Possible Causes for Failure of Endodontic Surgery – A Retrospective Series of 20 Resurgery Cases

Abstract

Objective: This study aimed to evaluate unsuccessful endodontic surgery cases for possible causes for treatment failure and evaluate if a nonsurgical retreatment (NSRTX) approach could have been a better alternative to resurgery. Methods: Analyses of clinical and cone-beam computed tomography (CBCT) images, periapical radiographs, and chart documentation determined study parameters. Preoperative factors were age, sex, tooth type, signs and/or symptoms, presence of periapical radiolucency, previous root canal treatment, timeline since previous endodontic surgery, presence of posts, cores, and restorations. The intra-operative factors were microsurgical classification, previous techniques, and current techniques utilized. Postoperative factors were signs and/or symptoms, time to follow-up, and healing status. The accessibility of the root canal system and the quality of the existing root filling were used to evaluate NSRTX as an alternative to resurgery. Results: A total of 1073 surgical cases from 2011-2019 were reviewed. In 14 patients, 20 cases matched the inclusion criteria and allowed for data extraction. The mean time since the previous surgery was 2.9±2.1 years, with a mean follow-up of 9.1±5.8 months after the resurgery. Possible reasons for failure identified were: insufficient root-end filling (leaking, off-axis preparation, lack of depth, overfill) n=12/20, 60.0%; missed anatomy (main and lateral canals, isthmus) n=9/20, 45.0%; incomplete resection n=6/20, 30.0%. In 18/20 cases (90.0%), resurgery appeared to be indicated for 2/20 cases (10.0%). Therefore, NSRTX may have been a potential alternative. Conclusion: Further evidence for possible causes of failure of endodontic surgery was provided, which were primarily iatrogenic. The evaluation of CBCT and high magnification intra-operative images proved beneficial for identifying critical issues for all investigated cases.

Marginal Adaptation and Porosity of a Novel MTA Brand Applied as Root-End Filling Material: A Micro-CT Study

“…The prognosis and long-term success of this complex procedure depend on many factors, such as case selection, instrumentation technique, suitable equipment, the clinician's qualification, skill, and experience, the age of the patients, etc. Among them, the choice of the appropriate retrograde filling material plays a critical role [16,17].…”

“…One of the most important requirements for the root-end filling material is the ability to ensure a hermetic seal of the apical area. Inadequate sealing of the retrograde cavity is considered the main reason for the failure of endodontic surgery [17][18][19]. Good marginal adaptation to dentin and internal porosity of calcium silicate cements are related to their sealing capacity and ability to resist bacteria penetration and prevent the percolation of tissue fluids [20,21].…”

II Jornada Integrada da Faculdade Santa Maria

“…O presente estudo expôs um caso de emergência endodôntica ao apresentar um pacientecom extensa lesão cariosa no dente 23 que diante do teste de percussão vertical foi relatada dor intensa e de longa duração. Neste contexto, a Literatura sempre foi enfática ao demonstrar que cárie dentária tem sido a causa mais comum de doença periapical aguda (FERNADES-COLLAZO et al, 2012;LEONARDI DULTA et al, 2016;SETZER et al, 2021).…”

Abordagem clínica e protocolo de atendimento de abscesso apical agudo: relato de caso clínico

“…Em relação aos fatores etiológicos, a literatura é enfática ao demonstrar que a cárie dentária tem sido a causa mais prevalente da doença periapical aguda (14,15).…”