Orthograde endodontic retreatment of teeth with individual cast posts: Report of two cases

Abstract

Introduction. The failure of primary endodontic treatment is manifested by various clinical symptoms following endodontic therapy or, more frequently, by the development of chronic inflammatory process in the apex region without any subjective symptoms. In case of unfavorable outcome of the primary endodontic treatment, orthograde endodontic retreatment is the method of choice for a prolonged therapy. Outline of Cases. Two female patients, 47 and 44 years old, were presented at the Dental Clinic of Vojvodina for endodontic retreatment of teeth 22, 23 and 13, within the repeated prosthetic restoration. Intraradicular individual cast posts were removed using ultrasonic instruments. Remains of gutta-percha were removed by engine driven rotary re-treatment files, root canals were shaped and cleaned using the crown-down technique, and obturated with gutta-percha and epoxy-resin-based sealer using the lateral compaction technique. Conclusion. When there are metal posts or broken instruments in the root canal, the use of ultrasonic instruments is considered a safe method characterized by negligible tooth substance loss and minimal root damage causing fractures and perforations, and the entire procedure is effective and predictable. Non-surgical orthograde endodontic retreatment, when properly performed in accessible and penetrable root canals, achieves a high cure rate, good and lasting results and eliminates the need for radical procedures, such as apical surgery or tooth extraction. When nonsurgical endodontic retreatment is done, treated teeth must be restored by full coronal coverage as soon as possible, to prevent coronal leakage or fracture.Uvod. Kod neuspesnog primarnog endodontskog lecenja ponovljena endodontska terapija, ili endodontski retretman, jeste terapija izbora ukoliko ju je moguce izvesti. Opstrukcije kanala korena zuba, ako postoje, neophodno je prethodno ukloniti, kako bi se neometano pristupilo kanalnom prostoru i primenilo ponovno endodontsko lecenje. Prikaz bolesnika. Dve pacijentkinje starosti od 47 godina i 44 godine javile su se na Odeljenje za bolesti zuba i endodonciju Klinike za stomatologiju Vojvodine radi uklanjanja individualnih livenih nadogradnji i endodontskog retretmana zuba 22, 23, odnosno 13. Nadogradnje su uklonjene primenom ultrazvucnog aparata i specijalnog nastavka namenjenog u te svrhe. Ostaci starog punjenja uklonjeni su masinskim endodontskim instrumentima pune rotacije, kanali korena su obradjeni primenom tzv. crown-down tehnike, a opturacija je izvrsena gutaperka-poenima i pastom za konacnu opturaciju na bazi epoksidne smole metodom hladne lateralne kompakcije. Zakljucak. Nehirurski, ortogradni, endodontski retretman, ukoliko podrazumeva pravilan rad na prohodnim kanalima korena zuba, daje visok procenat izlecenja, dobre i dugotrajne rezultate, te nisu potrebni radikalniji nacini lecenja, kao sto su apikalna hirurgija i vadjenje zuba. Kada se govori o uklanjanju makromehanickih elemenata retencije iz kanala korena, smatra se da primena ultrazvuka predstavlja bezbedan nacin rada, uz zanemarljiv gubitak zubne supstance i veoma mala ostecenja korena zuba, a citav postupak je brz, efikasan i predvidljiv. Najefikasniji i najbrzi nacin za uklanjanje gutaperke iz kanala korena jeste upotreba masinskih instrumenata pune rotacije. Nakon uspesno zavrsenog retretmana neophodna je pravovremena i adekvatna koronarna restauracija, kako bi se zastitila preostala zubna struktura i sprecilo koronarno mikrocurenje.