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Background: Evaluating the effect of different obturation techniques on postoperative pain level and radiographic healing on non-surgical endodontic retreatment (NSER) applied in a single visit in teeth with a single root canal and apical periodontitis (AP). Materials and methods: Sixty-three teeth from 50 systemically healthy patients (mean age 34.19 ± 9.75 years; 27 women, 23 men) were included in the study. Residual root canal filling materials were removed. All teeth were randomly divided into three groups according to the obturation technique: cold lateral compaction (CLC), continuous wave compaction (CWC), and thermoplasticized gutta-core (TGC). Pain status was evaluated using the Numerical Pain Rating Scale (NRS) in all cases. Periapical index (PAI) scores were recorded in preoperative and postoperative 6-month on the periapical radiographs. Data were analyzed as statistically (IBM, Armonk, NY, USA). The significance level was determined as p < 0.05. Results: It was found that more postoperative pain occurred in the 3rd-hour interval after CLC and CWC compared to the 7th-day interval (p < 0.05). There was no difference in postoperative pain between obturation techniques in all evaluated time intervals (p > 0.05). There was no difference in the PAI scores recorded at six months between obturation techniques for all periods (p > 0.05). Similar radiographic improvement was observed in all obturation techniques at 6-months (p > 0.05). Conclusion: CLC, CWC, and TGC root canal obturation techniques were found to have similar efficacy after NSER in a single visit in teeth with AP at six months. Trial registration: The research was retrospectively registered on the website www.clinicaltrials.gov with the registration number NCT06226740 on 26/01/2024. [ABSTRACT FROM AUTHOR]

Abstract Background Evaluating the effect of different obturation techniques on postoperative pain level and radiographic healing on non-surgical endodontic retreatment (NSER) applied in a single visit in teeth with a single root canal and apical periodontitis (AP). Materials and methods Sixty-three teeth from 50 systemically healthy patients (mean age 34.19 ± 9.75 years; 27 women, 23 men) were included in the study. Residual root canal filling materials were removed. All teeth were randomly divided into three groups according to the obturation technique: cold lateral compaction (CLC), continuous wave compaction (CWC), and thermoplasticized gutta-core (TGC). Pain status was evaluated using the Numerical Pain Rating Scale (NRS) in all cases. Periapical index (PAI) scores were recorded in preoperative and postoperative 6-month on the periapical radiographs. Data were analyzed as statistically (IBM, Armonk, NY, USA). The significance level was determined as p 0.05). There was no difference in the PAI scores recorded at six months between obturation techniques for all periods (p > 0.05). Similar radiographic improvement was observed in all obturation techniques at 6-months (p > 0.05). Conclusion CLC, CWC, and TGC root canal obturation techniques were found to have similar efficacy after NSER in a single visit in teeth with AP at six months. Trial registration The research was retrospectively registered on the website www.clinicaltrials.gov with the registration number NCT06226740 on 26/01/2024.

Background: All endodontic treatment techniques are associated with the extrusion of debris into periradicular tissues through the apex. The extrusion of apical debris can lead to delayed healing or even therapy failure. It is possible to reduce the extrusion into periapical tissues through various approaches. The objective of this systematic review is to evaluate whether, in cases of non-surgical endodontic retreatment, reciprocating instruments cause greater extrusion of debris compared to instruments with continuous rotation. Methods: A search was conducted on PubMed, Ovid MEDLINE, and the Web of Science. The inclusion criterion was in vitro studies comparing apical extrusion in endodontically treated elements using continuously rotating and reciprocating files. Results: The search on scientific databases yielded 164 results, out of which only 16 were eligible for evaluation after screening. Conclusions: The authors of the research included in this review do not agree on the results obtained. Based on the articles analyzed in this systematic review, it remains unclear whether continuous rotation or reciprocating movement of the endodontic instrument can lead to significant differences in apical debris extrusion; it is not possible to provide a clear clinical recommendation regarding the choice of instrument movement for endodontic procedures. [ABSTRACT FROM AUTHOR]

Background: All endodontic treatment techniques are associated with the extrusion of debris into periradicular tissues through the apex. The extrusion of apical debris can lead to delayed healing or even therapy failure. It is possible to reduce the extrusion into periapical tissues through various approaches. The objective of this systematic review is to evaluate whether, in cases of non-surgical endodontic retreatment, reciprocating instruments cause greater extrusion of debris compared to instruments with continuous rotation. Methods: A search was conducted on PubMed, Ovid MEDLINE, and the Web of Science. The inclusion criterion was in vitro studies comparing apical extrusion in endodontically treated elements using continuously rotating and reciprocating files. Results: The search on scientific databases yielded 164 results, out of which only 16 were eligible for evaluation after screening. Conclusions: The authors of the research included in this review do not agree on the results obtained. Based on the articles analyzed in this systematic review, it remains unclear whether continuous rotation or reciprocating movement of the endodontic instrument can lead to significant differences in apical debris extrusion; it is not possible to provide a clear clinical recommendation regarding the choice of instrument movement for endodontic procedures.

