Root-end Surgery or Nonsurgical Retreatment: Are There Differences in Long-term Outcome?

IntroductionThe decision of which modality of secondary endodontic treatment to perform is multifactorial and clinician dependent. The literature surrounding the long-term survival of nonsurgical retreatment compared with surgical retreatment remains equivocal and warrants further investigation. This 7-year retrospective study seeks to compare the outcome of nonsurgical retreatments with that of root-end surgeries performed on teeth without prior nonsurgical retreatments.MethodsInsurance claims from 1021 teeth of 987 patients in the Delta Dental of Wisconsin database were analyzed from the years 2008–2017. Tooth survival was evaluated using Cox regression models, and the P value was set at .05. Survival time was considered from the time of completion of nonsurgical retreatment or root-end surgery to the time of an untoward event, which was defined as extraction after root-end surgery or extraction/root-end surgery after nonsurgical retreatment. Only procedures performed by endodontists were included in the analysis.ResultsThe survival rate of teeth that received nonsurgical retreatment was 90% after 2 years, 86.8% after 4 years, and 85% after 6 years. The survival rate of teeth that received root-end surgery was 93.7% after 2 years, 90.5% after 4 years, and 88% after 6 years. No statistically significant difference was found in the survival of nonsurgical retreatment compared with root-end surgery. Likewise, no statistically significant difference was found within or between tooth types (anterior, premolar, or molar) when comparing nonsurgical retreatment with root-end surgery.ConclusionsThe results of this study indicate that clinicians can choose either nonsurgical retreatment or root-end surgery after failed primary root canal therapy. Tooth location was not a determining factor in the survival rate after nonsurgical retreatment or root-end surgery.     

Outcomes of Nonsurgical Retreatment and Endodontic Surgery: A Systematic Review

IntroductionThe purpose of this systematic review was to compare the clinical and radiographic outcomes of nonsurgical retreatment with those of endodontic surgery to determine which modality offers more favorable outcomes.MethodsThe study began with targeted electronic searches of MEDLINE, PubMed, and Cochrane databases, followed with exhaustive hand searching and citation mining for all articles reporting clinical and/or radiographic outcomes for at least a mean follow-up of 2 years for these procedures. Pooled and weighted success rates were determined from a meta-analysis of the data abstracted from the articles.ResultsA significantly higher success rate was found for endodontic surgery at 2–4 years (77.8%) compared with nonsurgical retreatment for the same follow-up period (70.9%; P < .05). At 4–6 years, however, this relationship was reversed, with nonsurgical retreatment showing a higher success rate of 83.0% compared with 71.8% for endodontic surgery (P < .05). Insufficient numbers of articles were available to make comparisons after 6 years of follow-up period. Endodontic surgery studies showed a statistically significant decrease in success with each increasing follow-up interval (P < .05). The weighted success for 2–4 years was 77.8%, which declined at 4–6 years to 71.8% and further declined at 6+ years to 62.9% (P < .05). Conversely, the nonsurgical retreatment success rates demonstrated a statistically significant increase in weighted success from 2-4 years (70.9%) to 4–6 years (83.0%; P < .05).ConclusionsOn the basis of these results it appears that endodontic surgery offers more favorable initial success, but nonsurgical retreatment offers a more favorable long-term outcome.     

The outcome of endodontic treatment: a retrospective study of 2000 cases performed by a specialist

The purpose of this study was to evaluate the treatment outcome of initial endodontic treatment and nonsurgical retreatment performed by an endodontic specialist in his private office. A total of 2,000 teeth were examined clinically and radiographically and the results were analyzed statistically by Pearson or Fisher's Exact test and multivariate logistic regression. The multivariate analysis evaluated joint associations among various factors, using logistic regression models. The dependent variable for this analysis was the dichotomous outcome: healed versus disease. The overall endodontic success rate was 91.45%, and the healed rate was significantly higher for initial endodontic treatments than for nonsurgical retreatments; teeth without lesion than for those with lesions; teeth treated without complications than for those with complications; recall period of 18-24 months than for other periods, and teeth with final coronal restoration than for those without. Of the 1376 teeth treated in the initial endodontic treatment sample, the success rate was 94.0%. Multivariate analysis identified the presence of procedural complications (file breakage, perforation and flare-up), as well as the absence of the restorations at follow-ups as the significant predictors of outcome, showing lower rates of success. Of the 624 teeth in the nonsurgical retreatment sample, 85.9% were successful. Stepwise logistic regression analysis revealed that preoperative radiolucency was a strong statistically significant factor to determine lower rates of success than in its absence. Two additional variables (age and tooth type) were found to have a significant influence on the outcome of the retreatment sample. A higher healed rate was observed for the 50-59 years age groups than others, while multirooted (molars) teeth revealed a significantly lower percentage of success than pre-molars and anterior teeth.     

