Endodontic retreatment remains a cornerstone in the management of post-treatment disease, demanding precise diagnosis and evidence-based clinical decision-making. The persistence of apical periodontitis is primarily associated with intraradicular infection, extraradicular biofilms, or procedural complications, necessitating a tailored therapeutic approach.
This lecture critically appraises contemporary strategies in endodontic retreatment, focusing on the decision-making process between non-surgical orthograde retreatment and surgical intervention. Key factors, including the quality of prior treatment, canal accessibility, and periapical status, will be critically evaluated, alongside the role of cone-beam computed tomography (CBCT) in treatment planning.
Complex cases involving altered canal anatomy, perforations, and separated instruments present significant challenges. Their management relies on minimally invasive, predictable techniques supported by magnification and ultrasonics, particularly with the use of the dental operating microscope. Advances in irrigation, disinfection, and conservative instrumentation will be discussed in the context of non-surgical retreatment, while modern endodontic microsurgery will be highlighted as a predictable option when orthograde approaches are limited. The application of contemporary bioactive materials is emphasized in both modalities to enhance healing outcomes.
Through evidence-based insights and case-based discussion, this session provides a practical framework for managing complex retreatment scenarios, improving clinical outcomes, and supporting confident decision-making in daily practice.
Learning Objectives:
By the end of this lecture, participants will be able to:
- Identify Causes of Treatment Failure: Recognize common factors contributing to endodontic treatment failures through effective assessment techniques.
- Implement Diagnostic Strategies: Apply various diagnostic methods, including imaging and clinical assessments, to evaluate failed treatments accurately.
- Develop Retreatments Plans: Formulate and execute appropriate non-surgical retreatment plans based on evidence based and individual case assessments.
- Evaluate Surgical Options: Determine when surgical intervention is appropriate and understand the techniques involved in performing endodontic surgery.
- Analyze Case Studies: Gain insights from case studies to enhance problem solving capabilities and improve clinical decision-making in challenging endodontic scenarios.