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Disinfection in Nonsurgical Retreatment Cases

  • Chapter
Endodontic Irrigation

Abstract

Clinicians should be prepared to retreat the root canal system if endodontic failure occurs, as a tooth with failed root canal treatment need not be deemed unsalvageable. Successful retreatment requires copious irrigation with particular irrigants to achieve disinfection. The effectiveness of the irrigation process and the level of disinfection achieved are heavily dependent on the thorough removal of the obturation material. Obtaining access to the apical foramen while preserving the root canal system’s anatomy and avoiding procedural errors is paramount to achieving a favorable outcome in retreatment cases.

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References

  1. AAE – glossary of endodontic terms. American Association of Endodontics, Chicago, IL, USA. 8th ed. 2012.

    Google Scholar 

  2. Ahmetoglu F, Keles A, Yalcin M, Simsek N. Effectiveness of different irrigation systems on smear layer removal: a scanning electron microscopic study. Eur J Dent. 2014;8(1):53–7.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Arslan H, Ayrancı LB, Karatas E, Topçuoğlu HS, Yavuz MS, Kesim B. Effect of agitation of EDTA with 808-nanometer diode laser on removal of smear layer. J Endod. 2013;39(12):1589–92.

    Article  PubMed  Google Scholar 

  4. Baratto Filho F, Ferreira EL, Fariniuk LF. Efficiency of the 0.04 taper ProFile during the re-treatment of gutta-percha-filled root canals. Int Endod J. 2002;35:651–4.

    Article  PubMed  Google Scholar 

  5. Barbosa SV, Burkard DH, Spångberg LS. Cytotoxic effects of gutta-percha solvents. J Endod. 1994;20(1):6–8.

    Article  PubMed  Google Scholar 

  6. Basrani BR, Manek S, Sodhi RN, Fillery E, Manzur A. Interaction between sodium hypochlorite and chlorhexidine gluconate. J Endod. 2007;33(8):966–9.

    Article  PubMed  Google Scholar 

  7. Beasley RT, Williamson AE, Justman BC, Qian F. Time required to remove guttacore, thermafil plus, and thermoplasticized gutta-percha from moderately curved root canals with ProTaper files. J Endod. 2013;39:125–8.

    Article  PubMed  Google Scholar 

  8. Brul S, Coote P. Preservative agents in foods. Mode of action and microbial resistance mechanisms. Int J Food Microbiol. 1999;50(1–2):1–17.

    Article  PubMed  Google Scholar 

  9. Bueno CE, Delboni MG, de Araújo RA, Carrara HJ, Cunha RS. Effectiveness of rotary and hand files in gutta-percha and sealer removal using chloroform or chlorhexidine gel. Braz Dent J. 2006;17(2):139–43.

    Article  PubMed  Google Scholar 

  10. Carr GB, Schwartz RS, Schaudinn C, Gorur A, Costerton JW. Ultrastructural examination of failed molar retreatment with secondary apical periodontitis: an examination of endodontic biofilms in an endodontic retreatment failure. J Endod. 2009;35(9):1303–9.

    Article  PubMed  Google Scholar 

  11. Cavenago BC, Ordinola-Zapata R, Duarte MA, del Carpio-Perochena AE, Villas-Bôas MH, Marciano MA, Bramante CM, Moraes IG. Efficacy of xylene and passive ultrasonic irrigation on remaining root filling material during retreatment of anatomically complex teeth. Int Endod J. 2014;47(11):1078–83.

    Article  PubMed  Google Scholar 

  12. Chutich MJ, Kaminski EJ, Miller DA, Lautenschlager EP. Risk assessment of the toxicity of solvents of gutta-percha used in endodontic retreatment. J Endod. 1998;24(4):213–6.

    Article  PubMed  Google Scholar 

  13. Crump MC, Natkin E. Relationship of broken root canal instruments to endodontic case prognosis: a clinical investigation. J Am Dent Assoc. 1970;80:1341–7.

    Article  PubMed  Google Scholar 

  14. Cunha RS, De Martin AS, Barros PP, da Silva FM, Jacinto Rde C, Bueno CE. In vitro evaluation of the cleansing working time and analysis of the amount of gutta-percha or Resilon remnants in the root canal walls after instrumentation for endodontic retreatment. J Endod. 2007;33(12):1426–8.