Tooth Survival after Surgical or Nonsurgical Endodontic Retreatment: Long-term Follow-up of a Randomized Clinical Trial

Introduction

The aim of the study was to determine long-term tooth survival after endodontic retreatment and whether the presence of intraradicular posts influences the outcome.

The 5-Year Survival Rate of Nonsurgical Endodontic Treatment: A Population-based Cohort Study in Korea

IntroductionThe purpose of the current population-based study was to analyze the 5-year survival rate of teeth that received nonsurgical endodontic treatment. Specifically, the variables affecting the 5-year survival rates of endodontically treated teeth were analyzed.MethodsThe present study included all endodontically treated teeth reported in 2010 in the National Health Insurance Cohort database of the Republic of Korea. By tracing the dental records of the sample to the end of 2015, the 5-year survival rates of the initial root canal treatment (RCT) and re-RCT were analyzed. Gender, age, institution type, diagnosis, arch type, tooth type, number of visits, and rubber dam usage were included in the analyses as confounding variables.ResultsIn total, 2,866,749 teeth received initial RCT, and 173,429 teeth received re-RCT. Five-year survival rates were 90.85% and 88.42%, respectively. The survival rate of teeth that received initial RCT was significantly higher than that of those that received re-RCT. Specifically, re-RCT showed a significantly higher rate of extraction within 12 months than during other intervals. Furthermore, the following characteristics significantly positively affected the 5-year tooth survival rate: being female, <20 years of age, hospital as the institution type, mandibular teeth, anterior teeth, initial RCT, and use of rubber dam.ConclusionsBecause of its high 5-year survival rate, endodontic treatment is an effective method for maintaining natural teeth.     

The Effect of Mineral Trioxide Aggregate Obturation Levels on the Outcome of Endodontic Retreatment: An Observational Study

IntroductionNo clinical studies have examined the effect of mineral trioxide aggregate (MTA) obturation levels on the outcome of endodontic retreatment. This retrospective study examined treatment outcomes in three cohorts that compared overfilling, flush filling, and underfilling after orthograde retreatment using MTA.MethodsTwo hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data.ResultsWithin the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)–38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing.ConclusionMTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention.     

Factors Influencing Quality of Life after Surgical and Nonsurgical Interventions of Persistent Endodontic Disease

IntroductionNonsurgical endodontic retreatment and apical surgery are predictable procedures for the management of endodontically treated teeth with persistent disease. However, there is no information available that compares these treatment modalities based on patients’ oral health–related quality of life (OHRQOL). The aims of this study were to compare the OHRQOL of patients who received nonsurgical endodontic retreatment versus those who received apical surgery and to identify correlations between OHRQOL, clinician-assessed healing outcome, and other factors.MethodsPatients who received treatment at 2 dental hospitals with a recall period of 6–24 months were invited to participate. They underwent follow-up examination and were surveyed with the Oral Health Impact Profile (OHIP-14). Healing outcomes were determined by clinical and radiographic evaluation. Potential influencing factors for OHIP-14 scores were investigated.ResultsOne hundred fifty patients (75 patients from each group) participated in the study. There were no differences in OHIP-14 scores between both groups at the follow-up. The overall adverse impact on OHRQOL was low, with patients experiencing greater impact in the domains of “physical pain” and “psychological discomfort.” Women and patients who had preoperative pain reported a greater impact. There was an overall high healed and healing rate for both groups. No correlation was found between OHIP-14 scores and healing outcome.ConclusionsPatients who received nonsurgical endodontic retreatment and apical surgery reported comparable OHRQOL, with women and patients with preoperative pain reporting greater impact. Both treatments are viable options for the management of persistent endodontic disease based on clinician- and patient-reported outcome assessments.     

