Nonsurgical Retreatment

  • Clifford J. Ruddle
    Address request for reprints to Dr. Clifford J. Ruddle, DDS, Advanced Endodontics, 227 Las Alturas Road, Santa Barbara, CA 93103;
    Dr. Ruddle is Director of Advanced Endodontics, Inc, and is an Assistant Professor of Graduate Endodontics at Loma Linda University and University of California, Los Angeles, is an Associate Clinical Professor at University of California, San Francisco, and is an Adjunct Assistant Professor of Endodontics at University of the Pacific, School of Dentistry. Additionally, he maintains a private practice in Santa Barbara, California. Dr. Ruddle has a financial interest in the products he designed and developed, which include the ProUltra ENDO ultrasonic instruments, the Post Removal System (PRS), and the Instrument Removal System (iRS).
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      With all the potential for endodontic success, the fact remains clinicians are confronted with posttreatment endodontic disease. When the elected treatment plan is endodontic nonsurgical retreatment, then the goal is to access the pulp chamber and remove materials from the root canal space and if present, address deficiencies or repair defects that are pathologic or iatrogenic in origin. This article provides a literature review with clinical recommendations for one important group of retreatment issues: the removal of posts and broken instruments.
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        • Ruddle CJ
        Nonsurgical endodontic retreatment.
        J Calif Dent Assoc. 2004; 32: 474-484
        • Friedman S
        • Stabholz A
        Endodontic retreatment: case selection and technique. Part 1: criteria for case selection.
        J Endod. 1986; 12: 28-33
        • Stabholz A
        • Friedman S
        Endodontic retreatment: case selection and technique. Part 2: treatment planning for retreatment.
        J Endod. 1988; 14: 607-614
        • Friedman S
        • Stabholz A
        • Tamse A
        Endodontic retreatment: case selection and technique. Part 3: retreatment techniques.
        J Endod. 1990; 16: 543-549
        • Ruddle CJ
        Ch. 25: nonsurgical endodontic retreatment.
        in: Cohen S Burns RC Pathways of the Pulp. 8th ed. Mosby, St. Louis2002: 875-929
        • Hoen MM
        • Pink FE
        Contemporary endodontic retreatments: an analysis based on clinical treatment findings.
        J Endod. 2002; 28: 834-836
        • Machtou P
        Ch. 8: la cavité d’accès.
        in: Machtou P Endodontie—guide clinique. Editions CdP, Paris1993: 125-137
        • Wolcott J
        • Ishley D
        • Kennedy W
        • Johnson S
        • Minnich S
        Clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars.
        J Endod. 2002; 28: 477-479
        • Ruddle CJ
        Microendodontic nonsurgical retreatment.
        in: Microscopes in Endodontics, Dent Clin North Am. 41. W.B. Saunders, Philadelphia1997: 429-454
        • Schilder H
        Cleaning and shaping the root canal system.
        Dent Clin North Am. 1974; 18: 269-296
        • Schilder H
        Filling root canals in three dimensions.
        Dent Clin North Am. 1967; : 723-744
        • Stamos DE
        • Gutmann JL
        Survey of endodontic retreatment methods used to remove intraradicular posts.
        J Endod. 1993; 19: 366-369
        • Machtou P
        • Sarfati P
        • Cohen AG
        Post removal prior to retreatment.
        J Endod. 1989; 15: 552-554
        • Masserann J
        The extraction of posts broken deeply in the roots.
        Acta Odont Stomatol. 1966; 75: 329-342
        • Goon WWY
        Managing the obstructed root canal space: rationale and techniques.
        J Calif Dent Assoc. 1991; 19: 51-57
        • Hess W
        Anatomy of the root canals of the teeth of the permanent dentition. William Wood & Co, New York1925
        • Smith BJ
        Removal of fractured posts using ultrasonic vibration: an in vivo study.
        J Endod. 2001; 27: 632-634
        • Yoshida T
        • Gomyo S
        • Itoh T
        • Shibata T
        • Sekine I
        An experimental study of the removal of cemented dowel-retained cast cores by ultrasonic vibration.
        J Endod. 1997; 23: 239-241
        • Bergeron BE
        • Murchison DF
        • Schindler WG
        • Walker 3rd, WA
        Effect of ultrasonic vibration and various sealer and cement combinations on titanium post removal.