    Article  PubMed  Google Scholar 

  15. De Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto study–phases 3 and 4: orthograde retreatment. J Endod. 2008;34(2):131–7.

    Article  PubMed  Google Scholar 

  16. De-Deus G, Souza EM, Marins JR, Reis C, Paciornik S, Zehnder M. Smear layer dissolution by peracetic acid of low concentration. Int Endod J. 2011;44(6):485–90.

    Article  PubMed  Google Scholar 

  17. De Mello Junior JE, Cunha RS, Bueno CE, Zuolo ML. Retreatment efficacy of gutta-percha removal using a clinical microscope and ultrasonic instruments: part I – an ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(1):e59–62.

    Article  PubMed  Google Scholar 

  18. Di Fiore PM, Genov KA, Komaroff E, Li Y, Lin L. Nickel-titanium rotary instrument fracture: a clinical practice assessment. Int Endod J. 2006;39:700–8.

    Article  PubMed  Google Scholar 

  19. Du T, Wang Z, Shen Y, Ma J, Cao Y, Haapasalo M. Effect of long-term exposure to endodontic disinfecting solutions on young and old Enterococcus faecalis biofilms in dentin canals. J Endod. 2014;40(4):509–14.

    Article  PubMed  Google Scholar 

  20. Dugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman S. Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations. Int Endod J. 2003;36(3):181–92.

    Article  PubMed  Google Scholar 

  21. Edgar SW, Marshall JG, Baumgartner JC. The antimicrobial effect of chloroform on Enterococcus faecalis after gutta-percha removal. J Endod. 2006;32(12):1185–7.

    Article  PubMed  Google Scholar 

  22. European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006;39(12):921–30.

    Article  Google Scholar 

  23. Falk KW, Sedgley CM. The influence of preparation size on the mechanical efficacy of root canal irrigation in vitro. J Endod. 2005;31(10):742–5.

    Article  PubMed  Google Scholar 

  24. Faria-Júnior NB, Loiola LE, Guerreiro-Tanomaru JM, Berbert FL, Tanomaru-Filho M. Effectiveness of three solvents and two associations of solvents on gutta-percha and resilon. Braz Dent J. 2011;22(1):41–4.

    PubMed  Google Scholar 

  25. Filipo-Perez C, Bramante CM, Villas-Boas MH, Húngaro Duarte MA, Versiani MA, Ordinola-Zapata R. Micro-computed tomographic analysis of the root canal morphology of the distal root of mandibular first molar. J Endod. 2015;41(2):231–6.

    Article  Google Scholar 

  26. Fruchi Lde C, Ordinola-Zapata R, Cavenago BC, Hungaro Duarte MA, Bueno CE, De Martin AS. Efficacy of reciprocating instruments for removing filling material in curved canals obturated with a single-cone technique: a micro-computed tomographic analysis. J Endod. 2014;40(7):1000–4.

    Article  PubMed  Google Scholar 

  27. Gordon MPJ. The removal of gutta-percha and root canal sealers from root canals. N Z Dental J. 2005;101:44–52.

    Google Scholar 

  28. Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004;30(1):1–4.

    Article  PubMed  Google Scholar 

  29. Grischke J, Müller-Heine A, Hülsmann M. The effect of four different irrigation systems in the removal of a root canal sealer. Clin Oral Investig. 2014;18(7):1845–51.

    Article  PubMed  Google Scholar 

  30. Hunter KR, Doblecki W, Pelleu Jr GB. Halothane and eucalyptol as alternatives to chloroform for softening gutta-percha. J Endod. 1991;17(7):310–1.

    Article  PubMed  Google Scholar 

  31. Karapinar-Kazandag M, Basrani BR, Friedman S. The operating microscope enhances detection and negotiation of accessory mesial canals in mandibular molars. J Endod. 2010;36(8):1289–94.

    Article  PubMed  Google Scholar 

  32. Keleş A, Köseoğlu M. Dissolution of root canal sealers in EDTA and NaOCl solutions. J Am Dent Assoc. 2009;140(1):74–9.

