS ile aktive irrigasyon uygulanarak toplamda dört çalışma grubu elde edildi ve kanal dolgusu uzaklaştırma etkinlikleri değerlendirildi. Örnekler iki parçaya ayrılarak stereomikroskop ile X8 büyütmede fotoğraflandı. Elde edilen kök görüntülerinin koronal, orta ve apikal bölümlerinde kalan artık miktarları yüzde olarak hesaplandı. İstatiksel değerlendirmelerde kanal yenileme tekniği grupları ve kök kanal bölgeleri için iki yönlü varyans analizi, her bir kök kanal bölgesi içerisinde kullanılan kanal yenileme teknikleri karşılaşatırılırken de tek yönlü varyans analizi uygulanmıştır. PIPS ucu kullanılarak Er:Yag lazer ile aktivasyon, konvansiyonel irrigasyona göre kanal dolgusu uzaklaştırmada daha etkili bulundu. ProTaper Retreatment ve Mtwo Retreatment döner aletleri arasında kanal dolgusu uzaklaştırma etkinliği açısından anlamlı fark bulunmadı. Kanal dolgusu artık miktarı büyükten küçüğe kökün sırasıyla apikal, orta ve koronal bölümünde görülmüştür ve aralarındaki fark istatistiksel olarak anlamlıdır. Çalışmamızın sonuçları dahilinde kanal tedavisi yenilenmesinde kökün koronal ve orta bölümlerinde PIPS ucu kullanılan Er:Yag lazer ile aktive irrigasyonun düz kanallarda kanal dolgusu uzaklaştırmada etkin bir yöntem olarak kullanılabileceğini düşünmekteyiz., The aim of this study was to evaluate the efficacy of Er:Yag laser actived irrigation in extracted teeth on root canal retreatment process using two different rotary instrument systems. Extracted mandibular premolar teeth were decoronated and instrumented up to ProTaper Universal(Dentsply Maillefer, Ballaigues, Switzerland) F3 file, and then filled with ProTaper Universal F3 guttapercha and AH Plus (Dentsply De Trey GmbH, Konstanz, Germany)sealer. Root canal fillings were removed with ProTaper Retreatment(Dentsply Maillefer, Ballaigues, Switzerland) kit for half of the samples and Mtwo Retreatment(VDW, Munich, Germany) kit for the other half. Conventional irrigation was used to half of the samples in both groups and actived irrigation with PIPS was applied to the remaining half. Four study groups were obtained in total and root canal filling removal activities were evaluated. Samples were sectioned longitudinally and photographed with a stereomicroscope at 8X magnification. The percentage of remaining filling material on coronal, middle and apical canal walls was calculated. For statistical evaluation two-way analysis of variance for root canal retreatment technique groups and root canal regions was performed while one way analysis of variance was performed for root canal retreatment techniques used in each root canal region were encountered. Er:Yag laser activation with PIPS was more effective in removing canal filling material than conventional irrigation. There was no significant difference in canal filling removal efficiency between the ProTaper R and Mtwo R rotary kits. The amount of residuel filling material was seen in the apical, middle and coronal regions of root in the order of higher to lower, respectively, and the difference between them was statistically significant. According to the results of our study, we think that Er:Yag laser activated irrigation with PIPS can be used as an effective method for root canal filling removal in coronal and middle part of the root in endodontic retreatment.

