With the fast rise of dental implants now being done by almost any dental provider, endodontic retreatment has been slowly waning. So, who’s at fault for this dilemma? Is it the dentist, the endodontist, or the dental companies? However, it is our duty as dental professionals to give the most current recommendation to our patients based on evidence-based research. Unfortunately, this has not been practiced lately, especially during this time of economic uncertainty. As with anything “new,” the “hotness” has to die off before we can look at the cold, hard facts. Similar to when the original root canal filling material was gutta-percha and then it changed to silver points, or a combination of both, about 46 years ago. After some time, we realized silver points leak and corrode contributing to apical periodontitis.1 Now, years later, we are back to using gutta-percha (or some form thereof) as the root canal obturation material of choice. Perhaps we may see this cycle repeat itself again when comparing true success rates or “retained rates” of endodontic retreatment versus implants long-term.
According to the American Association of Endodontist (AAE) in 2010, there are more than 15 million root canals performed in the United States each year. In addition, according to the AAE, dentists refer an average of 46% of their root canal patients to an endodontist. This means more than one half of root canal therapies are performed by the general dentist (GP).
Studies have shown that success rates of conventional endodontic treatment can be upwards of 95%.2 In a survey of survivability of endodontically treated teeth completed by endodontists and GPs, endodontists experienced significantly greater success (98.1%) than did general dentists (89.7%).3 New techniques, in-depth training, microsurgical instruments, new materials, microscopes, and understanding biological principles inside and outside the root canal system have greatly enhanced the endodontist’s ability to successfully treat and/or retreat endodontically involved teeth.
Although initial root canal therapy success rates are very high, patients can experience “post-treatment disease,” as coined by Dr. Shimon Friedman in 2002.4 When this happens, conventional endodontic retreatment has been suggested as preferable to surgical intervention.5 “Endodontic retreatment has been defined as a procedure performed on a tooth that has received prior attempted definitive treatment, resulting in a condition requiring further endodontic treatment to achieve a successful result.”4 According to Bergenholtz et al,5 overall average retreatment usually results in successful outcomes of 75%. However, successful retreatment can be as high as 98% in teeth without apical periodontitis (no lesion present), according to Sjogren et al6 in a 10-year follow-up; and as high as 86% in teeth with apical periodontitis (lesion present), according to Farazneh et al7 in a 4-year follow-up.
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