Adequate removal of the previous filling material may be pivotal to a favorable outcome of root canal retreatment of teeth with post-treatment periodontitis in order to permit the access of irrigants and medicaments to persistent bacteria. However, even with recent technological advances, including the introduction of specially designed instruments, no technique has been shown to predictably promote complete filling removal. Supplementary approaches used after chemomechanical preparation, including the use of finishing instruments, ultrasonics and laser, have shown promising results in enhancing root canal cleaning and disinfection. This narrative review addresses the importance and implications of maximal filling removal during retreatment and discusses the effectiveness of different techniques and supplementary approaches used for this purpose. [ABSTRACT FROM AUTHOR]

Non-surgical endodontic retreatment is a reliable conservative option for managing post-treatment apical periodontitis. However, effective microbial control, based on the maximization of filling removal and disinfection protocols, is not yet predictable. Traditional gutta-percha solvents, which are indistinctively used for both the core and sealer filling materials, became obsolete due to unprecedented advances in endodontic technology. Nonetheless, microtomography, scanning electronic microscopy findings, and histobacteriological analysis tend to confirm the persistence of filling materials and the lack of association between root canal enlargement and superior disinfection. There is a controversy regarding the most suitable clinical protocols surrounding the shaping procedures and the supplementary disinfection steps. Based on the literature and the previous work of the team, the authors aimed to summarize the current knowledge regarding specific solvent formulations that target filling materials. Additionally, the advantage of an additional irrigation step to optimize disinfection was highlighted. This adjunctive procedure serves a dual role in the dissolution of filling materials, and in conferring an antibiofilm effect. Further research is needed to understand the novel contribution of these strategies upon clinical practice outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite the general guidelines for retreatment, differences in decision making exist for secondary endodontic treatment and may be related to many factors including education, clinical experience, dentist specialty, patient preferences and economic resources. Aim of the study was to evaluate the decision making of the Saudi Board in Restorative Dentistry (SBRD) senior residents in the endodontic retreatment of molar teeth as per the scientific guidelines of the American Association of Endodontists (AAE) and also to identify the causes of retreatment and measure how far they become deviated from their taught retreatment principles and inter-individual variability. Materials and methods: Case histories have been obtained from the files of cases treated in the SBRD Resident Comprehensive Case Archives in the SCHS from 2003 to 2015 in Riyadh region. The cases were only confined to Complex I and Complex II cases according to RDITN (Restorative Dental Index of Treatment Need), and seen by R3 and R4 residents only. Residents’ diagnosis was recorded as well as their treatment plan and any given notes regarding their decisions to retreat. Differences between the two groups (R3 and R4) residents and within the same group, regarding endodontic retreatment decisions and reasons for their treatment options were analyzed using Chi-Square test and Fisher’s Exact test. Results: The majority of residents in both R4 and R3 groups followed the recommended guidelines. R3 residents preferred to retreat all cases while R4 chose ‘no to retreat’ in few cases. Although R4 residents preferred nonsurgical retreatment more than R3 residents, the difference was insignificant. R4 residents preferred ‘no therapy’ or ‘follow up’ more frequent than R3 residents. Members of the R3 residents agreed more or less with each other as did those of the R4 residents without significant inter-individual variations within each group regarding the choice of retreatment). Conclusions: R4 residents appeared more likely, although not significant, to choose no retreatment or follow up than R3 residents. Conventional nonsurgical retreatment had the highest selection by both R3 and R4 residents. No significant inter-individual variations within each group regarding the choice of retreatment. There is a need to establish evidence based guidelines for more uniform management of failed root treated teeth.

