Endodontic retreatment that sets the stage for dental success

Endodontic Insight

Dr. Stephanie Tran depends on tools from SS White to increase her direct and indirect restorative options.

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Dr. Stephanie Tran discusses the tools she uses for minimally invasive endodontics

”Begin with the end in mind.” That key principle from Stephen R. Covey’s book, The 7 Habits of Highly Effective People, can be used to describe the modern concept of restoratively driven endodontics. Root canal treatment has always been about maintaining the tooth so that it can be functional and free of disease, and in recent years we have seen a shift toward more minimally invasive treatment that also conserves more tooth structure and sets the stage for a successful long-term restoration.1,2 Endodontic retreatment aims to manage previously treated cases with persistent or recurrent apical periodontitis. Like modern restorative dentistry concepts trending toward more conservative prep designs and advancements in bonding, contemporary endodontic retreatment can also consequently enhance the survival rate and thus the options of direct and indirect restorative options for the restorative dentist.3

Figures 1A and 1B: Retreatment with Tooth No. 3 (ExactTaperH DC)

Minimally invasive techniques have emerged as a cornerstone in modern endodontic practice, focusing on preserving tooth structure while effectively managing endodontic cases. This idea of restoratively driven endodontics is a newer phenomenon that wasn’t always possible. With advancements in magnification and visualization along with the contemporary armamentarium, we are able to conservatively remove the restorative material as well as remove less tooth structure. By removing less tooth structure and preserving the maximum amount of peri-cervical dentin, we’re helping to prevent future coronal and root fractures in the restored tooth.4,5

Figure 2: Anterior post removal easily achieved using the EndoGuide (EG3) to delicately remove core build-up around the post.

The chance of teeth with apical periodontitis to completely heal after initial treatment or retreatment is 74% to 86%, and their chance to be functional over time is 91% to 97%.6,7,8 Endodontic retreatment has a high success even with previous techniques, and with modern armamentarium and technology, we can improve the conservation of tooth structure and the efficacy of restorative material removal for retreatment. It has been shown that the endodontic access can affect the fracture load of crowns.9,10

SS White has a variety of burs that can reduce the microfractures and decrease the chance of crown fracture. For example, Great White®Z Diamonds are designed for Endo Access in all types of ceramic crowns such as Zirconia, Lithium Disilicate, e.max® and BruxZir®, reducing the chance of micro-fracture. The SS White SmartBursII® instruments are used with biomimetic principles to safely remove soft carious dentin and will not cut harder, healthier tissues (enamel, healthy dentin) or amalgam or composite, allowing for an increase of maintaining tooth structure.

Figures 3-7: Conservative removal of restoration and cast post using Great White Ultra

Efficient, straight-line access to canals is achievable with EndoGuide, a unique set of eight carbide burs for non-surgical root canal treatment. The funnel-shaped bur design improves canal visualization, removing less tooth structure while unveiling missed anatomy and untreated canals for root canal retreatment. The conical shaped micro-diameter tip acts as a self-centering guide for precision access to canals to remove root-filling materials and clean isthmuses while conserving healthy peri-cervical dentin. The minimally invasive high-speed carbides both from this kit as well as the SS White Great White carbides can be used in conjunction to conservatively remove restorative materials and loosen posts for retreatment of even some of the most daunting cases.

For removal of the root filling materials conservatively and efficiently, the Exact Retreatment File system uses heat treatment technology and a minimally invasive design to remove root canal obturating material such as gutta percha, carrier-based obturators, and fillers from coronal, middle, and apical thirds of root canal prior to canal reshaping. These heat-treated and controlled-memory NiTi rotary files are more flexible with increased resistance to cyclical and tortional fatigue. They also have a smaller maximum flute diameter which still allows for adequate instrumentation of the canal. These minimally invasive instruments allow for precise and controlled removal of gutta percha and sealer while minimizing stress on the root canal walls.

Through these contemporary techniques and technologies, restoratively driven endodontics results in more conservative yet effective management of the canal systems, and improved treatment options for the patient. Minimally invasive techniques have revolutionized the field of endodontic retreatment, offering a conservative yet effective approach to managing endodontic failures.14 By prioritizing tooth preservation and tissue conservation, these techniques ensure optimal treatment outcomes while minimizing patient discomfort and preserving long-term dental health. We are fortunate to work in a field that is constantly advancing, enabling us to work together to comprehensively take care of the patient by maintaining their teeth and giving it the greatest chance for long-term survival.

Besides delivering minimally invasive endodontics, SS White also cares about endodontists’ hand fatigue. Read about the ultralight Manta cordless handpiece for various stages of a root canal procedure here. https://endopracticeus.com/manta-cordless-endodontic-handpiece-ss-white-dental/

Stephanie Tran, DDS, is an endodontist who is passionate about endodontic education and helping patients relieve their dental pain while helping them maintain their teeth. Born in Connecticut and raised in California, Dr. Tran completed her undergraduate studies at the University of the Pacific in San Francisco, California. She completed a General Practice Residency program at SUNY Stony Brook University Medical Center, where she became experienced in managing advanced dental cases, trauma, and complex surgeries. After several years building her comprehensive dentistry background as a general dentist, Dr. Tran then decided to pursue her passion for endodontics. She completed her post-graduate endodontics specialty residency at the University of Tennessee Health Science Center, where she served as Chief Resident of the program. Dr. Tran is an experienced clinician who is trained in contemporary advanced endodontic techniques, microscopic surgical and nonsurgical endodontic treatment, and management of traumatic injuries. She provides endodontic treatment for both adults and pediatric patients in private practice, serving the New York City and Long Island, New York regions to help patients treat dental disease and save their teeth. She is also passionate about endodontic education and lectures both nationally and internationally to share her enthusiasm for endodontics with other clinicians along with posting on her social media @her_holiness_the_pulp. In her free time, Dr. Tran enjoys traveling, snorkeling, exploring NYC’s many restaurants and museums, cooking, and going to the beach with her dog.

 

Disclosure: Dr. Tran uses and lectures on SS White products.

  1. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature–Part 1. Composition and micro- and macrostructure alterations. Quintessence Int. 2007 Oct;38(9):733-743.
  2. Dimitriu B, Vârlan C, Suciu I, Vârlan V, Bodnar D. Current considerations concerning endodontically treated teeth: alteration of hard dental tissues and biomechanical properties following endodontic therapy. J Med Life. 2009 Jan-Mar;2(1):60-65.
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  12. Qeblawi D, Hill T, Chlosta K. The effect of endodontic access preparation on the failure load of lithium disilicate glass-ceramic restorations. J Prosthet Dent. 2011 Nov;106(5):328-336.
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  16. Plotino, G. Minimally Invasive Approaches in Endodontic Practice; Springer Nature: Cham, Switzerland, 2021

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