Retreatment (4th year)

Non-Surgical
Retreatment
Oh My God! I hate
that ?@!!@? dentist
he keeps sending me
those failed root
canals for me to ﬁx!!!

Dr. Ashraf Refai
BDS Msc DD HMD
Al-Azhar University

Lecturer of
AshrafRefai
Samir
Endodontics
Al-Azhar University
BDS MSc DD HMD

ashraf_refai@hotmail.com
Ashraf Samir Refai
www.arefai.edublogs.org
www.idclinics.com
+20101434323

What
IsRetreatment?

Non-Surgical
Surgical

Of
Steps RCT
Non-Surgical
Finding & Removal of
Coronal
Negotiating Obturation
Disassembly
Missed Canals Materials

Managing
Removal of
Perforation blocks ledges &
Posts, Fractured
Repair apical
instruments
perforations

Coronal
Disassembly
Three
Possibilities
Intact Properly
Intact Properly Constructed Restoration
Constructed (Needs Extra Access)
Restoration
(No need for extra
access)
Improperly
Constructed
Restoration

Coronal
Disassembly
Grasping
Instrument

Percussive
Instrument

Active
Instrument

Coronal
Disassembly
Cementing
Removal Device Agent

Factors
Affectin
Restoration
g Design
Removal
Preparation
Type Restoration
Type

Coronal
Disassembly

Grasping
Instrument

Coronal
Disassembly

Percussive
Instruments

Coronal
Disassembly

Active
Instruments

Finding
Missed Canals
Familiarity with
Anatomy

Techniques

Armamentarium

Finding
Missed Canals
Radiographic Analysis

SLOB Rule

Centralization
of the
Obturation

Finding
Missed Canals
Vision & Microscopy

Finding
Missed Canals
Properly Accessed
Tooth

Finding
Missed Canals
Ultrasonics

Finding
Missed Canals Size #10 & #15

Micro-Openers
7 mm
4% & 6%
Taper

Angulated for
Comfort

Finding
Missed Canals
Methylene
Dyes Blue

Finding
Missed Canals
NaOCl Test

Bubbling at the
Suspected Area

Finding
Missed Canals
Transillumination

Color

Explorer
Pressure

Finding
Missed Canals

White Line Test

Red Line Test

The Road to
Hell is Paved
with Good
Intention…

NegotiatingThose
Canals
Molars are difficult

Conventionally done with
stainless steel instruments &
lubricants

#8, #10 & #15

Of Using
Conventional
Disadvantages Methods…
They take time to negotiate

Errors

Ledging
Apical zipping
Canal Transportation

A NiTi
Rotary
Solution…

Pathﬁles

Review
1. What is
Retreatment?
2. Causes of
Failure
3. Steps of
Retreatment
I. Coronal
Disassembly
II. Negotiation of
Missed Canals

Of
Removal Obturation
Materials

Obturation
Materials

Silver Gutta Resilon Carrier
Points Percha Based
Materials

Of
RemovalSilver Points
Careful Removal
of Filling
Material

Use Ultrasonics &
Surgical burs

Of
Grasping
Instrument

Try to use a Fulcrum Don’t Over
Manipulate

Of
Indirect
Ultrasonics

Don’t Touch the Silver
Trough Around the Point Directly
Sivler Point

Of
Files, Solvents &
Chelators

Of
Micro Tube &
Glue

Of
Micro Tube &
Files

Of

IRS
Instrument Removal
System

Of

IRS
0.8 mm

0.6 mm

MicroTube

Instrument Removal
System

Screw Wedge

Of

Create
Staging Expose The Position The Insert The Remove The
Platform Silver Point Micro tube Screw Wedge & Apparatus
or Secure The
Instrument Silver point or
nstrument

Of
RemovalGutta Percha
Files & Solvent

Of
RemovalGutta Percha
Heat &
Instrument
Removal

Of
RemovalGutta Percha
Heat Removal of
Gutta Percha

Of
RemovalGutta Percha
Ultrasonic
Removal

Of
RemovalGutta Percha
Paper Points &
Solvent
(Wicking)

Of
RemovalGutta Percha
Rotary Niti
Instrument
Removal

ProTaper
Retreatment

Of
RemovalResilon & Co.

