Retrograde root canal treatment: a prospective case series

Jonasson, Peter; Lennholm, C; Kvist, Thomas

doi:10.1111/iej.12656

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…no history of a non‐surgical (NS) endodontic treatment/presence of root canal filling), according to Jonasson et al . (2017) Retrograde root canal after a NS initial root canal treatment Retrograde root canal after a NS retreatment Re‐surgery Quality of the endodontic treatment before the surgery according to Tronstad et al . (2000) Adequate: All visible root canals are obturated within 2 mm of the radiographic apex with no voids Inadequate: Root filling is more than 2 mm short of the radiographic apex, overextension of the filling, at least one canal is missing, or poor filling density. Errors during surgery by the clinician No error Minor procedural error: An error that did not result in root perforation, and all portals of exit are sealed (i.e.…”

Section: Methodsmentioning

confidence: 99%

The Buffalo study: Outcome and associated predictors in endodontic microsurgery‐ a cohort study

et al. 2020

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Aim To (i) evaluate and compare the outcome of endodontic microsurgery (EMS) using periapical radiographs (PAs) and cone‐beam computed tomography (CBCT) scans; (ii) identify prognostic factors affecting the outcome; and (iii) correlate the effect of guided tissue regeneration (GTR) on the pattern of apical bone remodelling. Methodology Eighty‐two patients (101 teeth) who received EMS were included and followed‐up using clinical and radiographic examinations (PAs and CBCT scans). Two calibrated endodontists evaluated the radiographic healing (favourable or unfavourable) by assessing PAs and CBCT. The success (favourable radiographic outcome with no clinical symptoms) and survival rates (tooth retention without clinical symptoms) were calculated, and the cause of failure (diseased or fractured) was identified. Pre‐treatment (age, sex, tooth type, position, sequence of treatment, quality of root canal before surgery, presence/absence of through‐and‐through lesion, presence/absence apico‐marginal defect) and treatment (presence/absence of errors during surgery, type of error (major or minor), retro‐preparation depth, presence/absence of an isthmus, retro‐filling material used, presence/absence bone graft material and/or resorbable membrane) factors were recorded. Data were analysed statistically to determine the inter‐observer, intra‐observer and inter‐radiographic agreements. Univariate, bivariate and logistic regression analysis were used to determine prognostic factors affecting the outcome and the effect of GTR on the pattern of apical bone remodelling. The significance level was set at 5%. Results Sixty‐eight patients (83 teeth) presented for outcome evaluation (recall rate: 84%). The survival rate was 93%. The success rate was 88% using PA and 86% using CBCT when vertical root fracture (VRF) cases were included and 94% using PAs, and 91% using CBCT when VRF cases were excluded. The intra‐ and inter‐observer agreements were substantial using CBCT, slight to a fair agreement using PA (P < 0.001), and slight to moderate for inter‐radiographic agreement. The occurence of a major procedural error during surgery was the only negative predictor for the outcome of EMS (P = 0.013). GTR did not affect the success rate or the type of healing when assessed using PA but it affected the type of healing on CBCT scans (complete vs incomplete healing) and the pattern of cortical plate remodelling (P < 0.001). Conclusion The success and survival rate of endodontic microsurgery was very high, and the occurrence of a major procedural error during surgery was the only factor affecting the outcome. GTR did not improve the outcome, but did affect the quality of apical bone remodelling following EMS.

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Section: Methodsmentioning

confidence: 99%

The Buffalo study: Outcome and associated predictors in endodontic microsurgery‐ a cohort study

et al. 2020

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“…Johnson and Fayad (2016) have stated that endodontic microsurgery should be considered an extension of nonsurgical retreatment, because the underlying aetiology of the disease process and the objectives of treatment are the same. The concept of surgical retreatment, which was originally suggested by Nygaard‐Östby (1971) and clinically explored by Reit and Hirsch (1986), is aimed at debriding the root canal space as coronally as possible in order to adhere to the aforementioned objectives (Jonasson et al, 2017; Nygaard‐Östby, 1971; Reit & Hirsch, 1986; Weissman et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Healing after surgical retreatment at four time points: A retrospective study