A Scoping Review of 4 Decades of Outcomes in Nonsurgical Root Canal Treatment,Nonsurgical Retreatment,and Apexification Studies—Part 2: Outcome Measures

IntroductionInconsistencies in the definitions of endodontic outcome terminology jeopardize evaluations of proposed interventions and patient care quality. This scoping review aimed to provide groundwork to develop a set of basic outcomes in endodontics.MethodsWe performed a comprehensive literature search for randomized controlled trials, cohort studies, case-control studies, and case series (≥10 patients) published after 1980 with patients ≥10 years of age with any preoperative pulpal and periapical diagnosis in permanent teeth requiring nonsurgical root canal treatment, retreatment, or apexification. Abstracted data on outcome assessment methods, assessors, and domains were reported after univariate and bivariate analyses.ResultsTreatment outcomes were evaluated radiographically (88%) or clinically (73%). Although 2-dimensional radiography exceeded 3-dimensional radiography, the use of the latter has increased since 2010, mostly for nonsurgical retreatments. Of 19 identified outcomes, 5 were most frequent: success (168 studies, 40%), radiographic healing (128 studies, 30%), survival (of an asymptomatic tooth [48 studies, 12%] or of a procedure code in administrative databases [31 studies, 7%]), pain assessment (14 studies, 3%), and quality of life (11 studies, 3%). Clinician-centered outcomes have been most frequently studied since the 1980s (71%), in academic settings (76%), and using a prospective design (45%). Patient-centered outcomes were reported in 19% of studies before 2010 and 30% since 2010. They were more common among retrospective studies (49%).ConclusionsPatient-centered outcome measures are lacking in endodontic studies. The state of available research can provide a baseline for the development of a core outcome set in endodontics, which should represent the important patient-centered outcomes in conjunction with well-validated clinician-centered outcomes.     

Additional Treatment Indicative of an Unfavorable Endodontic Outcome in a Swedish County—A 10-year Observational Study

IntroductionThis study's aim was to calculate the incidence of first additional endodontic treatment or extraction as the result of an unfavorable endodontic outcome following orthograde root canal treatment (RCT) performed by general dental practitioners during a 10-year period and to identify possible predictors for outcomes.MethodsA randomized cohort of 280 individuals (and as many teeth) with an orthograde RCT was followed for over 10 years. Dental records were reviewed, and individuals were recalled when data were missing. The following terminal events indicative of unfavorable endodontic treatment outcome were orthograde retreatment, surgical endodontics, and tooth extractions exclusively due to endodontic reasons. Selected variables related to individuals and treatment (pre-, intra-, and postoperative) were harvested to analyze possible associations with the terminal events. Unadjusted survival analysis and Cox regression analysis were performed and P < .05 was considered statistically significant.ResultsTerminal events were registered for 22 teeth/individuals and 17 of these were orthograde retreatments. The cumulative 10-year survival of RCTs was 92.7% (standard error 1.7%), with a higher yearly incidence during the first 2 years. The univariate analysis identified 5 factors associated with the outcome. There were too few events to perform a multivariate analysis.ConclusionsThe mean incidence of additional treatment indicative of unfavorable endodontic outcome was 0.7% per year during the first 10 years, but the mean incidence was greater during the first 2 years. Five factors were associated with an unfavorable outcome; however, confounders cannot be excluded from the associations.     

Four-year Outcome of Nonsurgical Root Canal Retreatment Using Cone-beam Computed Tomography: A Prospective Cohort Study

