Conventional Endodontic Retreatment of Persistent Pain on Previously Treated Tooth in an Elderly Patient: A Case Report

Clinical evaluation for a successful root canal treatment is assessed by various criteria, which are clinical, histopathological, and radiographical criteria. Therefore, failure of endodontic treatment can be described as a recurrence of clinical symptoms, with the presence of a periapical radiolucency or both. Failure factors in the treatment are frequently related to persistent infection. Conventional endodontic retreatment is indicated for symptomatic previously treated teeth or asymptomatic teeth with inadequately done initial endodontic treatment to avoid potential recurrence. Endodontic retreatment in elderly patients is a great challenge because the clinician has to reassure both the physical and psychological factors of the patient to determine whether to save a tooth or perform an extraction. Some difficulties may also be found in root canal retreatment, including finding the root canal hole or root canal blockage found in parts of the root canal that have not been repaired in the previous treatment. A 60-year-old female patient came with the chief complaint of recurrent pain, and subjective discomfort in the maxillary left central incisor. The patient had anxiety about the dental treatment. The tooth had a history of root canal treatment four months ago. The clinical examination showed a positive response to the percussion test. The radiographical analysis showed a root canal underfilling, 2-3 mm short of length from the apex. The tooth was diagnosed as a previously treated tooth with symptomatic apical periodontitis. Endodontic retreatment was performed based on the patient’s clinical condition and consent, followed by composite restoration. The clinical and radiographic re-evaluation after four weeks of follow-up revealed an excellent condition. This favorable result showed that a conventional retreatment plan of persistent pain on the previously treated tooth in an elderly patient led to progressive healing, and a longer follow-up was advised.

Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix

Endodontic perforations are common accidents that occasionally happen as a result of misuse or difficult anatomy of some teeth; it may lead to teeth loss unless a good management is provided. Bioceramic (silicate-based) cements like mineral trioxide aggregate have a big role in management of such accidents. This case report aimed to evaluate the ability of five mineral oxides cement “5MO” in sealing two root canal perforations (furcation and postdrill perforations) and inducing clinical and radiographic healing in the periodontal tissues with/without the use of collagen sponge matrix. A 58-year-old healthy female was referred to our dental office complaining of severe pain in the upper left premolars’ region. Periapical radiographic examination revealed unsatisfactory root canal treatment of the teeth #24 and #25 with a furcation perforation and a postdrill perforation, respectively. Cone-beam computed tomography “CBCT” scans confirmed the findings of the periapical radiography and revealed the presence of radiolucent lesions surrounding the apex of both teeth #24 and #25. The treatment plan was a nonsurgical root canal retreatment by endodontic access through the full-ceramic crowns. After three years of follow-up, CBCT scans revealed a complete healing and bone formation on both premolars. This case report indicates the use of 5MO cement for endodontic perforations management.

Effect of handpiece light and material used in pulp chamber on dentin removal during root canal retreatment

This study evaluated the effect of the use of glass ionomer cement (GIC) and flowable bulk-fill resin composite (BFRC) for filling pulp chambers and the type of high-speed handpiece light used on dentin removal during access preparation for endodontic retreatment in molar teeth. Twenty maxillary molars were treated endodontically. BFRC (Opus Bulk Fill Flow APS, FGM) was used to fill the pulp chamber and replace coronal dentin (n = 10). In the remaining teeth, the pulp chamber was filled with GIC (Maxion R, FGM). Conventional resin composite (Opallis, FGM) was used to restore the enamel layer in all teeth. The samples in each group were divided into two subgroups, and the root canals were reaccessed using a handpiece with white or ultraviolet light. The teeth were scanned using micro-CT before and after root canal reaccess. The dentin volume removed was calculated and analyzed using 2-way analysis of variance and Tukey’s test (α = 0.05). The crown and pulp chamber locations with dentin removal are described using frequency distribution. During the access, fewer pulp chamber walls were affected and a lower volume of dentin was removed from the pulpal floor in the group restored with GIC than in the group restored with BFRC. No effect was observed on the coronal dentin walls with respect to the filling protocols and type of light used. For dentin removal from the pulp chamber, handpieces with white light performed better than those with ultraviolet light, irrespective of the filling protocol used. The use of GIC to fill the pulp chamber and use of white handpiece light reduced dentin removal from the pulpal floor and resulted in fewer affected dentin walls.

