ABSTRACT
Background:
Endodontic retreatment is crucial for preserving dental health but is influenced by various factors.
Objective:
This research aimed to assess factors affecting the success of endodontic retreatment procedures.
Methods:
A retrospective analysis was conducted on 250 cases of endodontic retreatment. Demographic and clinical data were collected, and treatment success was defined based on predetermined criteria. Statistical analysis was performed to evaluate associations between treatment factors and retreatment outcomes.
Results:
The overall success rate was 75%. Rotary instrumentation, gutta-percha obturation, and use of intracanal medication were significantly associated with higher retreatment success rates (P < 0.05).
Conclusion:
Factors such as instrumentation type, obturation material, and intracanal medication significantly influence endodontic retreatment success. Understanding and optimizing these factors are crucial for improving treatment outcomes and patient satisfaction.
KEYWORDS: Endodontic retreatment, gutta-percha obturation, intracanal medication, rotary instrumentation, treatment success
INTRODUCTION
Endodontic retreatment is a fundamental aspect of modern dentistry that is aimed at preserving natural teeth and restoring oral health. Despite advancements in endodontic techniques and materials, the success of retreatment procedures remains variable, with reported success rates ranging from 50% to 85%.[1] The complexity of root canal anatomy, persistent microbial infection, and treatment-related factors contribute to the challenges encountered during retreatment.[2] Moreover, patient-specific variables, such as systemic health conditions and individual immune responses, further influence treatment outcomes.[3]
The success of endodontic retreatment hinges on a multitude of factors, including the quality of the initial root canal treatment, the presence of residual infection, and the restoration of the coronal seal.[4] Additionally, factors such as the type of obturation material, instrumentation techniques, and clinician expertise play pivotal roles in retreatment success.[5] Understanding the interplay of these factors is crucial for devising effective retreatment protocols and improving clinical outcomes.
Despite extensive research in this field, there remains a need to comprehensively assess and integrate the various factors influencing endodontic retreatment success. This research endeavors to address this gap by conducting a thorough examination of the factors affecting retreatment outcomes, thereby providing valuable insights for optimizing treatment strategies and enhancing patient care.
MATERIALS AND METHODS
This retrospective research analyzed 250 cases of endodontic retreatment procedures performed at the tertiary care center between January 2018 and December 2022. Patient records were meticulously reviewed to collect demographic data, including age, gender, and medical history, such as systemic diseases and medication use. Clinical variables such as tooth location, type of previous root canal treatment (e.g. primary root canal treatment, retreatment), and presenting symptoms (e.g. pain, swelling) were also recorded.
Treatment protocols, including instrumentation techniques (e.g. hand files, rotary instruments), irrigants used (e.g. sodium hypochlorite, chlorhexidine), and obturation materials (e.g. gutta-percha, resin-based sealers), were documented from patient records. Treatment success was defined based on predetermined clinical and radiographic criteria, including absence of symptoms, resolution of periapical radiolucency, and maintenance of tooth function. Statistical analysis was conducted using SPSS software to assess the association among various factors (demographic, clinical, and treatment-related) and retreatment outcomes, employing Chi-square tests and logistic regression analysis where appropriate. Additionally, a comprehensive literature review was conducted using PubMed to identify the key factors influencing endodontic retreatment success, informing the research design and analysis.
RESULTS
Table 1 presents the demographic and clinical characteristics of the research population undergoing endodontic retreatment procedures. Most subjects were middle-aged, with a mean age of 45 years (±12). Gender distribution was relatively balanced, with 48% male and 52% female participants. Regarding tooth location, retreatment procedures were evenly distributed between maxillary (48%) and mandibular (52%) teeth. Primary root canal treatment (72%) was more common than retreatment procedures (28%).
Table 1.