IntroductionThe purpose of this prospective study was to investigate the 4-year outcome and prognostic factors of nonsurgical root canal retreatment determined by measuring the volumetric change of periapical radiolucencies on cone-beam computed tomographic (CBCT) scans.MethodsNinety-seven endodontically treated teeth from 80 patients diagnosed as apical periodontitis and indicated for root canal retreatment were included. Retreatment was performed by 7 endodontic specialists using a standardized treatment protocol. The teeth were reexamined clinically and radiographically 48–67 months after retreatment. The volume of preoperative and postoperative periapical radiolucencies on CBCT images was independently measured by 2 examiners. Radiographic outcome is presented in 4 categories: absence, reduction, enlargement, or unchanged. Reduction or enlargement was determined when the volumetric change of radiolucency was 20% or more. Multivariate logistic regression was performed for predictor analysis.ResultsSixty-two teeth (63.9%) from 50 patients returned for follow-up. Fifty-eight teeth were included in the prognostic analysis, all of which were symptom free. The 4 remaining teeth that had been extracted because of fracture were excluded. The total volume of periapical radiolucencies at 4 years postoperatively decreased by 94.6% compared with that preoperatively (P < .001), with an average reduction of 83.4% (95% confidence interval, 69.2%–97.5%). The periapical radiolucencies were determined as absence in 44 teeth (75.9%), reduction in 10 teeth (17.2%), unchanged in 1 tooth (1.7%), and enlargement in 3 teeth (5.2%). Tooth type was identified as an outcome predictor (P < .05).ConclusionsThe 4-year outcome of endodontic retreatment is predictable, with a significant volumetric reduction in periapical radiolucencies.     

Success and Survival of Endodontically Treated Cracked Teeth with Radicular Extensions: A 2- to 4-year Prospective Cohort

IntroductionThere are no long-term, prospective clinical studies assessing outcomes of endodontically treated cracked teeth with radicular extensions. The purpose of this prospective study was to examine the 2- to 4-year success and survival rates of endodontically treated, coronally restored, cracked teeth, specifically where the crack extends beyond the level of the canal orifice internally.MethodsSeventy consecutive teeth requiring endodontic treatment with cracks extending to the level of the canal orifice and up to 5 mm beyond were included in the cohort. Treatment was performed by a single endodontist using current techniques, and cases were followed over time. Specific treatment and posttreatment protocols were used. A tooth was “survived” if it was present, asymptomatic, and functional. The category of “success” was given to a case if strict radiographic and clinical criteria were met.ResultsFifty-nine teeth were eligible for survival analysis, and 53 teeth were available for success analysis. There was a 100% survival rate in the first 2 years and 96.6% survival up to the 4-year period; 90.6% were classified as “success” in the 2- to 4-year term. No significant differences (P < .05) were found for periodontal pocketing (up to 7 mm) at the site of the crack, marginal ridge involvement, crack depth, or pretreatment diagnoses.ConclusionsThis study showed that the success and survival rates for cracked teeth with radicular extensions may be similar to endodontically treated teeth in general and may be higher than previously reported in cracked tooth studies. Treatment outcomes in cracked teeth with radicular extensions may be improved by using the following protocols: microscope-assisted intraorifice barriers placed apical to the extent of the crack, complete occlusal reduction, specific postoperative instructions, and expeditious placement of a full-coverage restoration.     

Decision making process by senior residents of Saudi Board in restorative dentistry for nonsurgical endodontic retreatment: A retrospective study

BackgroundDespite 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 methodsCase 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.ResultsThe 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).ConclusionsR4 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.     

Clinician-centered Outcomes Assessment of Retreatment and Endodontic Microsurgery Using Cone-beam Computed Tomographic Volumetric Analysis

Introduction

Outcomes assessment of retreatment and endodontic microsurgery (EMS) are traditionally based on clinical findings and radiographs. The purpose of this study was to assess the volumetric change of periapical radiolucencies (PARLs) by cone-beam computed tomographic (CBCT)-based analysis in retreatment and EMS cases.

Clinical Outcome of Nonsurgical Root Canal Treatment Using a Matched Single-Cone Obturation Technique with a Calcium Hydroxide–based Sealer: A Retrospective Analysis

IntroductionThe aim of this retrospective study was to estimate the outcome of nonsurgical root canal treatment using matched single-cones with a calcium hydroxide–based sealer and to identify the various prognostic factors influencing the outcome.MethodsThis was a retrospective study that enrolled 272 patients who underwent routine endodontic therapy and were obturated with matched single-cones and Sealapex as sealer. This study involved 223 patients with 261 teeth meeting the selection criteria and recalled between 24 and 84 months. The outcome was categorized as success (healed/healing clinically and radiographically) or failure (not healed clinically and/or radiographically). Two calibrated examiners assessed the treatment outcomes. A binomial logistic regression model was performed to identify the effect of various prognostic factors. The χ² test was used to find the association between sealer extrusion and the initial periapical index scores.ResultsThe overall success rate was found to be 89.7% for a mean recall period of 39.18 (±11.05) months. An increase in age was associated with increased odds of success, whereas the success rates were reduced by an increase in the number of roots and negative pulp sensibility status. Initial periapical index scores, presence of preoperative sinus tract, number of visits, and sealer extrusion did not affect the outcome significantly (P > .05).ConclusionWithin the limitations of this study, it was found that teeth obturated with matched single-cone and Sealapex achieved substantial success rates. Sealer extrusion did not have any significant effect on the treatment outcome.     