Adequate removal of the previous filling material may be pivotal to a favorable outcome of root canal retreatment of teeth with post-treatment periodontitis in order to permit the access of irrigants and medicaments to persistent bacteria. However, even with recent technological advances, including the introduction of specially designed instruments, no technique has been shown to predictably promote complete filling removal. Supplementary approaches used after chemomechanical preparation, including the use of finishing instruments, ultrasonics and laser, have shown promising results in enhancing root canal cleaning and disinfection. This narrative review addresses the importance and implications of maximal filling removal during retreatment and discusses the effectiveness of different techniques and supplementary approaches used for this purpose.

Non-surgical endodontic retreatment is a reliable conservative option for managing post-treatment apical periodontitis. However, effective microbial control, based on the maximization of filling removal and disinfection protocols, is not yet predictable. Traditional gutta-percha solvents, which are indistinctively used for both the core and sealer filling materials, became obsolete due to unprecedented advances in endodontic technology. Nonetheless, microtomography, scanning electronic microscopy findings, and histobacteriological analysis tend to confirm the persistence of filling materials and the lack of association between root canal enlargement and superior disinfection. There is a controversy regarding the most suitable clinical protocols surrounding the shaping procedures and the supplementary disinfection steps. Based on the literature and the previous work of the team, the authors aimed to summarize the current knowledge regarding specific solvent formulations that target filling materials. Additionally, the advantage of an additional irrigation step to optimize disinfection was highlighted. This adjunctive procedure serves a dual role in the dissolution of filling materials, and in conferring an antibiofilm effect. Further research is needed to understand the novel contribution of these strategies upon clinical practice outcomes.

Despite the general guidelines for retreatment, differences in decision making exist for secondary endodontic treatment and may be related to many factors including education, clinical experience, dentist specialty, patient preferences and economic resources. Aim of the study was to evaluate the decision making of the Saudi Board in Restorative Dentistry (SBRD) senior residents in the endodontic retreatment of molar teeth as per the scientific guidelines of the American Association of Endodontists (AAE) and also to identify the causes of retreatment and measure how far they become deviated from their taught retreatment principles and inter-individual variability. Case histories have been obtained from the files of cases treated in the SBRD Resident Comprehensive Case Archives in the SCHS from 2003 to 2015 in Riyadh region. The cases were only confined to Complex I and Complex II cases according to RDITN (Restorative Dental Index of Treatment Need), and seen by R3 and R4 residents only. Residents' diagnosis was recorded as well as their treatment plan and any given notes regarding their decisions to retreat. Differences between the two groups (R3 and R4) residents and within the same group, regarding endodontic retreatment decisions and reasons for their treatment options were analyzed using Chi-Square test and Fisher's Exact test. The majority of residents in both R4 and R3 groups followed the recommended guidelines. R3 residents preferred to retreat all cases while R4 chose 'no to retreat' in few cases. Although R4 residents preferred nonsurgical retreatment more than R3 residents, the difference was insignificant. R4 residents preferred 'no therapy' or 'follow up' more frequent than R3 residents. Members of the R3 residents agreed more or less with each other as did those of the R4 residents without significant inter-individual variations within each group regarding the choice of retreatment). R4 residents appeared more likely, although not significant, to choose no retreatment or follow up than R3 residents. Conventional nonsurgical retreatment had the highest selection by both R3 and R4 residents. No significant inter-individual variations within each group regarding the choice of retreatment. There is a need to establish evidence based guidelines for more uniform management of failed root treated teeth. [ABSTRACT FROM AUTHOR]

The aim of this comparative study is to analyze the efficacy of EndoVac and Endoactivator endodontic irrigation systems for removing the endodontic smear layer present in the coronal, middle, and apical root third of the root canal system (RCS) and the isthmus from mesial roots from the first lower molar teeth using micro-computed tomography (micro-CT) analysis. The study was performed on 40 mesial roots that were randomly assigned to the following groups: Group A, EndoVac endodontic irrigation system (EV) (n = 10); Group B, Endoactivator endodontic irrigation system (EA) (n = 10); Group C, Root canal systems performed with F2 ProTaper Gold endodontic rotary system but not irrigated (Positive control) (n = 10); Group D, Root canal systems not performed or irrigated (Negative control) (n = 10). The samples were exposed to micro-CT analysis and the mesial roots were segmented using an advanced image segmentation technique based on partial differential equations (ROI: 10 × 10 × 10 mm) and the root canal systems and isthmus were reconstructed at a resolution of 25 microns per voxel. The EA study group showed statistically significant different residual endodontic smear layer volume (0.48 ± 0.24 mm3) compared to the EV study group (0.18 ± 0.15 mm3) (p = 0.016). The EV endodontic irrigation system performed a higher smear layer removal at coronal and middle root thirds, compared to the EA endodontic irrigation system; however, the EA endodontic irrigation system performed a higher smear layer removal at the apical root third, compared to the EV endodontic irrigation system. [ABSTRACT FROM AUTHOR]

