Selective Retreatment of a Three-Canalled Mandibular Premolar using Cone Beam Computed Tomography: 5-Year Follow-up

Öz

Root canal retreatment is traditionally considered an “all or none” treatment approach. However, the use of three-dimensional imaging such as cone-beam computed tomographic imaging allows for a more accurate evaluation of the periapical status of individual roots associated with multi-rooted teeth. This information has introduced a novel and conservative treatment alternative for previously endodontically treated teeth with multiple roots presenting with post-treatment disease. This new approach is termed selective root retreatment. This case report presents the selective retreatment by using CBCT and 5-year follow-up of the lower second premolar tooth, which has been previously treated with canal treatment but has recurrent infection symptoms. The patient was followed up for 6 months, 1 year and 5 years. At control appointments, the patient was asymptomatic and radiographic evaluation showed that periapical infection had healed. This case report shows that the selective retreatment method can be successfully applied to multi-rooted teeth with symptoms of recurrent infection after root canal treatment.

Anahtar Kelimeler

• Cone beam computed tomography
• multi-rooted tooth
• reinfection
• selective retreatment

Kaynakça

1. Aguiar, C., Mendes, D., Camara, A., Figueiredo, J. (2010). Endodontic treatment of a mandibular second premolar with three root canals. J Contemp Dent Pract, 11(2), 078-084.
2. Barnett, F., Abbott, J., Hartwell, G. (2011). Cone beam-computed tomography in endodontics. Endodontics: colleagues for excellence. Chicago: American Association of Endodontists, 1-7.
3. Bram, S. M., Fleisher, R. (1991). Endodontic therapy in a mandibular second bicuspid with four canals. J Endod, 17(10), 513-515.
4. Chan, K., Yew, S. C., Chao, S. Y. (1992). Mandibular premolar with three root canals--two case reports. Int Endod J, 25(5), 261-264.
5. Cleghorn, B. M., Christie, W. H., Dong, C. C. (2008). Anomalous mandibular premolars: a mandibular first premolar with three roots and a mandibular second premolar with a C-shaped canal system. Int Endod J, 41(11), 1005-1014.
6. Davis, S., Gluskin, A. H., Livingood, P. M., Chambers, D. W. (2010). Analysis of temperature rise and the use of coolants in the dissipation of ultrasonic heat build-up during post removal. J Endod, 36(11), 1892-1896.
7. Friedman, S., Abitbol, S., Lawrence, H. P. (2003). Treatment outcome in endodontics: the Toronto Study. Phase 1: initial treatment. J Endod, 29(12), 787-793.
8. Friedman, S., Mor, C. (2004). The success of endodontic therapy--healing and functionality. J Calif Dent Assoc, 32(6), 493-503.

9. Lotfi, M., Vosoughhosseini, S., Zand, V., Fatemi, A., Shyezadeh, V., Ranjkesh, B. (2008). A mandibular second premolar with three canals and atypical orifices. J Oral Sci, 50(3), 363-366.
10. Maggiore, F., Jou, Y. T., Kim, S. (2002). A six-canal maxillary first molar: case report. Int Endod J, 35(5), 486-491.
11. Nair, P. N. (1999). Cholesterol as an aetiological agent in endodontic failures--a review. Aust Endod J, 25(1), 19-26.
12. Nair, P. N. (2006). On the causes of persistent apical periodontitis: a review. Int Endod J, 39(4), 249-281.
13. Nair. P. N., Sjogren, U., Krey, G., Sundqvist, G. (1990). Therapy-resistant foreign body giant cell granuloma at the periapex of a root-filled human tooth. J Endod, 16(12), 589-595.
14. Nudera, W. J. (2015). Selective root retreatment: a novel approach. J Endod, 41(8), 1382-1388.
15. Parekh, V., Shah, N., Joshi, H. (2011). Root canal morphology and variations of mandibular premolars by clearing technique: an in vitro study. J Contemp Dent Pract, 12(4), 318-321.
16. Patel, S. (2009). New dimensions in endodontic imaging: part 2. Cone beam computed tomography. Int Endod J, 42(6), 463-475.
17. Peters, O. A., Barbakow, F., Peters, C. I. (2004). An analysis of endodontic treatment with three nickeltitanium rotary root canal preparation techniques. Int Endod J, 37(12), 849-859.
18. Poorni, S., Karumaran, C. S., Indira, R. (2010) Mandibular first premolar with two roots and three canals. Aust Endod J, 36(1), 32-34.
19. Prakash, R., Nandini, S., Ballal, S., Kumar, S. N., Kandaswamy, D. (2008). Two-rooted mandibular second premolars: case report and survey. Indian J Dent Res, 19(1), 70-73.
20. Ramachandran Nair, P. N., Pajarola, G., Schroeder, H. E. (1996). Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 81(1), 93-102. Doi: 10.1016/s1079-2104(96)80156-9
21. Roda, R. S. (2006). Nonsurgical retreatment. Pathways of the Pulp, 944-1010.
22. Schilder, H. (1967). Filling root canals in three dimensions. Dent Clin North Am, 723-744.
23. Schilder, H. (1974). Cleaning and shaping the root canal. Dent Clin North Am, 18(2), 269-296.
24. Torabinejad, M., Anderson, P., Bader, J. (2007). Outcomes of root canal treatment and restoration, implant supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review. J Prosthet Dent, 98(4), 285-311.
25. Tronstad, L., Barnett, F., Cervone, F. (1990). Periapical bacterial plaque in teeth refractory to endodontic treatment. Endod Dent Traumatol, 6(2), 73-77.
26. Vertucci, F. A., Francois, K. J. (1986). Endodontic therapy of a mandibular second premolar: a case report with clinical correlations. Fla Dent J, 57(1), 25-27.
27. Vertucci, F. J., Haddix, J. E. (2011). Tooth morphology and access cavity preparation. Cohen’s Pathways of the Pulp, Elsevier, 136-222.