Microsurgical endodontic retreatment of post restored posterior teeth: A case series

Endodontic Retreatment of a Maxillary First Molar With Orthograde Retrieval of a Separated File by a Combination of Ultrasonic and File Braiding Techniques: A Case Report

The persistence of apical periodontitis after endodontic therapy can be attributed to biological causes or when the treatment approaches have proven insufficient in completely eradicating the intra-radicular infection. This case report describes the endodontic retreatment of a maxillary molar in which file separation occurred during the cleaning and shaping procedure. The separated file was successfully retrieved utilizing a combination of ultrasonic and braiding techniques. The field of ultrasonics has undergone a thorough investigation and has been demonstrated to be a conservative technique with minimal radicular dentin trephination. The braiding technique is also a conservative method that involves the use of several braided H-files to apply a gripping force, facilitating the extraction of foreign bodies. The utilization of this methodology has been documented in the endodontic academic literature.

Healing of Periapical Lesions After Surgical Endodontic Retreatment: A Systematic Review

Background: Surgical root canal retreatment is required when peri-radicular pathosis associated with endodontically treated teeth cannot be treated by non-surgical root canal therapy (retreatment), or when retreatment was ineffective, not feasible or contraindicated. Endodontic failures maybe happen when irritants remain within the confines of the root canal, or when an extra-radicular infection cannot be eradicated by orthograde root canal treatment. Following enhanced microsurgical techniques in the last years, the success rates of surgical root canal retreatment have improved considerably.

Objective: The aim of this systematic review is to gather updated data in regard to the surgical root canal (retrograde) retreatment to heal the periapical lesions.

Materials and methods: The electronic databases PubMed and Google Scholar were searched in this review using specific inclusion and exclusion criteria. The search was performed in June 2019 and updated in November 2019. Among 3900 studies, 10 studies satisfied the eligibility criteria and were included in the review to be analyzed.

Results: The 10 studies showed the importance of surgical root canal retreatment as a treatment option in removing infections within the root canal system and its efficiency in periapical tissue healing. These studies investigated different aspects of healing of periapical lesion after surgical (retrograde) retreatment including success rates, follow-up duration, and updated studies in surgical (retrograde) retreatment.

Conclusions: Surgical root canal (retrograde) retreatment demonstrates its efficiency in reducing the period needed for healing of the periapical lesions in short-term follow-up compared to conventional orthograde retreatment.

[Increasing the effectiveness of mandibular molars root resection surgery using retrograde endodontic revision]

The purpose of the present study was to increase the effectiveness of mandibular molars apical root resection surgery. The study included 21 patients with diagnosis 'persistent apical periodontitis', 'root cyst', in 11 cases surgery was performed with less traumatic access with piezoelectric surgery system for separation of cortical bone block and subsequent reposition after resection and retrograde root filling. The planning and procedure was described by 2 clinical cases. Bone block reposition surgical procedure showed clinical effectiveness and was considered as a most acceptable technique of root resection.

Outcome of Endodontic Surgery: A Meta-analysis of the Literature-Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials

INTRODUCTION

The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements).

METHODS

An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used.

RESULTS

Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005).

CONCLUSIONS

The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

Evaluation of apical preparations performed with ultrasonic diamond and stainless steel tips at different intensities using a scanning electron microscope in endodontic surgery

Objective: The objective of our study is to analyse (with the help of scanning electron microscopes) the quality of the dental root surface and the appearance of dental cracks after performing apical preparations using two diffe-rent types of ultrasonic tips. Study design: We used 32 single-rooted teeth that underwent a root canal and apical resection. Afterwards, the teeth were divided into 4 groups of 8 teeth each, with preparations of the apical cavities in the following manner: Group 1: stainless steel ultrasonic tip at 33KHz. Group 2: stainless steel ultrasonic tip at 30KHz. Group 3: diamond ultrasonic tip at 30KHz. Group 4: diamond ultrasonic tip at 33 KHz. The quality of the root surface and the presence of cracks were evaluated by one single observer using a scanning electron microscope. Results: All of the teeth in our study had cracks after the apical preparations. The mean number of cracks per tooth ranged between 6.1±1.9 (group 1) and 3.5±2.4 (group 4), with a significantly higher number found in the groups that used stainless steel tips (P=.03). The types of cracks produced involved: 8 complete cracks (4.5%), 167 incomplete cracks (94.4%), and 2 intradentinal cracks (1.1%), with no significant differences observed between the different frequencies used for each group. Conclusions: Stainless steel ultrasonic tips provoked a larger number of cracks than diamond tips. The frequency of vibration used did not have any effect on the number of cracks found.

Key words:Apicoectomy, scanning electron microscope, therapeutic ultrasound, endodontic surgery, dentinal crack.