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Title Endodontic Retreatment or Endodontic Surgery for Teeth with Failed Non-surgical Root Canal Therapy?
Clinical Question In a healthy adult patient with failed non-surgical root canal therapy, does endodontic retreatment have a higher success rate than endodontic surgery?
Clinical Bottom Line Endodontic surgery results in a more favorable initial success, but non-surgical retreatment had a higher success rate long term. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19567310Torabinejad/2009Systematic Review
Key resultsAt 2-4 years, a significantly higher success rate was found for endodontic surgery (77.8%) compared with non-surgical retreatment (70.9%; P < .05). At 4-6 years, non-surgical retreatment showed a higher success rate of 83.0% compared with 71.8% for endodontic surgery (P < .05). There were insufficient numbers of articles available to make comparisons after 6 years of follow-up period.
Evidence Search Using Pubmed, searched: Endodontic retreatment AND Endodontic surgery with the limit of Systematic Reviews ...view in PubMed
Comments on
The Evidence
This study has a relatively high strength of evidence, although there is a very limited amount of comparative evidence. The authors did a comprehensive, detailed search for relevant trials using Medline, PubMed and Cochrane databases. They also searched relevant chapters from three major endodontic texts and every issue of the two most recent years of several major endodontic journals. A total of 34 articles were included in this systematic review with 8198 teeth. The review only stated the total number of teeth and did not specify how many total patients were evaluated. A meta-analysis was performed and based on the information provided in the review, there were no competing interests. Some of the studies were completed 38 years ago and the field of endodontics is continually improving. It would have been more helpful to have only included more recent articles.
Applicability The results of this study indicate although endodontic surgery is more successful initially, that non-surgical retreatment has a higher long term success rate. It is suggested that this is because lesions associated with teeth treated with non-surgical retreatment take longer to resolve. A patient should be retreated with non-surgical treatment, especially if a reason for failure can be identified or if access for endodontic surgery would be difficult.
Specialty/Discipline (Endodontics)
Keywords "retreatment" and "endodontic surgery"
ID# 2060
Date of submission: 05/30/2011spacer
E-mail Lindskog@livemail.uthscsa.edu
Author Hanna Lindskog
Co-author(s) e-mail
Faculty mentor/Co-author Ivy Schwartz, DDS
Faculty mentor/Co-author e-mail schwartz@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by James Ball (San Antonio, TX) on 08/09/2013
Although the conclusion of this CAT is correct, the reasoning is inaccurate. Nonsurgical retreatment should be attempted first for the following reasons. The most common cause for post treatment disease is inadequately disinfecting the root canal system (Haapasalo, Endodontic Topics 2003). For this reason nonsurgical retreatment should be attempted prior to surgical retreatment. Not attempting nonsurgical retreatment first adversely affects the outcome of surgery (Wang 2004, 15505504). Additionally, the article cited in this CAT includes outcome studies using dated techniques. Newer microsurgical techniques have improved outcomes of endodontic surgery to over 90% (Setzer 2011, 21496650 ).

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