Elif COŞKUN ŞAHİN, Berna KAHRAMAN, KAMRAN GÜLŞAHI

Kök Kanal Tedavisinin Yenilenmesine Güncel Bir Bakış

Kök kanal tedavisinin temel amacı, kök kanal sistemini temizlemek, şekillendirmek ve dişin tekrar enfeksiyonunu önlemek için 3 boyutlu doldurma sağlamaktır. Primer kök kanal tedavisinin başarısız olduğu durumlarda dişin yeniden tedavi edilmesi gerekir. Bu yeniden tedavi, cerrahi yöntemlerden önce endodontik olarak gerçekleştirilebilir. Tedavinin yenilenmesi, aynı hastalığın ilk tedavisinden sonra aynı yöntem veya alternatif bir yöntem ile tedavisi olarak tanımlanır. Kök kanal tedavisi yenilenmesinin başarısı önceki dolgu maddelerinin kök kanallarından tamamen uzaklaştırılmasına, kök kanalların yeniden şekillendirilmesine, temizlenmesine ve doldurulmasına bağlıdır. Uygun yapılmayan kök kanal preparasyonu, kanalların bulunamaması, eksik veya taşkın kök kanal dolgusu, post yerleştirilmesi sırasında yapılan hatalar, yetersiz izolasyon, perforasyonlar, alet kırıkları, dişin doğru restore edilmemesi gibi birçok faktör kök kanal dolgusunun başarısız olmasına sebep olabilir. Artan mekanik zorluklar ve kanaldaki mikrobiyal içeriklerin değişmesi nedeniyle önceki kök kanal tedavisi başarısız olan bir dişin yeniden tedavisi zorlu bir tedavi yaklaşımıdır. Bu sebeple kök kanal tedavisi yenilenmesinin zorlu bir tedavi yaklaşımı olduğu göz ardı edilmemeli, prognoz iyi değerlendirilmeli ve kök kanal tedavisi yenilenmesi uzman kişilerce yapılmalıdır. Günümüzde en sık kullanılan kök kanal dolgu maddesi güta-perkadır. Geçmişte kök kanal tedavisi yenilenmesi sırasında el aletleri ve çözücüler kullanılırken, teknolojinin ilerlemesi ve yeni materyallerin geliştirilmesiyle nikel titanyum döner alet sistemleri ve ilave sistemlerin kullanımı da yaygınlaşmıştır. Kök kanal tedavisi yenilenmesinde kullanılmak üzere özel üretilmiş döner alet sistemleri ve ilave sistemlerden faydalanılarak daha etkili ve hızlı bir tedavi uygulanabilmektedir. Bu makalenin amacı, kök kanal tedavisi yenilenmesi sırasında kullanılan materyalleri gözden geçirmek, döner alet sistemlerinin etkinliklerini incelemek ve güncel kök kanal tedavisi yenileme sistemlerinin etkinlikleri hakkında bilgi vermektedir.

Anahtar Kelimeler:

Kanal tedavisinin yenilenmesi, Çözücü, Enfeksiyon, Nikel-titanyum döner alet sistemleri (Ni-Ti)

A Current Overview of Root Canal Retreatment

The main purpose of root canal treatment is cleaning and shaping of root canal system and to prevent tooth re-infection by providing 3-dimensional obturation. The tooth must be re-treated in cases which primary root canal treatment was failure. This retreatment can be endodontically performed before surgical procedures. Retreatment is defined as repeating the treatment of the same disease by the same or an alternative method after the first treatment. The success of retreatment depends on the completely removal of previous filling materials from the root canals, reshaping, cleaning and filling of the canals. Many factors can cause failure of root canal obturation such as inappropriate canal preparation, absence of canals, incmplete or over of root canal filling, making mistakes during placement of post, insufficient isolation, perforations, instrument fractures, and improper restoration of tooth. Because of increasing mechanical difficulties and changing of microbial contents in the canal, retreatment of a tooth which had an unsuccessful previous therapy is a challenging treatment approach. For this reason, challenging of treatment should not be ignored, prognosis should be well evaluated and retreatment should be performed by specialists. Nowadays, the most commonly used root canal filling material is gutta-percha. In the past, hand tools and solvents were used to remove of gutta-percha, but with the advancement of technology and the development of new materials, the use of nickel-titanium rotary file systems and additional systems has become widespread. A more effective and faster treatment prosedure can be applied by using rotary instrument systems and additional systems which specially produced for use in retreatment. The purpose of this article is to review materials used for root canal retreatment, to examine the effectiveness of rotary instrument systems, and to provide information about the effectiveness of current root canal retreatment systems.

