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	Endodontic Retreatment -- Part I	Endodontic Retreatment -- Part II

Endondontics Retreatment

Article by Dr. Jose Ibarrola
Retreatment of failing endodontic therapy can range from simple procedures to very complex and time-consuming approaches that require the use of specialized equipment. Retreatment can be non-surgical, surgical, or a combination of both. Careful examination and treatment planning of retreatment cases will enhance both the efficiency and end result of these procedures.
There are many contributing factors that affect the outcome of endodontic therapy, such as incomplete debridement of root canal systems, inadequate obturation, and procedural accidents. In addition there are other circumstances that can affect the overall prognosis of the tooth. These include periodontal involvement, loss of tooth structure, occlusion, and fractures.
Incomplete Canal Debridement
Failure to clean the entire root canal system will often result in failure. Incomplete treatment will leave pulp residue that can serve as a reservoir for bacteria that can initiate or perpetuate periradicular lesions.
Inadequate Gutta Percha Obturation
Inadequate gutta percha fills can be under extended (too short), under filled (too thin), or overextended (too long). Failing gutta percha fills can usually be linked to the lack of an adequate seal, and incomplete debridement of the canals. This also applies to overextended cases, where failures result from untreated anatomy and a lack of an adequate seal, than from the extruded material. All of these situations can be retreated non-surgically, including overextended fills. Organic solvents, headstrom files (figure 1 below), or rotary devices such as the GPX gutta removal kit can be used (figure 2 below).

Fig. 1 Number 15 headstrom file
Figure 1

A number 15 headstrom file was used in conjunction with an organic solvent, to remove the gutta percha from within the canal.

Image shows the GPX rotary removing the gutta percha from the canals.

GPX rotary device
Figure 2

Silver Points
Failures of silver points are usually associated with leakage and corrosion. The inability of silver points to seal irregular shaped canals allows leakage of the tissue fluids into the canal. Contact of these fluids with the silver point's result in the formation of corrosive products such as silver sulfates and silver carbonates, which can be very damaging to the periradicular tissues (figure 3).

Silver Points removed -- showing corrosion
Figure 3

With the silver points removed, you can see the points showing signs of corrosion.

The degree of difficulty in removing silver points is greatly impacted by two factors, access and fit. Points that are accessible and loose are easily removed by use of specialized forceps. Binding and/or inaccessible points require the use of more specialized equipment. Tight fitting silver points need to be "loosened" before retrieval is attempted. Ultrasonic devices, such as the EIE CT-4 ultrasonic tip, are very useful for this purpose. Once the silver point is loosened, it can be easily removed if accessible.
Many devices and techniques have been suggested to retrieve inaccessible silver points. Some that I have found useful are the Roydent extractor system. This utilizes the use of headstrom files that are worked along side the silver point, and withdrawn in a single firm motion (figure 4). The description of the Union Broach extractor system follows in Part II.

The image shows a retreatment, with the use of the headstrom file being worked along side of the silver point.

Retreatment with use of headstrom file
Figure 4

Endondontic Retreatment Part II
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Endodontic Retreatment -- Part I Endodontic Retreatment -- Part II

The First Electronic Endodontic Magazine

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	Figure 1	A number 15 headstrom file was used in conjunction with an organic solvent, to remove the gutta percha from within the canal.
	Image shows the GPX rotary removing the gutta percha from the canals.	Figure 2
	Silver Points Failures of silver points are usually associated with leakage and corrosion. The inability of silver points to seal irregular shaped canals allows leakage of the tissue fluids into the canal. Contact of these fluids with the silver point's result in the formation of corrosive products such as silver sulfates and silver carbonates, which can be very damaging to the periradicular tissues (figure 3).
	Figure 3	With the silver points removed, you can see the points showing signs of corrosion.


	The degree of difficulty in removing silver points is greatly impacted by two factors, access and fit. Points that are accessible and loose are easily removed by use of specialized forceps. Binding and/or inaccessible points require the use of more specialized equipment. Tight fitting silver points need to be "loosened" before retrieval is attempted. Ultrasonic devices, such as the EIE CT-4 ultrasonic tip, are very useful for this purpose. Once the silver point is loosened, it can be easily removed if accessible. Many devices and techniques have been suggested to retrieve inaccessible silver points. Some that I have found useful are the Roydent extractor system. This utilizes the use of headstrom files that are worked along side the silver point, and withdrawn in a single firm motion (figure 4). The description of the Union Broach extractor system follows in Part II.
	The image shows a retreatment, with the use of the headstrom file being worked along side of the silver point.	Figure 4


	*The First Electronic Endodontic Magazine*
	Back to: www.endoweb.com Home Page Email: nahmiasoffice@endoweb.com