et al. 2021

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Aim To evaluate the outcome of surgical retreatment at four time points, that is 6, 12, 24 and 48 months post‐operatively, and to search for prognostic factors that may affect the outcome. Methodology Clinical records and intraoral periapical radiographs were collected from patients who had undergone surgical retreatment between 2009 and 2015 and attended 6‐, 12‐, 24‐ and 48‐month follow‐up visits. Surgical retreatment was performed by one endodontist and involved minimal root‐end resection and maximal length root‐end preparation using prebent ultrasonic files. Outcomes were categorized as complete, incomplete, uncertain or unsatisfactory healing, based on clinical and radiographic findings. The complete and incomplete categories were pooled and considered successes, while uncertain and unsatisfactory outcomes were considered failures. Changes in healing outcome were analysed using the McNemar‐Bowker test, and prognostic factors were analysed using univariate analysis. Results The study cohort included 297 patients with 384 teeth. The overall success rate after 48 months was 90.6% compared with 88.5%, 93% and 92.4% after 6, 12 and 24 months respectively. Age, gender, presence of isthmus and length of canal preparation had no significant influence on the outcome. Lesion size and tooth type had a significant influence only after 6 and 12 months, respectively, with no significant differences at other time points. Fifty per cent of the teeth classified as unsatisfactory or uncertain healing at the 6 months follow‐up improved to incomplete or complete healing after 12 months. None of the cases classified as unsatisfactory healing after 12 months subsequently improved, and only 2 cases that were classified as uncertain healing after 12 months improved after 24 months. Conclusions Surgical retreatment was found to be a predictable procedure with a high success rate of 90.6% after 4 years. Over the follow‐up periods, only a minor regression in the success rate was found. The 12 months follow‐up results closely indicated the long‐term outcome of surgical retreatment.

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“…Jonasson et al . (, ) explored Nygaard‐Ostby's concept for initial retrograde endodontic treatment in cases with limited orthograde access. The outcome of a retrograde retreatment technique using ultrasonic files was first reported by Wang et al .…”

Section: Discussionmentioning

confidence: 99%

“…Amagasa et al (1989) applied angled reamers and angled files held in broach holders for a similar purpose. Jonasson et al (2008Jonasson et al ( , 2017 explored Nygaard-Ostby's concept for initial retrograde endodontic treatment in cases with limited orthograde access. The outcome of a retrograde retreatment technique using ultrasonic files was first reported by Wang et al (2004) as one of the surgical techniques used in the Toronto study.…”

Section: Discussionmentioning

confidence: 99%

Retrograde root canal retreatment with pre‐bent ultrasonic files. A retrospective outcome study

et al. 2019

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Aim To assess retrospectively the clinical and radiographic outcomes of retrograde root canal retreatment (RRR) and to identify possible prognostic factors that may affect the outcome. Methodology Clinical records and radiographs were collected from patients who had undergone RRR between 2009 and 2016 and had a 1‐year follow‐up. All surgical procedures were performed by a single endodontist. The RRR technique involved minimal root‐end resection and maximal length retrograde preparation using pre‐bent ultrasonic files. Outcomes were categorized as complete, incomplete, uncertain or unsatisfactory healing based on clinical and radiographic findings. The complete and incomplete healing cases were pooled and considered as successes, while uncertain and unsatisfactory cases were considered failures. Prognostic factors were analysed using univariate analysis and multivariate logistic regression. Results In total, 575 patients with 721 teeth were included. The overall success rate was 91.8%. None of the prognostic factors (including age, gender, size of periapical radiolucency and isthmus presence) had a significant influence on the outcome (P > 0.05). Univariate analysis revealed tooth type had a significant influence on outcome (P = 0.008) with mandibular incisors having a significantly lower success rate (71.4%). Multivariate analysis using logistic regression revealed that the only variable with a significant association to the outcome was retrograde preparation length (P = 0.016, odds ratio = 1.299 (1.050, 1.607), C.I. = 95%)), i.e. the longer the retrograde preparation, the better the outcome. Conclusions Retrograde root canal retreatment was successful in 91.8% of cases. This predictable success rate was achieved while minimizing root‐end resection and maximizing retrograde canal preparation length.

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Retrograde root canal treatment: a prospective case series

Abstract: Retrograde root canal as a primary treatment was a reliable alternative to treat apical periodontitis on single- and two-rooted teeth with limited orthograde access to the root canals in the maxilla.

Cited by 9 publications

References 20 publications

The Buffalo study: Outcome and associated predictors in endodontic microsurgery‐ a cohort study

The Buffalo study: Outcome and associated predictors in endodontic microsurgery‐ a cohort study

Healing after surgical retreatment at four time points: A retrospective study

Retrograde root canal retreatment with pre‐bent ultrasonic files. A retrospective outcome study

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