Root canal retreatment is traditionally consider an “all or none” treatment approach. Meaning, all restorative and obturation material must be removed from the entire root canal space of all roots regardless of the individual periapical status. In contrast, surgical endodontics is not viewed as an “all or none” approach. It is a generally accepted that only the diseased root(s) should be addressed via root end resection androot end filling. Knowledge gained from CBCT imaging has introduced a new reasonable treatment option for endodontically treated teeth presenting with post treatment disease. This new concept allows the clinician to make predictable treatment decisions based on the periapical status of an individual root(s) rather than make assumptions about the tooth as a whole. A “selective root retreatment” combines the approach of an non-surgical retreatment with the selectivity of a surgical root resection.
Upon completion of this course, each participants should have a better understanding of the following:
– The current recommendations for root canal retreatment and associated risks.
– The conflict between the root canal retreatment model and the endodontic
surgical model.
– A literature based rationale justifying a more conservative approach to endodontic retreatment.
– The importance of CBCT imaging when determining the presence or absence of periapical pathosis.
– How to use the CBCT image to create a guided precision slot access designed to selectively treat one or more roots of a multi-rooted tooth diagnosed with post treatment disease.
We may be “over retreating” perviously root canal treated teeth that present with recurrent or persistent apical pathology. This presentation is designed to make a reasonable argument using our current “accepted evidence” and logical reasoning to defend the clinician’s choice to approach root canal retreatment in a different way. It is being suggested that retreatment could be limited to a single root or roots clearly demonstrating periapical pathology while leaving the root(s) with no visible or perceived pathology untouched.