Similar to
Gutta Percha
Techniques

Of
RemovalCarrier Based
Obturation
Fulcrum
Mechanics
IRS
Files & Solvent
Ultrasonics

Rotary Instrument
Removal

Of
RemovalPosts & Fractured
Instruments
Post Removal
Type of Post Type of
Cement
Factors
Affecting Anatomy
Removal

Material of
Accessibilit
Make
y

Of
Instruments
Post Removal
1. Gain SLA
2. Remove Material
From Around Post
3. Apply Method of
Removal

Of
Instruments
Post Removal Rotosonic
Vibration

Ultrasonic
Vibration

Mechanical
Method

Of
Instruments
Post Removal

Of
Instruments
Fractured
Instrument St. St. vs NiTi Size of the
Removal Instrument
Bound vs
Unbound
Factors Instrument
Affecting Design
Level of
Removal
Fracture

Of
Instruments
Fractured
Instrument
1. Gain SLA
Removal
2. Create Staging
Platform
3. Apply Method of
Removal

Of
Instruments
Fractured Microtubes &
Instrument IRS
Removal

Ultrasonic
Vibration

Blocks &
Managing Ledges
Managing Causes?
Blocks Take
Radiographs
Precurve
Instruments
Copious
Irrigation &
Pecking & Lubrication
Watch Winding
Motion

Blocks &
Managing Ledges
Managing
Ledges

Causes? Take
Radiographs

Precurve Scratch out
Instruments the ledge

Blocks &
Managing Ledges
Managing Apical
Transportation

Type I: Type II: Type III:
Obturate Retreated Surgical
Retreatment
MTA

Review
3. Steps of
Retreatment
III. Methods of
Removal of
Obturation
Materials
IV. ProTaper
Retreatment
V. Fractured
Instrument Removal
VI. Post Removal
VII. Managing
Blockages & Ledges

Non-Surgical Perforation
Repair

Before

After

Repair
Considerations
Timing
Location

Size
Level

Repair
Considerations Timing

Good Bad
Prognosis Prognosis

Immediate
1 Week 1 Month 6 Months 1 Year
Repair

Repair
Considerations Location

Buccal
Lingual
Surgical vs
Mesial
Distal
Non-Surgical
Furcal

Accessibility

Repair
Considerations Level

Causes
Coronal
Intraoral
Middle
Communication
Apical
Prognosis

Repair
Size
Considerations

Surface Area

Prognosis

Repair
Repair Materials Amalgam Tattoo

Difficult to
Manipulate

No Longer
Reccomended

Amalgam

Repair
Repair Materials 1985

Reinforced ZOE

White in Color

Amalgam Seals Better
Super EBA

Repair
Repair Materials Early 1990’s

Moisture
Sensitive

Tooth Colored

Soluble: Leaching
Glass Ionomer

Repair
Repair Materials Tooth Colored

Complex
Technique

Sensitive To Moisture

Bonded Composites

Repair
Repair Materials

All other Materials are
Sensitive To Moisture MTA

Repair
What Is it?

1990’s Torbindejad LomaLinda MTA

Repair
Chemical •Calcium Oxide 65%
Compostion •Silicon Dioxide 21%
•Ferric Oxide 5%
•Aluminum Oxide 4%
•Calcium Suflate 2.5%
•Magnesium Oxide 2%

MTA

Repair
pH: 12.5
Properties

Working Time: 5-6 min

Setting Time: 4-6 hrs

Radioopaque
Biocompatible
Needs Moisture To Set MTA

Repair
Biocompatible
Advantages

Highly
Inductive

Sealing Ability
MTA

Repair
Long Setting
Disadvantages Time

Difficult to
Handle

Grey Color
MTA

Repair
Uses Apexification

Perforation
Repair Pulpotomy
Root End
Filling
Pulp Capping
MTA

Repair
Basic Steps

Hemostasis
Applications of Barrier
Material
Repair of Perforation

Repair
Hemostasis
Calcium Hydroxide
(4 to5 Min in the Canal)

MTA
Calcium
Sulfate
Freeze Dried Bone
Collagen

Repair
Application of
Barrier Material

Absorbable Non-Absorbable
Collagen (CollaCote)
Calcium Sulfate MTA
(Capset)

Repair
Repair Of
Furcation Or
Coronal
Perforation
Step #1

Prepare &
Obturate The
Canals Fresh or Long Standing

Repair
Repair Of
Furcation Or
Coronal
Perforation
Step #2

Prepare the
Perforation
Fresh or Long Standing

Repair
Repair Of
Furcation Or
Coronal
Perforation
Step #3

Hemostasis

Repair
Repair Of
Furcation Or MTA is the
Coronal Material of Choice
Perforation
Step #4 •If There is a Sulcular
Communication MTA Can’t
be Used
Apply Barrier
•Choice Depends on
& Repair Esthetics (Old Gery)
Material

Repair
MTA is Difficult
to Handle

MAP System: Micro Apical Placement System

Repair
More Difficult to
Repair Of Reach
Middle & Apical
1/3 Perforations
Possibility of
Canal Blockage
Principles
are the
Same If you Can’t Acquire Hemostasis Repair
Perforation First (Maintain Canal)

Review
3. Steps of
Retreatment
IX. Non-Surgical
Perforation
Repair

Retreatment (4th year)

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