        J Endod. 2001; 27: 13-17
        • Gluskin AH
        • Ahmad I
        • Herrero DB
        The aesthetic post and core: unifying radicular form and structure.
        Practical Procedures & Aesthetic Dentistry. 2002; 14: 313-322
        • Schwartz RS
        • Robbins JW
        Post placement and restoration of endodontically treated teeth: a literature review.
        J Endod. 2004; 30: 289-301
        • Gomes APM
        • Kubo CH
        • Santos RAB
        • Santos DR
        • Padilha RQ
        The influence of ultrasound on the retention of cast posts cemented with different agents.
        Int Endod J. 2001; 34: 93-99
        • Abbott PV
        Incidence of root fractures and methods used for post removal.
        Int Endod J. 2001; 35: 63-67
        • Kleier DJ
        • Shibilski K
        • Averbach RE
        Radiographic appearance of titanium posts in endodontically treated teeth.
        J Endod. 1999; 25: 128-131
        • Ruddle CJ
        Nonsurgical endodontic retreatment.
        J Calif Dent Assoc. 1997; 25: 765-800
        • Satterthwaite JD
        • Stokes AN
        • Frankel NT
        Potential for temperature change during application of ultrasonic vibration to intra-radicular posts.
        Eur J Prosthodon Restor Dent. 2003; 11: 51-56
        • Romero AD
        • Green DB
        • Wucherpfennig AL
        Heat transfer to the periodontal ligament during root obturation procedures using an in vitro model.
        J Endod. 2000; 26: 85-87
        • Sweatman TL
        • Baumgartner JC
        • Sakaguchi RL
        Radicular temperatures associated with thermoplasticized gutta-percha.
        J Endod. 2001; 27: 512-515
        • Johnson WT
        • Leary JM
        • Boyer DB
        Effect of ultrasonic vibration on post removal in extracted human premolar teeth.
        J Endod. 1996; 22: 487-488
        • Gesi A
        • Magnolfi S
        • Goracci C
        • Ferrari M
        Comparison of two techniques for removing fiber posts.
        J Endod. 2003; 29: 580-582
        • Gettleman BH
        • Spriggs KA
        • ElDeeb ME
        • Messer HH
        Removal of canal obstructions with the endo extractor.
        J Endod. 1991; 17: 608-611
        • Dixon EB
        • Kaczkowski PJ
        • Nicholls JI
        • Harrington GW
        Comparison of two ultrasonic instruments for post removal.
        J Endod. 2002; 28: 111-115
        • Buoncristiani J
        • Seto BG
        • Caputo AA
        Evaluation of ultrasonic and sonic instruments for intraradicular post removal.
        J Endod. 1994; 20: 486-489
        • Altshul JH
        • Marshall G
        • Morgan LA
        • Baumgartner JC
        Comparison of dentinal crack incidence and of post removal time resulting from post removal by ultrasonic or mechanical force.
        J Endod. 1997; 23: 683-686
        • Frank AL
        The dilemma of the fractured instrument.
        J Endod. 1983; 9: 515-516
        • Fors UG
        • Berg JO
        Endodontic treatment of root canals obstructed by foreign objects.
        Int Endod J. 1986; 19: 2-10
        • Chenail BL
        • Teplitsky PE
        Orthograde ultrasonic retrieval of root canal obstructions.
        J Endod. 1987; 13: 186-190
        • Berutti E
        • Chiandussi G
        • Gaviglio I
        • Ibba A
        Comparative analysis of torsional and bending stresses in two mathematical models of nickel-titanium rotary instruments: protaper versus profile.
        J Endod. 2003; 29: 15-19
        • Wong R
        • Cho F
        Microscopic management of procedural errors.
        in: Microscopes in endodontics, Dent Clin North Am. 41. W.B. Saunders, Philadelphia1997: 455-479
        • Gorni FGM
        • Gagliani MM
        The outcome of endodontic retreatment: a 2-year follow-up.
        J Endod. 2004; 30: 1-4
        • Crump MC
        • Natkin E
        Relationship of broken root canal instruments to endodontic case prognosis: a clinical investigation.