CBCT Evaluation of Gutta-Percha Removal Using ProTaper and Mtwo Retreatment Files, WaveOne, and Hedstrom Files: An Ex Vivo Study

Objectives: This study aimed to evaluate the efficacy of ProTaper, Mtwo, and WaveOne retreatment files and Hedstrom files for removal of gutta-percha from the straight root canals using cone-beam computed tomography (CBCT). Materials and Methods: Forty freshly extracted single-rooted and single-canal teeth were selected for this study. The teeth were decoronated, and biomechanical preparation was performed up to #30 K-file. The root canals were obturated using lateral compaction technique with gutta-percha and Resilon sealer. The teeth were then randomly divided into 4 groups, and CBCT images were obtained. All the canals were then retreated with either ProTaper retreatment files, Mtwo retreatment files, WaveOne files, or Hedstrom files. The surface area of the remaining filling material after the retreatment procedure was quantified by CBCT. Statistical analysis was performed via one-way ANOVA and the Tukey-Kramer multiple comparisons test. Results: None of the file systems could completely remove the filling material from the canals. Data analysis revealed significant differences between the groups in the apical and middle thirds (P<0.05). Conclusion: All the file systems left some filling material in the canals. Mtwo retreatment files had maximum efficacy for removal of filling materials in comparison with other files. WaveOne files can also be used for root canal retreatment.

Comparison of the efficacy of laser-activated and ultrasonic-activated techniques for the removal of tricalcium silicate-based sealers and gutta-percha in root canal retreatment: a microtomography and scanning electron microscopy study

Background Tricalcium silicate-based sealers have been usually indicated for the single-cone technique and result in more residual filling materials in root canal retreatment. Passive ultrasonic irrigation and photon-initiated photoacoustic streaming have been reported to improve the removal efficacy of root canal filling materials. However, the abilities of both techniques combined with NiTi re-instrumentation to remove residual tricalcium silicate-based sealer and gutta-percha have not been compared. The aim of this study was to evaluate the efficacy of laser-activated and ultrasonic-activated techniques in vitro for the removal of the tricalcium silicate-based sealer iRoot SP and gutta-percha after standard canal retreatment procedures with the use of nickel-titanium (NiTi) rotary instruments.

The Ability of Three Different Protocols in Removing Biroceramic- and Resin based Sealers from Simulated Internal Root Resorption Cavities: An in vitro Study

The endodontic therapy is considered successful when it achieves certain criteria that include the absence of periapical radiolucency, root filling extending to 2 mm within the radiographic apex, root filling with no voids, and a satisfactory coronal restoration1.However, root canal failure could occur in a percentage of 15 - 22%, and the non-surgical root canal retreatment stays the treatment of choice as a conservative way to control the post-treatment disease2.In non-surgical root canal retreatment removing all of the old root filling material is essential to improve the chances of success because this material could make a mechanical barrier that potentially retains the bacteria responsible for the case failure and also hinders the contact of irrigating solutions and intracanal dressings to the root canal walls3.Sealers are used to obturate the root canal irregularities and to fill the voids between the root canal filling and the canal walls4. Many new sealers have been introduced in the market; most commonly used are the resin-based and the bioceramic based sealer, the retreatability of these sealers is still not fully known5.In more complicated cases of canal irregularities and atypical root canal system, the clinician faces a further challenge in the effective removal of the root canal filling. Internal root resorptions are a pathological condition caused by the inflammatory reaction of the pulp cells leaving a resorptive cavity, the limitations of conventional non-surgical retreatment protocols require a more effective approach to fully remove the root canal fillings6.Irrigant agitation through Ultrasonic (Passive Ultrasonic Irrigation –PUI) considered efficient when compared to the conventional syringe irrigation because of the acoustic transmission that can break the bacterial biofilm and other materials and debris in the root canal system7 other instruments have been introduced to the market for the same purpose, XP-endo Finisher (FKG Dentaire, Switzerland) stands out because of its special titanium alloy (Martensite-Austenite Elctropolish-Flex) that can react to a different temperature when the instrument reaches the body temperature it transforms from the straight martensite phase to a curved austenite phase the instrument tip could expand up to 6 mm when subjected to pressure, it has been demonstrated that this instrument could improve the removal of Ca(OH)2 from oval canals and reduce the bacterial count in the root canal system8, XP-Endo Shaper (FKG Dentaire) has the same titanium alloy as XP-endo Finisher and according to the manufacturer, this alloy has the ability to adapt to the morphology of the root canal and could expand to reach all canal walls.