Case Selection for Endodontic Retreatment

• History • Careful history taken to know nature of the case,

pathogenesis, urgency of treatment

History of pain or worsened. Spontaneous pain, pain on biting.

History of episode of facial swelling or swelling in the mucobuccal fold.

• Clinical findings: Swelling

Percussion and palpation sensitivity

Defective or missing coronal restoration

Active reccurent caries

Present of draining sinus tract

Periodontal status

• Radiographic findings: Evaluate anatomy of root canal in relation to canal curvature,

calcifications, unusual configurations Evaluate quality of obturation of primary endodontic treament Check for iatrogenic complications like seperated instruments,

ledges, perforations and canal blockages

Presence of one or more untreated root canals

Canals not prepared or not obturated to appropriate length

Recurrent caries that were not noted clinically.

Present of apical lesion or enlargement of pre-existing apical radiolucency.

Bony support of the tooth

• Patient’s factor exhibit good oral hygiene

have motivation to retain his/her natural dentition

financial capability

must understand procedure complexity and time consuming

Factors affecting prognosis of endodontic treatment

• Presence of any periapical radiolucency

• Quality of obturation

• Apical extension of the obturation canal

• Bacterial status of the canal

• Post-endodontic coronal restoration

• Iatrogenic complication

Contraindications of Retreatment

• Unfavorable root anatomy: shape, taper, remaining dentin thickness

• Presence of untreatable root resorption or perforations • Presence of root bifurcation caries• Inaccessible root canal space due to calcification or large

well-fitting post and core restorations• Root fracture• Insufficient crown/root ratio• Remaining tooth structure for restorability• Periodontal disease• Patient lack motivation to maintain oral hygiene