Adequate removal of the previous filling material may be pivotal to a favorable outcome of root canal retreatment of teeth with post-treatment periodontitis in order to permit the access of irrigants and medicaments to persistent bacteria. However, even with recent technological advances, including the introduction of specially designed instruments, no technique has been shown to predictably promote complete filling removal. Supplementary approaches used after chemomechanical preparation, including the use of finishing instruments, ultrasonics and laser, have shown promising results in enhancing root canal cleaning and disinfection. This narrative review addresses the importance and implications of maximal filling removal during retreatment and discusses the effectiveness of different techniques and supplementary approaches used for this purpose.