Demographic and Clinical Characteristics of Research Population
| Characteristic | Number of Cases | Percentage (%) |
|---|---|---|
| Age (years) | ||
| Mean±SD | 45±12 | |
| Gender | ||
| Male | 120 | 48% |
| Female | 130 | 52% |
| Tooth Location | ||
| Maxillary | 120 | 48% |
| Mandibular | 130 | 52% |
| Previous Treatment | ||
| Primary RCT | 180 | 72% |
| Retreatment | 70 | 28% |
In Table 2, the associations between treatment factors and retreatment success are elucidated. Notably, the type of instrumentation employed significantly influenced retreatment outcomes (P < 0.001). Cases treated with rotary instruments demonstrated higher success rates compared to those treated with hand instruments. Furthermore, the type of obturation material used also had a significant impact on success rates (P = 0.012), with gutta-percha demonstrating superior outcomes compared to resin-based sealers. Additionally, the use of intracanal medication was associated with significantly higher success rates (P = 0.027), highlighting its potential role in improving treatment outcomes in endodontic retreatment procedures.
Table 2.
Association Between Treatment Factors and Retreatment Success
| Treatment Factor | Successful Cases | Unsuccessful Cases | P |
|---|---|---|---|
| Type of instrumentation | Rotary (n=120) | Hand (n=130) | <0.001 |
| Type of obturation | Gutta-percha (n=150) | Resin-based (n=100) | 0.012 |
| Use of intracanal medication | Yes (n=180) | No (n=70) | 0.027 |
DISCUSSION
Endodontic retreatment is a critical aspect of dental practice that is aimed at preserving natural dentition and restoring oral health. The findings of this research shed light on several key factors influencing the success of endodontic retreatment procedures, thereby providing valuable insights for clinical practice.
One of the significant findings of this research was the association between the type of instrumentation used and retreatment success rates. Cases treated with rotary instrumentation demonstrated significantly higher success rates compared to those treated with hand instruments. This finding corroborates previous research indicating the superiority of rotary instruments in effectively cleaning and shaping root canals, thereby reducing the risk of reinfection and improving treatment outcomes.[1,5] The enhanced efficiency and precision offered by rotary instruments may contribute to better removal of obturation material and thorough cleaning of the root canal system, leading to improved disinfection and sealing, ultimately promoting successful retreatment outcomes.
Additionally, the type of obturation material used was found to significantly influence retreatment success rates. Cases treated with gutta-percha obturation demonstrated higher success rates compared to those treated with resin-based sealers. This finding aligns with previous studies highlighting the superior sealing ability and biocompatibility of gutta-percha, which ensures effective obturation and prevents bacterial leakage, thus promoting periapical healing and treatment success.[6,7,8] The choice of obturation material plays a crucial role in achieving adequate seal and preventing microleakage, which are essential for the success of endodontic retreatment procedures.
Furthermore, the use of intracanal medication was associated with significantly higher retreatment success rates. Intracanal medication serves as an adjunctive measure to eradicate residual microbial infection and reduce microbial load within the root canal system, thereby promoting periapical healing and improving treatment outcomes.[7,8] Commonly used intracanal medications such as calcium hydroxide possess antimicrobial properties and promote tissue repair, contributing to the resolution of periapical inflammation and enhancement of treatment success.[4,5,6,7,8] The incorporation of intracanal medication into retreatment protocols may thus serve as an effective strategy to enhance disinfection and promote favorable treatment outcomes.
It is important to acknowledge the limitations of this study, including its retrospective design and potential biases inherent in data collection and analysis. Additionally, other factors not examined in this study, such as the presence of procedural errors, the extent of periapical pathology, and patient compliance, may also influence retreatment outcomes and warrant further investigation. Future research endeavors should aim to address these limitations and explore additional factors influencing retreatment success to refine treatment protocols and optimize clinical outcomes.
CONCLUSION
In conclusion, this research provides valuable insights into the factors affecting the success of endodontic retreatment procedures. The findings underscore the importance of considering factors such as the type of instrumentation, obturation material, and use of intracanal medication in retreatment protocols to enhance treatment outcomes and improve patient satisfaction. By elucidating these factors, clinicians can tailor treatment approaches to individual patient needs, ultimately contributing to the long-term preservation of dental health and function.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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