        JADA. 1970; 80: 1341-1347
        • Nagai O
        • Tani N
        • Kayaba Y
        • Kodama S
        • Osada T
        Ultrasonic removal of broken instruments in root canals.
        Int Endod J. 1986; 19: 298-304
        • Hulsmann M
        Removal of fractured instruments using a combined automated/ultrasonic technique.
        J Endod. 1994; 20: 144-146
        • Masserann J
        The extraction of instruments broken in the radicular canal: a new technique.
        Acta Odont Stomatol. 1959; 47: 265-274
        • Ruddle CJ
        Ruddle on retreatment, 4-part DVD series. James Lowe Productions/Studio 2050, producers. Advanced Endodontics, Santa Barbara2004
        • Baumgartner C
        Advanced endodontics: ruddle on retreatment.
        J Endod. 2002; 28: 413
        • Mines P
        • Loushine RJ
        • West LA
        • Liewehr FR
        • Zadinsky JR
        Use of the microscope in endodontics: a report based on a questionnaire.
        J Endod. 1999; 25: 755-758
        • Ward JR
        • Parashos P
        • Messer HH
        Evaluation of an ultrasonic technique to remove fractured rotary nickel-titanium endodontic instruments from root canals: an experimental study.
        J Endod. 2003; 29: 756-763
        • Ward JR
        • Parashos P
        • Messer HH
        Evaluation of an ultrasonic technique to remove fractured rotary nickel-titanium endodontic instruments from root canals: clinical cases.
        J Endod. 2003; 29: 764-767
        • Ruddle CJ
        Broken instrument removal.
        Endodontic Practice. 2003; 6: 13-22
        • Hulsmann M
        • Schinkel I
        Influence of several factors on the success or failure of removal of fractured instruments from the root canal.
        Endod Dent Traumatol. 1999; 15: 252-258
        • Peters OA
        • Laib A
        • Rüegsegger P
        • Barbakow F
        Three dimensional analysis of root canal geometry using high resolution computed tomography.
        J Dent Res. 2000; 79: 1405-1409
        • Rhodes JS
        • Pitt Ford TR
        • Lynch PJ
        • Liepins PJ
        • Curtis RV
        Micro-computed tomography: a new tool for experimental endodontology.
        Int Endod J. 1999; 32: 165-170
        • Gorni FGM
        The removal of broken instruments.
        Endodontic Practice. 2001; 4: 21-26
        • Carr GB
        Ch. 24: retreatment.
        in: Cohen S Burns RC Pathways of the pulp. 7th ed. Mosby, St. Louis1998: 791-834
        • Ruddle CJ
        Ch. 8: cleaning and shaping root canal systems.
        in: Cohen S Burns RC Pathways of the pulp. 8th ed. Mosby, St. Louis2002: 231-291
        • Ruddle CJ
        Ruddle on clean-shape-pack, 2-part video set/DVD. Studio 2050, producer. Advanced Endodontics, Santa Barbara2002
        • Nehme WB
        Elimination of intracanal metallic obstructions by abrasion using an operational microscope and ultrasonics.
        J Endod. 2001; 27: 365-367
        • Fors UGH
        • Berg JO
        A method for the removal of broken endodontic instruments from root canals.
        J Endod. 1983; 9: 156-159
        • Hulsmann M
        Removal of silver cones and fractured instruments using the canal finder system.
        J Endod. 1990; 16: 596-600
        • Ruddle CJ
        Finishing the apical one-third.
        Endod Practice. 2002; 5: 15-26
        • Eleazer PD
        • O’Connor RP
        Innovative uses for hypodermic needles in endodontics.
        J Endod. 1999; 25: 190-191
        • D’Arcangelo C
        • Varvara G
        • De Fazio P
        Broken instrument removal—two cases.
        J Endod. 2000; 26: 368-370
        • Roig-Greene JL
        The retrieval of foreign objects from root canals: a simple aid.
        J Endod. 1983; 9: 394-397
        • Suter B
        A new method for retrieving silver points and separated instruments from root canals.
        J Endod. 1998; 24: 446-448
        • Kvist T
        • Reit C
        Results of endodontic retreatment: a randomized clinical study comparing surgical and nonsurgical procedures.
        J Endod. 1999; 25: 814-817