Zanza Alessio, Reda Rodolfo, Testarelli Luca
Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy.
Clin Cosmet Investig Dent. 2023 Oct 24;15:245-265. doi: 10.2147/CCIDE.S397835. eCollection 2023.
Endodontic orthograde retreatments are considered one of the possible treatment options in case of post-treatment diseases considering the promising results present in the literature. Despite this, a plethora of articles have been published on this topic, and drawing conclusions could be challenging. For this reason, this review aims to summarize the crucial points on each aspect of non-surgical endodontic retreatments, discussing and comparing the current protocols, techniques, materials, and indications. Taking into consideration data from the literature, in terms of diagnosis, CBCT should be considered the first choice, since it can thoroughly affect the diagnosis and treatment plan. Regarding the procedural phases, some conclusions can be drawn: when present, coronal restoration materials such as crowns, partial prostheses, post, and core should be removed; the use of magnification devices, ultrasonic instruments, and an in-depth interpretation of radiographic images with both 2D and 3D images are strongly recommended during the orifice location; additional protocols such as irrigants activation, ultrasonic cleaning, and rotary or reciprocating instrumentation of treated canals are strongly recommended for filling materials removal and to achieve a high-quality chemo-mechanical disinfection; perforations should be treated as soon as possible, and the material of choice to treat them is the MTA or other calcium-silicate-based repair materials; the presence of ledges does not intrinsically reduce the success rate of RCRts if properly managed; in case of instrument fragments, their removal should be considered as the first treatment option, however many variables should be considered to select the proper technique or consider the option of bypassing.
考虑到文献中呈现的良好结果，根管正向再治疗被认为是治疗后疾病的可能治疗选择之一。尽管如此，关于这个主题已经发表了大量文章，得出结论可能具有挑战性。因此，本综述旨在总结非手术根管再治疗各方面的关键点，讨论和比较当前的方案、技术、材料和适应症。考虑到文献数据，在诊断方面，CBCT应被视为首选，因为它可以全面影响诊断和治疗计划。关于操作阶段，可以得出一些结论：如果存在，应去除牙冠、部分修复体、桩核等冠部修复材料；在确定根管口时，强烈建议使用放大设备、超声器械，并对二维和三维射线图像进行深入解读；强烈推荐采用额外的方案，如激活冲洗液、超声清洗以及对已治疗根管进行旋转或往复式器械操作，以去除充填材料并实现高质量的化学机械消毒；穿孔应尽快处理，处理穿孔的首选材料是MTA或其他基于硅酸钙的修复材料；如果处理得当，台阶的存在并不会本质上降低根管再治疗的成功率；如果存在器械折断，应将其取出作为首要治疗选择，然而选择合适的技术或考虑绕过的选项时应考虑许多变量。
