Cerrahi Olmayan Kök Kanal Tedavi Yenilemesi: Retrospektif Başarı Değerlendirmesi

Amaç: Kök kanal tedavisi (KKT) başarısız olduğunda tedavinin yenilenmesi (TY) endikedir. Bu araştırmada, cerrahi olmayan TY’nin uzun dönemde gösterdiği başarı oranının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: 2013-2014 yılları arasında TY’si tamamlanan 132 hasta, gerek klinik olarak gerekse radyolojik inceleme ile 5 sene boyunca takip edildi. Bu süre içerisinde, kayıplar ile birlikte 83 hastaya erişildi. Paralel-kon tekniği kullanılarak alınan radyografiler JPEG formatında saklandı ve değerlendirildi. Hastaların intra-oral muayeneleri TY’den sonra 6 ay ve 1-5 sene arasında tamamlandı. Bulgular: TY’sini takiben %10,8 (n=9) hastada perküsyon sırasında duyarlılık kayıt edildi. %6,2 (n=5) oranında, farklı çaplarda fistül varlığı saptandı. %83 (n=69) oranında hasta “tamamen iyileşmiş” olarak kabul edildi. Bununla birlikte, %17 (n=31) oranında “iyileşmeyen” hasta olduğu saptandı. TY’den sonra, kök kanal dolgusunun kalitesi değerlendirildiğinde, çalışma uzunluğuna ulaşmayan kök kanallarının sayısı belirlendi. Kök kanallarının %84,3’nün “uygun”, %15,7’sini “kısa” dolgular olduğu görüldü.

Non-surgical Root Canal Retreatment: A Retrospective Outcome Study

Objective: When the prognosis of a root canal treated (RCT) teeth is poor, retreatment (RT) of the former RCT is indicated. The aim of this study was to assess the long-term success rate of nonsurgical retreatment for five years.Materials and Methods: RTs were performed on 132 patients in 2013-2014; after drop-outs, 83 patients were enrolled clinically and radiographically after 5 years. The parallel-cone technique was used with a film holder, and radiographs were saved in JPEG format for further evaluation. In addition, intra-oral examinations were performed for RTs at 6 months and 1 to 5 years.Results: After 5 years of follow-up, only 83 of the 132 patients could be reached and assessed. Following RTs, 10.8% (n=9) of the patients were symptomatic on percussion, 6.2% (n=5) patients had sinus tracts with different diameters, 83% (n=69) of the patients were accepted as "healed teeth", and 17% (n=31) patients were accepted as "unhealed". When the quality of the root canal obturation after RT was evaluated, the number of root canal obturations short of the working length were evaluated. 84.3% of the root canals were accepted as "good" and 15.7% of the others were accepted as "short" root canals.Conclusion: Providing the proper working length may help to eliminate residual bacteria in the untouched regions and improve the quality of the new treatment for tooth survival in regard to better disinfection.

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1. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 1974; 18: 269-96.
2. Paik S, Sechrist C, Torabinejad M. Levels of evidence for the outcome of endodontic retreatment. J Endod 2004; 30: 745-50.
3. Stabholz A, Friedman S. Endodontic retreatment - case selection and technique. Part 2: Treatment planning for retreatment. J. Endod 1988; 14: 607-14.
4. Imura N, Kato AS, Hata GI, Uemura M, Toda T, Weine F. A comparison of the relative efficacies of four hand and rotary instrumentation techniques during endodontic retreatment. Int Endod J 2000; 33: 361-6.
5. Schirrmeister JF, Wrbas KT, Schneider FH, Altenburger MJ, Hellwig E. Effectiveness of a hand file and three nickel-titanium rotary instruments for removing gutta-percha in curved root canals during retreatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 542-7.
6. European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 2006; 39: 921-30.
7. Çalışkan MK. Endodontide Tanı ve Tedaviler. Nobel Tıp Kitabevi, İstanbul 2006: 136-7.
8. Orstavik D. Time-course and risk analyses of the development and healing of chronic apical periodontitis in man. Int Endod J 1996; 29: 150-5.
9. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: Part 1: periapical health. Int Endod J 2011; 44: 583-609.
10. Trope M, Delano EO, Orstavik D. Endodontic treatment of teeth with apical periodontitis: Single vs. multivisit treatment. J Endod 1999; 25: 345-50.
11. Dorasani G, Madhusudhana K, Chinni SK. Clinical and radiographic evaluation of single visit and multi-visit endodontic treatment of teeth with periapical pathology: An in vivo study. J Conserv Dent 2013; 16: 484-8.
12. Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J 1995; 28: 12-8.
13. Eliyas S, Briggs PFA, Harris IR, Newton JT, Gallagher JE. Development of quality measurement instruments for root canal treatment. Int Endod J 2017; 50: 652-66.
14. Huumonen S, Ørstavik D. Radiographic follow-up of periapical status after endodontic treatment of teeth with and without apical periodontitis. Clin Oral Investig 2013; 17: 2099-104.
15. Stoll R, Betke K, Stachniss V. The influence of different factors on the survival of root canal fillings: a 10-year retrospective study. J Endod 2005; 31: 783-90.
16. Fonzar F, Fonzar A, Buttolo P, Worthington HV, Esposito M. The prognosis of root canal therapy: a 10-year retrospective cohort study on 411 patients with 1175 endodontically treated teeth. Eur J Oral Implantol 2009; 2: 201-8.
17. Nair PN, Sjögren U, Krey G, Sundqvist G. Therapy-resistant foreign body giant cell granuloma at the periapex of a root-filled human tooth. J Endod 1990; 16: 589-95.
18. Touboul V, Germa A, Lasfargues JJ, Bonte E. outcome of endodontic treatments made by postgraduate students in dental clinic of bretonneau hospital. Int J Dent 2014; 30: 1-11.
19. Hoskinson SE, Ng YL, Hoskinson AE, Moles DR, Gulabivala K. A retrospective comparison of outcome of root canal treatment using two different protocols. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 705-15.
20. Castelot-Enkel B, Nguyen JM, Armengol V, Volteau C, Laboux O, Lombrail P. A recall program for the outcome of conventional root canal treatment performed in a teaching hospital. Acta Odontol Scand 2013; 71: 1399-409.
21. Dammaschke T, Steven D, Kaup M, Ott KH. Long-term survival of root- canal–treated teeth: a retrospective study over 10 years. J Endod 2003; 29: 638-43.
22. Strindberg LZ. The dependence of the results of pulp therapy on certain factors: an analytic study based on radiographic and clinical follow-up examinations, Mauritzon. 1956.
23. Ricucci D, Russo J, Rutberg M, Burleson JA, Spångberg LS. A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: 825-42.
24. Mancini M, Palopoli P, Iorio L, Conte G, Cianconi L. Accuracy of an electronic apex locator in the retreatment of teeth obturated with plastic or cross-linked gutta-percha carrier-based materials: an ex vivo study. J Endod 2014; 40: 2061‐5.