Retreatment (orthograde revision). Clinical decisions and techniques. Module 3

Attention! 100 € – the cost of the registration fee. The full cost of the module is 794 €.

1. The concept of success and failure in endodontic treatment

– Comparison of the concepts of “success” in endodontics and implantology

– Modern classification of post-treatment outcomes (Healed, Healing, Disease)

– Analysis of clinical cases.

2. Factors leading to endodontic post-treatment disease

– Mechanical and biological approaches

– Intraradicular infection

– Errors during the treatment process

– Coronal sealing in modern dentistry and its impact on treatment prognosis

– Recommendations for retreatment: timing, and temporary restorations

– Extraradicular infection

– A trend or a clinical reality?

– Inadequate case selection

– Case report of misdiagnosis: periapical cemental dysplasia and cemento-ossifying fibroma

– The lack of (prosthodontic)restorative-periodontal evaluation

– Failure to utilize the tracing procedure

– Foreign body granuloma (talk, cellulose, cholesterol)

– True and pocket cysts

– Scar tissue

– Etiology, pathogenesis, and prognosis of foreign body granuloma, true and pocket cysts, and scar tissue. Detailed analysis of each group.

3. Predicting retreatments based on Fabio Gorni's study, and his author's decision-making scheme

4. Apical surgery and/or retreatment

– Modern microsurgical procedure aspects

– Advantages and disadvantages, risks, and prognosis of apical microsurgery

– Biological rationale for decision-making

– CBCT as a tool for treatment planning

– Healing peaks as traps for clinicians.

5. Clinical decision-making algorithm

– Based on the Stabholtz and Friedmann scheme updated by Dr. Solomonov, based on latest data and publications

– Treatment strategy of the two main problematic groups in everyday practice:

- Retreatment in the presence of endodontic pathology

- Retreatment as a preventive measure from endodontic pathology.

6. Technical aspects of retreatment

– Retreatment through the crown restoration

– Removal of crown/bridge 

– Removal of post and cores: metal and fiber posts

– Removal of cast restoration (Ultrasonic, Gonon extractor, Ruddle extractor, Masseran kit)

– Clinical techniques of retreatment:

- Gutta-percha

- Carrier-based gutta-percha (Termafil, Softcore)

- Zinc phosphate cement

- Resorcinol-formaldehyde

- Silver posts

- Paste fillings

- Instruments, chemical agents, clinical nuances, and cases.

7. Broken instruments

– Dr. Solmonov proposes a clinical decision tree based on the following factors:

- The vitality of the tooth (whether it is vital or infected)

- The stage of canal cleaning and shaping, whether it is in the initial or final stage

- The location of the broken fragment, whether it is broken before or after the canal curvature.

– Based on this scheme, the clinician can decide to either attempt to remove the instrument, choose leave it inside the canal, or try to bypass using anatomical rationale and technical procedures

– A detailed description of techniques for retrieving broken instruments.

8. Review of ultrasonic devices and tips used in Endodontics

– Spartan (MTS): CPR tips

– EMS / Sybronendo (mini piezon): RT1, RT2, RT3

– Satellec (P5, Newtron): ET20, ET(D)40, ET 25, K10/21/25, S04

– Osada (Enac): ST 17, ST 21

– NSK (Varios): E7, E6

– The Proultra tip

– The B&L tip

– Principle of action and applications: direct and indirect ultrasonic methods of work, clinical guidelines, compatibility with various diameters.

9. Perforations

Modern classification, factors influencing prognosis, treatment methods, and a review of materials used for perforation treatment: IRM, SuperEBA, MTA (ProRoot, MTA-Angelus, MM-MTA), BC Putty.