Outcomes of Nonsurgical Retreatment and Endodontic Surgery: A Systematic Review

Abstract

Introduction: The purpose of this systematic review was to compare the clinical and radiographic outcomes of nonsurgical retreatment with those of endodontic surgery to determine which modality offers more favorable outcomes. Methods: The study began with targeted electronic searches of MEDLINE, PubMed, and Cochrane databases, followed with exhaustive hand searching and citation mining for all articles reporting clinical and/or radiographic outcomes for at least a mean follow-up of 2 years for these procedures. Pooled and weighted success rates were determined from a meta-analysis of the data abstracted from the articles. Results: A significantly higher success rate was found for endodontic surgery at 2-4 years (77.8%) compared with nonsurgical retreatment for the same follow-up period (70.9%; P < .05). At 4-6 years, however, this relationship was reversed, with nonsurgical retreatment showing a higher success rate of 83.0% compared with 71.8% for endodontic surgery (P < .05). Insufficient numbers of articles were available to make comparisons after 6 years of follow-up period. Endodontic surgery studies showed a statistically significant decrease in success with each increasing follow-up interval (P < .05). The weighted success for 2-4 years was 77.8%, which declined at 4-6 years to 71.8% and further declined at 6+ years to 62.9% (P < .05). Conversely, the nonsurgical retreatment success rates demonstrated a statistically significant increase in weighted success from 2-4 years (70.9%) to 4-6 years (83.0%; P < .05). Conclusions: On the basis of these results it appears that endodontic surgery offers more favorable initial success, but nonsurgical retreatment offers a more favorable long-term outcome. (J Endod 2009;35:930-937)

A retrospective study of the intentionally replanted mandibular second molars with C-shaped root canal configurations

“…A meta-analysis 20 of rootend filling materials also reported that MTA was associated with the highest success when it was compared with IRM, Super-EBA or amalgam. The fact that the success rate of this study was similar to the weighted average success rate of periapical surgery 21 was a good evidence for the use of MTA as a root-end filling during the intentional replantation procedure.…”

Effectiveness of rotatory and reciprocating movements in root canal filling material removal

“…The rationale to explain the better time-related results is that only one file was used in the WS group, whereas four files were needed to perform the retreatment in the PTRS group. The PTRS consisted of three files; however, as suggested in previous studies, 3,8 further root canal refining is necessary because of the apical diameter of the D3 ProTaper Retreatment file (size 20). The last instrument designed to reach the working length does not permit complete cleansing action at the apical portion.…”

“…2 Problems related to canal anatomy, 3 as well as microbial factors, can explain failure rates of about 8% for treated canals. 4 In these cases, endodontic retreatment of the root canal system is necessary.…”

Influence of Passive Ultrasonic Irrigation on the Removal of Root Canal Filling Material in Straight Root Canals

“…Persistent or secondary intraradicular infection is a major cause of endodontic failure, and nonsurgical retreatment is indicated in these cases (1)(2)(3). Effective removal of filling material from the root canal system is essential to ensure a successful outcome of the retreatment procedure (4).…”