Keywords:

Root canal retreatment, Solvent, Infection, Nickel-titanium Rotary File Systems (Ni-Ti),

PDF

___

Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. Journal of endodontics. 2009 Jul;35(7):930–7.
Barrieshi-Nusair KM. Gutta-percha retreatment: effectiveness of nickel-titanium rotary instruments versus stainless steel hand files. Journal of endodontics. 2002 Jun;28(6):454–6.
Figdor D, Gulabivala K. Survival against the odds: Microbiology of root canals associated with post-treatment disease. Endodontic Topics. 2011;18:62–77.
Consensus report of the European Society of Endodontology on quality guidelines for endodontic treatment. International endodontic journal. 1994 May;27(3):115–24.
Lee B-S, Wang C-Y, Fang Y-Y, Hsieh K-H, Lin C-P. A novel urethane acrylate-based root canal sealer with improved degree of conversion, cytotoxicity, bond strengths, solubility, and dimensional stability. Journal of endodontics. 2011 Feb;37(2):246–9.
Nair PNR. On the causes of persistent apical periodontitis: a review. International endodontic journal. 2006 Apr;39(4):249–81.
Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. Journal of endodontics. 2011 Apr;37(4):429–38.
Alacam T. Endodonti. Ankara: Ozyurt Matbaacılık.; 2012.
Huumonen S, Ørstavik D. Radiological aspects of apical periodontitis. Endodontic Topics. 2002;1(1):3–25.
Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endodontics & dental traumatology. 1986 Feb;2(1):20–34.
Burry JC, Stover S, Eichmiller F, Bhagavatula P. Outcomes of Primary Endodontic Therapy Provided by Endodontic Specialists Compared with Other Providers. Journal of endodontics. 2016 May;42(5):702–5.
He J, White RK, White CA, Schweitzer JL, Woodmansey KF. Clinical and Patient-centered Outcomes of Nonsurgical Root Canal Retreatment in First Molars Using Contemporary Techniques. Journal of endodontics. 2017 Feb;43(2):231–7.
Duncan H, CHONG BUN. Removal of root filling materials. Endodontic Topics. 2011;19:33–57.
Hülsmann M, Stotz S. Efficacy, cleaning ability and safety of different devices for gutta-percha removal in root canal retreatment. International endodontic journal. 1997 Jul;30(4):227–33.
Hülsmann M, Bluhm V. Efficacy, cleaning ability and safety of different rotary NiTi instruments in root canal retreatment. International endodontic journal. 2004 Jul;37(7):468–76.
Takahashi CM, Cunha RS, de Martin AS, Fontana CE, Silveira CFM, da Silveira Bueno CE. In vitro evaluation of the effectiveness of ProTaper universal rotary retreatment system for gutta-percha removal with or without a solvent. Journal of endodontics. 2009 Nov;35(11):1580–3.
Khalilak Z, Vatanpour M, Dadresanfar B, Moshkelgosha P, Nourbakhsh H. In Vitro Comparison of Gutta-Percha Removal with H-File and ProTaper with or without Chloroform. Iranian endodontic journal. 2013;8(1):6–9.
Lee FS, Van Cura JE, BeGole E. A comparison of root surface temperatures using different obturation heat sources. Journal of endodontics. 1998 Sep;24(9):617–20
Lipski M, Woźniak K. In vitro infrared thermographic assessment of root surface temperature rises during thermafil retreatment using system B. Journal of endodontics. 2003 Jun;29(6):413–5.
de Mello Junior JE, Cunha RS, Bueno CE da S, Zuolo ML. Retreatment efficacy of gutta-percha removal using a clinical microscope and ultrasonic instruments: part I--an ex vivo study. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2009 Jul;108(1):e59-62.
Ladley RW, Campbell AD, Hicks ML, Li SH. Effectiveness of halothane used with ultrasonic or hand instrumentation to remove gutta-percha from the root canal. Journal of endodontics. 1991 May;17(5):221–4.
Walia HM, Brantley WA, Gerstein H. An initial investigation of the bending and torsional properties of Nitinol root canal files. Journal of endodontics. 1988 Jul;14(7):346–51.
Del Fabbro M, Afrashtehfar KI, Corbella S, El-Kabbaney A, Perondi I, Taschieri S. In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis. The journal of evidence-based dental practice. 2018 Mar;18(1):59–69.
Giuliani V, Cocchetti R, Pagavino G. Efficacy of ProTaper universal retreatment files in removing filling materials during root canal retreatment. Journal of endodontics. 2008 Nov;34(11):1381–4.
Marfisi K, Mercadé M, Plotino G, Clavel T, Duran-Sindreu F, Roig M. Efficacy of Reciproc(®) and Profile(®) Instruments in the Removal of Gutta-Percha from Straight and Curved Root Canals ex Vivo. Journal of oral & maxillofacial research. 2015;6(3):e1.
Madarati AA, Al-Nazzawi AA, Sammani AMN, Alkayyal MA. The efficacy of retreatment and new reciprocating systems in removing a gutta-percha-based filling material. Journal of Taibah University Medical Sciences. 2018 Oct;13(5):452–8.
