Outcome of non‐surgical re‐treatment

The purpose of this review was to critically analyze the relevant literature in order to synthesize an overview on the clinical outcomes (radiographically judged periapical healing and tooth survival) following root canal re‐treatment and the factors influencing them. A further aim was to explain the findings on the basis of current knowledge and understanding. The relevant literature was captured and critiqued using the principles of a systematic review. The data were classified into a coherent structure for analyses and presentation but are not presented as a systematic review; rather, the authors have chosen a narrative style to enable integration of the clinical outcomes with relevant findings from laboratory and animal studies. Overall, the outcomes were similar to those for teeth undergoing primary treatment with common factors influencing the outcomes. The major differences between the outcomes of primary and secondary root canal (re‐)treatment reside only in the ability to predictably access and negotiate the root canal system to the (residual) apical infection. The data offer a very favorable prognosis for non‐surgical root canal re‐treatment performed to guideline standards.     

Non‐surgical management of tooth hypersensitivity

Tooth sensitivity is a common complaint of patients in dental practices. Studies have demonstrated dentinal hypersensitivity to affect 10–30% of the population. There are various potential causes of tooth sensitivity and a variety of available treatment options. This narrative review will discuss the possible aetiology of this condition, as well as the treatment modalities available. A tailor‐made treatment plan that starts with the most non‐invasive treatment options and escalates only when those options have proven insufficient in alleviating symptoms should be provided for each patient. Only after all non‐ and less‐invasive methods have failed to reduce the symptoms should more invasive treatment options, such as root‐coverage, be considered.     

Surgical endodontics: post‐surgical care

The post‐surgical management of the patient is as important as the treatment planning for surgery and the surgical management of the patient. Patients who do not receive adequate and contemporary post‐surgical instructions or who ignore these instructions are predisposed to untoward sequelae, including pain, swelling and possible infection, in addition to the potential for altered healing of both the oral soft tissues and supporting osseous structures. It is the endodontic surgeon's professional responsibility to ensure that verbal and written instructions are provided to patients that clearly define activities during the critical, early healing process. Furthermore, it is imperative that the endodontic surgeon have a complete understanding of and rationale for the instructions being given to the patient.     

Treatment choices for negative outcomes with non‐surgical root canal treatment: non‐surgical retreatment vs. surgical retreatment vs. implants

The revision of negative treatment outcomes is a significant part of current endodontic practice. Both non‐surgical and surgical retreatment procedures share the problem of a significant negative outcome in the presence of apical periodontitis. More positive results may be achieved in certain teeth with a combination of both procedures rather than either alone. However, there are pressures to replace these ‘failed’ endodontically treated teeth with implants. When comparable criteria are applied to outcomes, the survival rates of endodontic treatment and implant placement are the same. Time, cost, and more flexible clinical management indicate that endodontic retreatment procedures should always be performed first unless the tooth is judged to be untreatable. Endodontists should be trained in implantology to assist patients and referring colleagues in making informed treatment decisions.