Page 18 - GP Spring 2019

Endodontic Retreatment of Periapical Lesions

By Stanislav V. Zagorsky, Svetlana Tarasenko, and Arthur R. Volker, DDS, MSEd, FAGD

Maximum preservation of the patient’s implant placement or re-treatment of the
natural teeth remains an important priority root canal, most patients prefer to retain
in dentistry. Nonetheless, recent statistics their natural teeth. Endodontic retreat-
show that the most common procedure ment is a less invasive procedure than the
performed in dental clinics is the extraction alternative option of tooth extraction and
of teeth due to caries and periodontal is- implant placement.
sues. 1
Elimination of the microbial factor and
According to the American Dental removal of infection from the canals
10
Association, endodontic treatment is is a necessary condition for success.
successful in 97% of cases if the treatment Otherwise, infection of periapical foci can Figure 1. Pre-operative periapical radio-
protocols are fully followed. However, 3% sensitize the body and cause odontogenic graph of tooth #19.
2
inflammatory processes in the maxillofacial
of cases required endodontic retreatment. 3
region. 11,12 Although it is not possible to
Failures of endodontic treatment are completely sterilize the root canal system, it
associated with multiple factors including: is possible to achieve a significant reduction
in microbial contamination, which may
incomplete obturation and sealing of the provide an optimal condition for healing
root canal system, insufficient antiseptic and regeneration of the periapical tissues. 13
treatment, vertical root fracture, perfora-
tion, the presence of untreated canals, and It should be noted that in the process of
poor restoration of the coronal aspect of the endodontic retreatment, complications can
tooth. 4 periodically occur, such as perforations,
ledges, and instrument separation.
According to studies, approximately 75% Dental perforations account for 9% of all
of cases of endodontic retreatment cases complications of endodontic retreatment.
1
resulted in successful outcomes. A ten- Treatment of such teeth requires certain
5
year follow-up study shows that there is skills, as well as compliance with additional Figure 2. Section of CBCT. The arrows
successful regeneration of periodontal treatment protocols and equipment, such as show the foci of destruction and perforation.
tissues in 98% of cases absent of damage a dental operating microscope, ultrasonic
to the apical periodontium , and in tips, and advanced dental materials required Using a Seiler dental operating microscope
6
86% of cases with damage to the apical for repairing root canal system perforations (Figure 3), we carefully removed the re-
periodontium (4 years of observation) . 7 (i.e. Mineral Trioxide Aggregate (MTA)). maining filling material and performed a
mechanical treatment with Protaper rota-
In Russia, the index of successful primary The literature with respect to the level of ry files (Dentsply Maillefer), employing
endodontic treatment is reduced to 30% success in endodontic retreatment is quite Pracan (3% solution of sodium hypochlorite
8
and the success of endodontic retreatment promising and supportive of this treatment from Septodont) for irrigation. The perfo-
is generally minimal. This is due to the option. 6,14 In any case, it is crucial that ration was repaired with MTA, and the ca-
fact that retreatment is a complex and in- the patient is informed of all alternative nals were temporarily sealed with calcium-
volved process. Not all dentists have the treatment options, their advantages, containing METAPASTE (Meta Biomed)
necessary knowledge, skills, tools and/or disadvantages, and associated risks of for a period of two weeks (Figure 4).
the equipment to successfully complete complications.
9
the treatment. Additionally, when faced Case Report
with poorly obturated canals or periapical Patient T., who is 28-years-old, complained
lesions, dentists are often inclined to ex- of spontaneous discomfort, pain upon bit-
tract these teeth and subsequently place ing, and periodic swelling of the gingiva in
dental implants. the area of tooth #19. Using both intraoral
contact radiography (CTGG) and cone-
Modern protocols of dental implantation beam computed tomography (CBCT), a
provide a greater venue for patients with foci of bone tissue destruction in the api-
secondary abscesses of the involved teeth. cal region was detected showing a pres-
Consequently, the decision between root ence of bifurcation and perforation at the
canal therapy and the placement of a dental upper third of the mesial root and separat-
implant is a common dilemma in dental ed instrument in the distal root (Figures
practice. However, when giving the patient 1,2). The diagnosis was determined to be
the choice between tooth extraction with chronic periapical endo-periodontitis.
Figure 3. Use of a dental microscope
ensures excellent visual access and lighting.
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