The aim of this comparative study is to analyze the efficacy of EndoVac and Endoactivator endodontic irrigation systems for removing the endodontic smear layer present in the coronal, middle, and apical root third of the root canal system (RCS) and the isthmus from mesial roots from the first lower molar teeth using micro-computed tomography (micro-CT) analysis. The study was performed on 40 mesial roots that were randomly assigned to the following groups: Group A, EndoVac endodontic irrigation system (EV) (n = 10); Group B, Endoactivator endodontic irrigation system (EA) (n = 10); Group C, Root canal systems performed with F2 ProTaper Gold endodontic rotary system but not irrigated (Positive control) (n = 10); Group D, Root canal systems not performed or irrigated (Negative control) (n = 10). The samples were exposed to micro-CT analysis and the mesial roots were segmented using an advanced image segmentation technique based on partial differential equations (ROI: 10 × 10 × 10 mm) and the root canal systems and isthmus were reconstructed at a resolution of 25 microns per voxel. The EA study group showed statistically significant different residual endodontic smear layer volume (0.48 ± 0.24 mm3) compared to the EV study group (0.18 ± 0.15 mm3) (p = 0.016). The EV endodontic irrigation system performed a higher smear layer removal at coronal and middle root thirds, compared to the EA endodontic irrigation system; however, the EA endodontic irrigation system performed a higher smear layer removal at the apical root third, compared to the EV endodontic irrigation system.

The completion of root development and closure of the apex occurs up to 3 years after eruption of the permanent tooth. The treatment of pulpal injury during this period provides a significant challenge for the clinician. Conventional endodontic treatment in a non-vital tooth will result in overfilling of the obturating material as there is no apical stop for the obturating material. Hence knowledge of the biological process of root development is must to avoid endodontic failure. Here we present a case report where nonsurgical endodontic retreatment was successfully done to remove the overextended gutta-percha from immature permanent teeth. Apexification was carried out by placing an apical plug of MTA. This paper even throws light on causes of endodontic failures, option available to retrieve the old filling material and the significance of preoperative radiograph in establishing the root condition before carrying out any endodontic procedure. [ABSTRACT FROM AUTHOR]

The aim of this study is to analyze and compare the efficacy of three non-surgical endodontic retreatment techniques in removing a carrier-based root canal filling material from straight root canal systems. The study was performed on 99 single-rooted extracted teeth using the ProTaper Gold endodontic rotary system up to the F2 file (Dentsply Maillefer, Baillagues, Switzerland), which were sealed with GuttaCore (Dentsply Maillefer, Ballaigues, Switzerland) and AH plus epoxy resin sealer (Dentsply DeTrey, Konstanz, Germany) and randomly assigned to the following non-surgical retreatment techniques: ProTaper Retreatment endodontic rotary instruments (D1–D3 files, Dentsply Maillefer, Ballaigues, Switzerland; n = 33, PTR), Reciproc Blue endodontic reciprocating instrument (R50, VDW, Munich, Germany; n = 33, RCB50), and a combined root canal retreatment technique between Gates-Glidden drills (sizes #3 and #2, Dentsply Maillefer, Ballaigues, Switzerland) and Hedstrom files (file size 35, 30, and 25, Dentsply Maillefer, Ballaigues, Switzerland; n = 33; H-GG). All of the teeth were submitted twice to a micro-computed tomography (micro-CT) scan, before and after non-surgical endodontic retreatment procedures. The volume of root canal filling material (mm3), volume of remaining root canal filling material (mm3), non-surgical endodontic retreatment working time (min), proportion of remaining root canal filling material (%), and efficacy of root canal filling material removal between the non-surgical endodontic retreatment techniques were analyzed using ANOVA one-way statistical analysis. Statistically significant differences were observed between the proportions of remaining root canal filling material of PTR and H-GG (p = 0.018), between the non-surgical endodontic retreatment working times (min; p < 0.001), and between the efficacies of root canal filling material removal by the non-surgical endodontic retreatment techniques (p = 0.009). However, the non-surgical endodontic retreatment systems allow for similar carrier-based root canal filling material removal. [ABSTRACT FROM AUTHOR]