    Article  PubMed  Google Scholar 

  33. Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod. 1979;5:83–90.

    Article  PubMed  Google Scholar 

  34. Leonardo MR, Tanomaru Filho M, Silva LAB, et al. In vivo antimicrobial activity of 2 % chlorhexidine used as a root canal irrigating solution. J Endod. 1999;25:167–71.

    Article  PubMed  Google Scholar 

  35. Leoni GB, Versiani MA, Pécora JD, Damião de Sousa-Neto M. Micro-computed tomographic analysis of the root canal morphology of mandibular incisors. J Endod. 2014;40(5):710–6.

    Article  PubMed  Google Scholar 

  36. Lottanti S, Gautschi H, Sener B, Zehnder M. Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J. 2009;42(4):335–43.

    Article  PubMed  Google Scholar 

  37. Marquis VL, Dao T, Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto Study. Phase III: initial treatment. J Endod. 2006;32(4):299–306.

    Article  PubMed  Google Scholar 

  38. Martos J, Ferrer Luque CM, González-Rodríguez MP, Arias-Moliz MT, Baca P. Antimicrobial activity of essential oils and chloroform alone and combinated with cetrimide against Enterococcus faecalis biofilm. Eur J Microbiol Immunol (Bp). 2013;3(1):44–8.

    Article  Google Scholar 

  39. McDonald MN, Vire DE. Chloroform in the endodontic operatory. J Endod. 1992;118(6):301–3.

    Article  Google Scholar 

  40. Metzger Z, Teperovich E, Zary R, Cohen R, Hof R. The self-adjusting file (SAF). Part 1: respecting the root canal anatomy–a new concept of endodontic files and its implementation. J Endod. 2010;36(4):679–90.

    Article  PubMed  Google Scholar 

  41. Mohammadi Z, Abbott PV. The properties and applications of chlorhexidine in endodontics. Int Endod J. 2009;42:288–302.

    Article  PubMed  Google Scholar 

  42. Nair PN. Pathogenesis of apical periodontitis and the causes of endodontic failures. Crit Rev Oral Biol Med. 2004;15(6):348–81.

    Article  PubMed  Google Scholar 

  43. Nevares G, Cunha RS, Zuolo ML, Bueno CE. Success rates for removing or bypassing fractured instruments: a prospective clinical study. J Endod. 2012;38(4):442–4.

    Article  PubMed  Google Scholar 

  44. Nevares G, Albuquerque DS, Zuolo ML, Bueno CES, Cunha RS. Efficacy of retreatment in root canals filled with thermoplasticized techniques. In: 92nd International Association for Dental Research General Session – IADR, 2014, Cape Town. J Dent Res. 93(Special Issue B):1498.

    Google Scholar 

  45. Ordinola-Zapata R, Bramante CM, Aprecio RM, Handysides R, Jaramillo DE. Biofilm removal by 6 % sodium hypochlorite activated by different irrigation techniques. Int Endod J. 2014;47(7):659–66.

    Article  PubMed  Google Scholar 

  46. Ordinola-Zapata R, Monteiro Bramante C, Gagliardi Minotti P, Cavalini Cavenago B, Gutmann JL, Moldauer BI, Versiani MA, Hungaro Duarte MA. Micro-CT evaluation of C-shaped mandibular first premolars in a Brazilian subpopulation. Int Endod J. 2014. [Epub ahead of print]

    Google Scholar 

  47. Paiva SS, Siqueira Jr JF, Rôças IN, Carmo FL, Ferreira DC, Curvelo JA, Soares RM, Rosado AS. Supplementing the antimicrobial effects of chemomechanical debridement with either passive ultrasonic irrigation or a final rinse with chlorhexidine: a clinical study. J Endod. 2012;38(9):1202–6.

    Article  PubMed  Google Scholar 

  48. Panitvisai P, Parunnit P, Sathorn C, Messer HH. Impact of a retained instrument on treatment outcome: a systematic review and meta-analysis. J Endod. 2010;36:775–80.

    Article  PubMed  Google Scholar 

  49. Paqué F, Ganahl D, Peters OA. Effects of root canal preparation on apical geometry assessed by micro-computed tomography. J Endod. 2009;35(7):1056–9.