Kök kanal tedavisinde başarısızlıkla karşılaşıldığında, ilk tedavi seçeneği kök kanal tedavisinin yeniden yapılmasıdır. Kök kanal tedavisi tekrarındaki en önemli aşama foramen apikaleye ulaşarak daha önce yapılan kanal dolgusunun tamamen uzaklaştırılmasıdır. Kök kanallarının şekillendirilmesinde kullanılan Ni-Ti döner aletler zaman içerisinde kök kanal tedavisinin yenilenmesi amacıyla da geliştirilmiştir. Kanal dolgu maddesi olan güta perkanın uzaklaştırılması ve kanal tedavisi tekrarı için çeşitli nikel titanyum döner aletler piyasaya sürülmüştür.Çalışmamızın amacı, kanal tedavisi tekrarı için piyasaya sunulmuş olan dört ayrı Ni - Ti döner alet sistemlerinin (R-Endo, Mtwo R, Protaper Universal Retreatment, D-RaCe) retreatment etkinliklerini mikro bilgisayarlı tomografi ile incelemek; kalan artık madde miktarını hacimsel olarak hesaplayarak geleneksel H-File el aletleriyle karşılaştırmaktır. Bunun yanında herbir retreatment işlemi için geçen süre bakımından da fikir edinilmeye çalışılmıştır.Çalışmamızda 75 adet üst çene santral diş kullanılmıştır. Kök kanalları K-File el aletleri ile stepback tekniği kullanılarak şekillendirilmiş ve dişlerin kanal dolgusu güta perka ve AH Plus kullanılarak sıcak vertikal kondansasyon tekniği ile yapılmıştır. Çalışmamızda 4 deneysel grup oluşturulmuş ve kanal dolgusu R-Endo, Mtwo R, Protaper UR, D-RaCe retreatment sistemleri kullanılarak uzaklaştırılmıştır. Kontrol grubu olarak H-File el aletleri kullanılmıştır. Kalan dolgu maddesi miktarı hacimsel olarak mikro bilgisayarlı tomografi ile değerlendirilmiştir. İstatiksel analizler, Kruskal Wallis testi, Mann Whitney U test, Friedman Testi ve Wilcoxon Sign testi ile yapılmıştır.Sonuçlara göre, kullanılan tüm sistemlerin tüm kök yüzeyinden, apikal 1/3 ve kuronal 1/3 bölgeden uzaklaştırdıkları dolgu maddesi miktarı arasında istatiksel olarak anlamlı bir farklılık bulunmamıştır (p>0,05). Tüm deney grupları orta 1/3 bölgede H-File paslanmaz çelik el aletlerine göre daha az dolgu maddesi uzaklaştırmıştır.Anahtar Kelimeler : Kanal tedavisi tekrarı, Protaper UR, R-Endo, Mtwo R, D-RaCe.Bu çalışma, İstanbul Üniversitesi Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: 9384 When initial root canal retreatment fails, endodontic retreatment is the first treatment method. The main goal of retreatment is regain access the apical foramen by complete to removal of the root canal filling material. Rotary nickel-titanium files have been used primarily for root canal enlargement and shaping, and their use for the removal of root canal filling has been increasing. Various rotary retreatment systems have been developed for their efficacy in the removal of gutta-percha during retreatment.The aim of this study is to utilize micro ct to evaluate the effectiveness of removal procedure using four Ni-Ti retreatment systems (R-Endo, Mtwo R, Protaper Universal, D-RaCe) for retreatment supplemented by manual procedures. Besides this, it has been tried to have an idea about retreatment time of every systems.Seventy five maxillary anterior theeth were instrumented with K-Files and filled using warm vertical compaction of gutta-percha and AH Plus. In our study teeth were divided into 4 experimental groups that the root fillings removed with R-Endo, Mtwo R, Protaper UR, D-RaCe retreatment systems, and one control group that was used H-Files manuel instruments. Micro ct imaging was used to assess the percentage of residual filling material. Data were analysed using analysis Kruskal Wallis test, Mann Whitney U test, Friedman testi and Wilcoxon Sign test.No significant differences were observed residual filling material between the all retreatment systems in entire root canals, apical 1/3 and coronal 1/3 (p>0,05). All experimental groups removed less filling material in the middle 1/3 when compared with the manuel technique.Key Words: Retreatment, Protaper UR, R-Endo, Mtwo R, D-RaCe.The present work was supported by the Research Fund of Istanbul University. Project No. 9384 147