Can I retreat only one canal? Selective endodontic retreatment.
A frequent question from our students is whether endodontic retreatment of just one root is possible. The answer depends on several factors: clinical, radiographic and treatment history.
Selective endodontic retreatment. In: Apostolo et al. Research, Society and Development, v. 11, n. 1, e46411125211, 2022 1.
Introduction
Hard and soft tissues are affected by oral diseases such as cancer, caries and periodontal disease, among others, which have a significant impact on the general and socioeconomic health of individuals. Apical periodontitis (AP), being one of the oral diseases, develops from the exposure of the vital pulp to different oral microbiota as a result of dental caries, accidental trauma or iatrogenic causes, through the colonization of microorganisms leading to the necrosis of the dental pulp and the development of infection in the periapical region of the affected teeth (Loureiro et al., 2021), 2021). This activates the host's immune response and leads to acute or chronic local inflammation, as well as resorption and destruction of periapical tissues and formation of periapical lesions such as granuloma and/or cyst (Jakovljevic, et al., 2020).
When we see the need for endodontic treatment, we think about the success of the treatment in an attempt to prevent the loss of the tooth. However, some factors may be associated with failure, the main one being the control of bacterial biofilm, which does not reverse the disease (Siqueira and Roças, 2008; Estrela, et al., 2014; Olcay et al., 2018). Failures during endodontic treatment can lead to the need for a second intervention, with endodontic retreatment being the first alternative in most cases (Estrela, et al., 2014). One of the main objectives of endodontic therapy is to clean, shape and decontaminate the root canal system, in addition to sealing the entire pulp space to prevent infection or reinfection of the tooth.
Initial treatment shows a high degree of success, but failures of 14% to 16% can occur after treatment, attributable to persistent intraradicular infection in non-instrumented canals, dentinal tubules or in the irregularities of the root canal system, as well as extraradicular causes such as periapical actinomycosis, cystic lesions, foreign body reactions due to extravasated endodontic materials or the presence of cholesterol crystals. Non-surgical retreatment and parendodontic surgery can be performed on teeth with persistent periapical lesions as long as they are restorable and have a healthy periodontium (Torabinejad, et al., 2009; Travassos et al., 2020; Farias et al., 2021). A good preoperative diagnosis of the pulp and periapical tissues must be established before endodontic treatment, as some clinical conditions can lead to a poor prognosis.
These include root perforation and fracture, periodontal injury, instrument fracture, extraradicular biofilm, filling beyond the working length, root resorption, among others (Estrela, et al., 2014; Gomes, et al. 2021). With the individual assessment of each root of the dental element in which the need for reintervention has been determined, with the aid of CT scans the clinician can make treatment decisions as opposed to making assumptions about the tooth as a whole. A new treatment modality called selective root retreatment can be opted for, combining a selective non-surgical root retreatment with the selectivity of a surgical root resection. Can I retreat only one canal? Selective endodontic retreatment.
Can I retreat only one canal? Selective endodontic retreatment.