    Article  PubMed  Google Scholar 

  50. Paqué F, Peters OA. Micro-computed tomography evaluation of the preparation of long oval root canals in mandibular molars with the self-adjusting file. J Endod. 2011;37(4):517–21.

    Article  PubMed  Google Scholar 

  51. Parashos P, Gordon I, Messer HH. Factors influencing defects of rotary nickel-titanium endodontic instruments after clinical use. J Endod. 2004;30:722–5.

    Article  PubMed  Google Scholar 

  52. Peters OA, Boessler C, Paqué F. Root canal preparation with a novel nickel-titanium instrument evaluated with micro-computed tomography: canal surface preparation over time. J Endod. 2010;36(6):1068–72.

    Article  PubMed  Google Scholar 

  53. Ricucci D, Siqueira Jr JF, Lopes WS, Vieira AR, Rôças IN. Extraradicular infection as the cause of persistent symptoms: a case series. J Endod. 2015;41(2):265–73.

    Article  PubMed  Google Scholar 

  54. Rios Mde A, Villela AM, Cunha RS, Velasco RC, De Martin AS, Kato AS, Bueno CE. Efficacy of 2 reciprocating systems compared with a rotary retreatment system for gutta-percha removal. J Endod. 2014;40(4):543–6.

    Article  PubMed  Google Scholar 

  55. Sae-Lim V, Rajamanickam I, Lim BK, Lee HL. Effectiveness of ProFile.04 taper rotary instruments in endodontic retreatment. J Endod. 2000;26(2):100–4.

    Article  PubMed  Google Scholar 

  56. Sağlam BC, Koçak MM, Türker SA, Koçak S. Efficacy of different solvents in removing gutta-percha from curved root canals: a micro-computed tomography study. Aust Endod J. 2014;40(2):76–80.

    Article  PubMed  Google Scholar 

  57. Salehrabi R, Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study. J Endod. 2004;30(12):846–50.

    Article  PubMed  Google Scholar 

  58. Salehrabi R, Rotstein I. Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment. J Endod. 2010;36(5):790–2.

    Article  PubMed  Google Scholar 

  59. Scelza MF, Coil JM, Maciel AC, Oliveira LR, Scelza P. Comparative SEM evaluation of three solvents used in endodontic retreatment: an ex vivo study. J Appl Oral Sci. 2008;16(1):24–9.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Schirrmeister JF, Meyer KM, Hermanns P, Altenburger MJ, Wrbas KT. Effectiveness of hand and rotary instrumentation for removing a new synthetic polymer-based root canal obturation material (Epiphany) during retreatment. Int Endod J. 2006;39(2):150–6.

    Article  PubMed  Google Scholar 

  61. Signoretti FG, Endo MS, Gomes BP, Montagner F, Tosello FB, Jacinto RC. Persistent extraradicular infection in root-filled asymptomatic human tooth: scanning electron microscopic analysis and microbial investigation after apical microsurgery. J Endod. 2011;37(12):1696–700.

    Article  PubMed  Google Scholar 

  62. Siqueira Jr JF, Rôças IN. Diversity of endodontic microbiota revisited. J Dent Res. 2009;88(11):969–81.

    Article  PubMed  Google Scholar 

  63. Siqueira Jr JF. A etiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001;34(1):1–10.

    Article  PubMed  Google Scholar 

  64. Só MVR, Saran C, Magro ML, Vier-Pelisser FV, Munhoz M. Efficacy of ProTaper retreatment system in root canals filled with gutta-percha and two endodontic sealers. J Endod Oct. 2008;34(10):1223–5.

    Article  Google Scholar 

  65. Solomonov M, Paqué F, Kaya S, Adigüzel O, Kfir A, Yiğit-Özer S. Self-adjusting files in retreatment: a high-resolution micro-computed tomography study. J Endod. 2012;38(9):1283–7.

    Article  PubMed  Google Scholar 

  66. Spili P, Parashos P, Messer HH. The impact of instrument fracture on outcome of endodontic treatment. J Endod. 2005;31:845–50.