Outcome of Endodontic Treatment through Existing Full Coverage Restorations: An Endodontic Practice Case Series

IntroductionThis case series assessed the outcome of nonsurgical endodontic treatment completed through retained full coverage restorations (FCRs) in a board-certified endodontist private practice. The number of cases completed by the first author was 153.MethodsAll cases were performed following a standardized protocol for treatment and restoration depending on the type of FCR. Number of cases that showed up for 2- to 4-year follow-up was 127, with 83% recall rate. The age range of patients was 33–95 years, with mean age of 54.734 years. The mean recall time was 2.448 years. FCRs and their distribution were as follows: 4 anterior teeth, 14 premolars, and 109 molars. There were 103 nonsurgical root canal treatments and 24 retreatments. Patients who presented for recall had 74 porcelain fused to metal crowns, 17 zirconia crowns, 15 abutments of porcelain fused to metal bridges, 14 lithium disilicate crowns, 5 gold crowns, 1 full metal crown, and 1 gold onlay.ResultsThere were no endodontically related failures. Six cases failed; 3 were due to vertical root fractures, 1 was due to horizontal root fracture, and 2 were due to extensive recurrent caries causing restorative failure. The percentage of healed cases following the American Association of Endodontists outcome criteria adopted in 2004 with intact retained FCR was 95.3%.ConclusionsThe results suggest predictable favorable outcomes for nonsurgical endodontic treatment through FCR following the proposed protocol for diagnosis, treatment, and restoration.     

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants

Initial root canal treatment and the replacement of a single tooth with an implant are both viable treatment options, but various success rates have been reported for each treatment modality. This retrospective study compared 196 implant restorations and 196 matched initial nonsurgical root canal treatment (NSRCT) teeth in patients for four possible outcomes: success, survival, survival with subsequent treatment intervention and failure. Cross classifications/tabulations were analyzed using Pearson's chi2 test for association of the two classifications (endodontic vs implant and outcome). Polytomous regression with likelihood ratio tests were used in testing association with tooth location and outcome. Outcomes were as follows for implants and NSRCT respectively: success 73.5% and 82.1%; survival with no intervention 2.6% and 8.2%; survival with intervention 17.9% and 3.6%; and failure 6.1% and 6.1%. Location of the restoration in the mouth did not affect outcome. This study suggests that restored endodontically treated teeth and single tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.     

Outcome of Nonsurgical Root Canal Retreatment Procedures Obturated with Warm Gutta-percha Techniques: A Longitudinal Clinical Study

IntroductionTo evaluate the success rate of nonsurgical root canal retreatment at the 2–3-year follow-up and identify the possible prognostic factors.MethodsPatients who underwent root canal retreatment at a university dental clinic were contacted for clinical and radiographic follow-up. The retreatment outcomes in these cases were based on clinical signs, symptoms, and radiographic criteria. Inter- and intraexaminer concordances were calculated using Cohen's kappa coefficient. The retreatment outcome was dichotomized into success or failure according to strict and loose criteria. The radiographic success criteria consisted of complete resolution or absence of a periapical lesion (strict criteria) or a reduction in the size of an existing periapical lesion at recall (loose criteria). χ² tests were used to evaluate possible variables associated with retreatment outcomes (age, sex, tooth type, location, contact points, periapical status, quality of previous and final root canal filling, previous and final restoration, number of visits, and complications).ResultsOverall, 129 teeth (113 patients) were included in the final evaluation. The success rate was 80.6% under strict criteria and 93% under loose criteria. Molars, teeth with an initially higher periapical index score, and teeth with >5 mm periapical radiolucency had a lower success rate according to the strict criteria model (P < .05). When the loose success criteria were used, teeth with larger (>5 mm) periapical lesions and those that had been perforated during retreatment showed a lower success rate (P < .05).ConclusionsThe present study demonstrated that nonsurgical root canal retreatment is a highly successful procedure after an observation period of 2–3 years. Treatment success is primarily affected by the presence of large periapical lesions.     

