Endodontic retreatment utilizing a conservative gutta-percha removal instrument

Editor’s intro: Although removing existing gutta percha from previously treated root canals can be accomplished in several ways, this conservative gutta-percha removal instrument has many benefits for root canal retreatment.

Dr. Nishan Odabashian discusses how this instrument benefits his retreatment process

According to the American Dental Association publication 2005-06 Survey of Dental Services Rendered, approximately 22.6 million endodontic procedures were performed each year of the survey.¹ Over the next decade, that number increased to closer to 25 million endodontic procedures annually. Initial endodontic treatment success is reported in the endodontic literature with a wide range from a low of 59% to a high of 95%.^2,3 That translates to a failure rate of approximately 5% to 40%! Even if we consider a more conservative 10% failure rate, considering that there are more studies demonstrating success range of initial endodontic treatment to be closer to 90%, that translates to 2.5 million retreatment cases — less those that are planned for surgery or extracted. These numbers are corroborated when the clinician considers the percentage of teeth that are retreated in the private endodontic office. As an example, my practice consists of 60% initial endodontic treatment and 40% of endodontic retreatment. This is likely because I’m a specialist and am referred retreatment-type cases rather than initial root canal treatment.

Several years ago, as I walked through the Exhibit Hall at the American Association of Endodontists Annual Meeting, I came across a gutta-percha removal instrument at the DenMat booth. At first glance, it looked like an endodontic explorer; but on closer examination, I observed it had small hooks at each end (Figure 3). I was intrigued and purchased a set; upon return to my practice, I fell in love with the instruments after the first use.

Removing existing gutta percha from previously treated root canals can be accomplished several ways. This includes using a Gates Glidden bur to remove the coronal part of the gutta percha; using a GPX file, soaking the canal with chloroform and using hand K-type or Hedstrom files; or using a heating System B® or similar instruments. Every method has its unique advantages and disadvantages.

The beauty of using the DenMat Gutta-Percha Removal Instrument is that it eliminates the majority of the disadvantages of the previously mentioned methods. It maintains the size of the canal as is; greatly reduces the amount of chloroform used, specifically in the coronal two-thirds of the canal; and saves time in the gutta-percha removal process of retreating a failing root canal treatment.

Simply by heating the gutta percha using heating pluggers (e.g., System B), the instruments, which have the hooks pointing in four different directions (two on each instrument), are introduced to remove the gutta percha from the canals by latching on to the softened gutta percha (Figure 1) and pulling against the inner wall of the tooth. The DenMat Gutta-Percha Removal Instruments come in two lengths for both regular length and longer canals (Figure 2).

Tooth conservation during root canal treatment continues to gain importance among restorative and endodontic community as well as our patients. As such, I favor the use of these DenMat instruments during root canal retreatment. Additional uses of this conservative instrument are removal of pulp tissue; removal of the cotton pellet or endo sponge during the second appointment in multi-visit endodontic cases; removal of loose dentin chips that lodge into the prepared canal; and, in the rare case of a separated instrument being loose in the canal, the ability to insert the gutta-percha instrument hook alongside of the SI and remove it.

I have come to use the instrument on so many occasions, that it is now part of my routine endodontic setup. I am confident that the DenMat Gutta-Percha Removal Instrument and implemented as part of the regular endodontic tray setup for anyone performing retreatment and/or conservative endodontics.

After reading about Dr. Odabashian’s use of a conservative gutta-percha removal instrument, read about Dr. Virdee’s approach to retreatment of a maxillary first molar in Endodontic retreatment of a maxillary first molar. If you are a subscriber, take the quiz and receive your 2 CE credits!