    Article  PubMed  Google Scholar 

  67. Subha N, Prabhakar V, Koshy M, Abinaya K, Prabu M, Thangavelu L. Efficacy of peracetic acid in rapid disinfection of Resilon and gutta-percha cones compared with sodium hypochlorite, chlorhexidine, and povidone-iodine. J Endod. 2013;39(10):1261–4.

    Article  PubMed  Google Scholar 

  68. Takahashi CM, Cunha RS, de Martin AS, Fontana CE, Silveira CF, da Silveira Bueno CE. In vitro evaluation of the effectiveness of ProTaper universal rotary retreatment system for gutta-percha removal with or without a solvent. J Endod. 2009;35(11):1580–3.

    Article  PubMed  Google Scholar 

  69. Tamse A, Fuss Z, Lustig J, Kaplavi J. An evaluation of endodontically treated vertically fractured teeth. J Endod. 1999;25:506–8.

    Article  PubMed  Google Scholar 

  70. Tamse A, Unger U, Metzger Z, Rosenberg M. Gutta-percha solvents—a comparative study. J Endod. 1986;12(8):337–9.

    Article  PubMed  Google Scholar 

  71. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009;35(7):930–7.

    Article  PubMed  Google Scholar 

  72. Tsesis I, Rosen E, Tamse A, Taschieri S, Kfir A. Diagnosis of vertical root fractures in endodontically treated teeth based on clinical and radiographic indices: a systematic review. J Endod. 2010;36(9):1455–8.

    Article  PubMed  Google Scholar 

  73. Vieira AR, Siqueira Jr JF, Ricucci D, Lopes WS. Dentinal tubule infection as the cause of recurrent disease and late endodontic treatment failure: a case report. J Endod. 2012;38(2):250–4.

    Article  PubMed  Google Scholar 

  74. Weiger R, ElAyouti A, Löst C. Efficiency of hand and rotary instruments in shaping oval root canals. J Endod. 2002;28(8):580–3.

    Article  PubMed  Google Scholar 

  75. Wilcox LR. Endodontic retreatment with halothane versus chloroform solvent. J Endod. 1995;21(6):305–7.

    Article  PubMed  Google Scholar 

  76. Wourms DJ, Campbel AD, Hicks ML, Pelleu Jr GB. Alternative solvents to chloroform for gutta-percha removal. J Endod. 1990;16(5):224–6.

    Article  PubMed  Google Scholar 

  77. Wu MK, R’oris A, Barkis D, Wesselink PR. Prevalence and extent of long oval canals in the apical third. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(6):739–43.

    Article  PubMed  Google Scholar 

  78. Yeung W, Raldi DP, Cunha RS, Mello I. Assessment of smear layer removal protocols in curved root canals. Aust Endod J. 2014;40(2):66–71.

    Article  PubMed  Google Scholar 

  79. Zamany A, Safavi K, Spangberg LS. The effect of chlorhexidine as an endodontic disinfectant. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:578–81.

    Article  PubMed  Google Scholar 

  80. Zehnder M. Root canal irrigants. J Endod. 2006;32(5):389–98.

    Article  PubMed  Google Scholar 

  81. Zehnder M, Paqué F. Disinfection of the root canal system during root canal re-treatment. Endod Topics. 2011;19:58–73.

    Article  Google Scholar 

  82. Zuolo AS, Mello Jr JE, Cunha RS, Zuolo ML. Bueno CE Efficacy of reciprocating and rotary techniques for removing filling material during root canal retreatment. Int Endod J. 2013;46(10):947–53.

    Article  PubMed  Google Scholar 

  83. Zuolo ML, Kherlakian D, Mello Jr JE, de Carvalho MC. Fagundes MIRC. Reintervention in Endodontics. São Paulo, Brazil. 1st ed. Quintessence; 2014. p. 314.

    Google Scholar 

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Correspondence to Rodrigo Sanches Cunha DDS, MSc, PhD, FRCD(C) .

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Cunha, R.S., da Silveira Bueno, C.E. (2015). Disinfection in Nonsurgical Retreatment Cases. In: Basrani, B. (eds) Endodontic Irrigation. Springer, Cham. https://doi.org/10.1007/978-3-319-16456-4_17

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