Epidemiological evaluation of the outcomes of nonsurgical root canal treatment in a large cohort of insured dental patients.

Selected outcomes following initial nonsurgical root canal treatment (NSRCT) procedures were retrospectively assessed using an insurance company database of 110,766 nonsurgical root canal procedures that were completed by endodontists and their referring general dentists. A subset of 44,613 cases, with a minimum required follow-up time of 2 yr, showed incidences of extraction, retreatment and periradicular surgery equal to 5.56%, 2.47%, and 1.41%, respectively. The incidence of subsequent extraction increased with patient age. Teeth that were not restored after root canal therapy were significantly more likely to undergo extraction than restored teeth. Although the practice pattern for endodontists consisted of a significantly higher proportion of molars (48% more; p < 0.001) and a smaller proportion of anterior teeth (43% less; p < 0.001) than general dentists, both groups of providers had comparable rates of untoward events. These data strongly support the hypothesis that the specialist practice provides similar rates of clinical success compared with other providers, even when treating significantly more complex NSRCT cases. Overall, 94.44% of nonsurgical root canal treated teeth remained functional over an average follow-up time of 3.5 yr. These results are an important indication of the benefits of endodontic treatment when provided in an integrated health care delivery system of endodontists and their referring general dentists.     

Regenerative Endodontic Treatment as a Biologically Based Approach for Non-Surgical Retreatment of Immature Teeth

IntroductionThe goal of regenerative endodontic treatment (RET) is to regenerate the pulp-dentin complex in immature teeth with pulp necrosis. There is no consensus in using RET in previously treated teeth. This article reports on long-term outcomes of RET in previously treated immature teeth.MethodsPreviously treated immature teeth with signs/symptoms of failure were included. After local anesthesia and rubber dam isolation, the root canal filling material was removed without the use of chemical solvents. The root canals were irrigated with 6% sodium hypochlorite using an EndoVac (Kerr Endodontics, Culver City, CA), and a creamy mix of metronidazole and ciprofloxacin was placed in the canals for 4 weeks. At the second visit, the antibiotic dressing was removed using 17% EDTA. Bleeding was induced into the root canal space, and SynOss Putty (Collagen Matrix Inc, Oakland, NJ) was placed. Bioceramic putty was placed over the SynOss Putty, and the teeth were restored at a subsequent visit.ResultsFive teeth in 4 patients were included. The patients’ ages ranged from 14–46 years. Recall examinations were performed from 20 to 72 months with an average of 54.4 months. The apical openings of the teeth ranged from 1–3.7 mm. All teeth were functional and asymptomatic at the recall visits. All periapical lesions resolved with partial or complete mineralization of the root canals, and all teeth showed partial to complete apical closure at the follow-up visits.ConclusionsRET can be a viable option for nonsurgical retreatment of immature teeth. This article adds a new perspective to the field of regenerative endodontics.     

First untoward events and reasons for tooth extraction after nonsurgical endodontic treatment in Taiwan

In this study, 857 teeth having undergone nonsurgical root canal treatment (NSRCT) in Taiwan in 2000 were evaluated during a 5-year follow-up period for first untoward events and reasons for tooth extractions. First untoward events occurred in 83 (9.7%) teeth during this follow-up period, and nonsurgical retreatment was performed for 20 (24.1%), 4 (4.8%) received apical surgery, and 59 (71.1%) were extracted. By the end of this 5-year follow-up period a total of 64 (7.5%) teeth had been extracted. There were 65 reasons for tooth extraction given by the 56 performing dentists who responded to the extraction reason questionnaires; 6 (10.7%) were attributed to endodontically related diseases, 15 (26.8%) to periodontal diseases, 26 (46.4%) to large decay or unrestorable tooth, and 18 (32.1%) to tooth fracture. The conclusion was that 7.5% of the NSRCT teeth were extracted by the end of the 5-year follow-up period, and only 10.7% of these teeth were extracted as a result of endodontically related diseases.