Mollo A, Botti G, Prinicipi Goldoni N, Randellini E, Paragliola R, Chazine M, et al. Efficacy of two Ni-Ti systems and hand files for removing gutta-percha from root canals. International endodontic journal. 2012 Jan;45(1):1–6.
Marfisi K, Mercade M, Plotino G, Duran-Sindreu F, Bueno R, Roig M. Efficacy of three different rotary files to remove gutta-percha and Resilon from root canals. International endodontic journal. 2010 Nov;43(11):1022–8.
Madani ZS, Simdar N, Moudi E, Bijani A. CBCT Evaluation of the Root Canal Filling Removal Using D-RaCe, ProTaper Retreatment Kit and Hand Files in curved canals. Iranian endodontic journal. 2015;10(1):69–74.
Martins MP, Duarte MAH, Cavenago BC, Kato AS, da Silveira Bueno CE. Effectiveness of the ProTaper Next and Reciproc Systems in Removing Root Canal Filling Material with Sonic or Ultrasonic Irrigation: A Micro-computed Tomographic Study. Journal of endodontics. 2017 Mar;43(3):467–71.
Fruchi L de C, Ordinola-Zapata R, Cavenago BC, Hungaro Duarte MA, Bueno CE da S, De Martin AS. Efficacy of reciprocating instruments for removing filling material in curved canals obturated with a single-cone technique: a micro-computed tomographic analysis. Journal of endodontics. 2014 Jul;40(7):1000–4.
Jorgensen B, Williamson A, Chu R, Qian F. The Efficacy of the WaveOne Reciprocating File System versus the ProTaper Retreatment System in Endodontic Retreatment of Two Different Obturating Techniques. Journal of endodontics. 2017 Jun;43(6):1011–3.
de Souza PF, Goncalves LCO, Marques AAF, Junior ECS, Garcia L da FR, de Carvalho FMA. Root canal retreatment using reciprocating and continuous rotary nickel-titanium instruments. European journal of dentistry. 2015;9(2):234–9.
Crozeta BM, Silva-Sousa YTC, Leoni GB, Mazzi-Chaves JF, Fantinato T, Baratto-Filho F, et al. Micro-Computed Tomography Study of Filling Material Removal from Oval-shaped Canals by Using Rotary, Reciprocating, and Adaptive Motion Systems. Journal of endodontics. 2016 May;42(5):793–7.
Bago I, Plotino G, Katić M, Ročan M, Batinić M, Anić I. Evaluation of filling material remnants after basic preparation, apical enlargement and final irrigation in retreatment of severely curved root canals in extracted teeth. International endodontic journal. 2020 Jul;53(7):962–73.
Preethee T, Kandaswamy D, Arathi G, Hannah R. Bactericidal effect of the 908 nm diode laser on Enterococcus faecalis in infected root canals. Journal of conservative dentistry : JCD. 2012 Jan;15(1):46–50.
Gorduysus MO, Al-Rubai H, Salman B, Al Saady D, Al-Dagistani H, Muftuoglu S. Using erbium-doped yttrium aluminum garnet laser irradiation in different energy output levels versus ultrasonic in removal of root canal filling materials in endodontic retreatment. European journal of dentistry. 2017;11(3):281–6.
Keleş A, Alcin H, Kamalak A, Versiani MA. Oval-shaped canal retreatment with self-adjusting file: a micro-computed tomography study. Clinical oral investigations. 2014 May;18(4):1147–53.
Pawar AM, Thakur B, Metzger Z, Kfir A, Pawar M. The efficacy of the Self-Adjusting File versus WaveOne in removal of root filling residue that remains in oval canals after the use of ProTaper retreatment files: A cone-beam computed tomography study. Journal of conservative dentistry : JCD. 2016;19(1):72–6.
Uygun AD, Gündoğdu EC, Arslan H, Ersoy İ. Efficacy of XP-endo finisher and TRUShape 3D conforming file compared to conventional and ultrasonic irrigation in removing calcium hydroxide. Australian endodontic journal : the journal of the Australian Society of Endodontology Inc. 2017 Aug;43(2):89–93.
De-Deus G, Belladonna FG, Zuolo AS, Cavalcante DM, Carvalhal JCA, Simões-Carvalho M, et al. XP-endo Finisher R instrument optimizes the removal of root filling remnants in oval-shaped canals. International endodontic journal. 2019 Jun;52(6):899–907.
Hülsmann M, Baxter S, HOLSCHER C. Shaping and filling root canals during root canal re‐treatment. Endodontic Topics. 2011;19:74–124.
Vajrabhaya L-O, Suwannawong SK, Kamolroongwarakul R, Pewklieng L. Cytotoxicity evaluation of gutta-percha solvents: Chloroform and GP-Solvent (limonene). Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2004 Dec;98(6):756–9.
McDonald MN, Vire DE. Chloroform in the endodontic operatory. Journal of endodontics. 1992 Jun;18(6):301–3.
Schilder H. Filling root canals in three dimensions. Dental clinics of North America. 1967 Nov;723–44.
Pécora JD, Spanó JC, Barbin EL. In vitro study on the softening of gutta-percha cones in endodontic retreatment. Brazilian dental journal. 1993;4(1):43–7.
Friedman S, Stabholz A, Tamse A. Endodontic retreatment--case selection and technique. 3. Retreatment techniques. Journal of endodontics. 1990 Nov;16(11):543–9.
Wourms DJ, Campbell AD, Hicks ML, Pelleu GBJ. Alternative solvents to chloroform for gutta-percha removal. Journal of endodontics. 1990 May;16(5):224–6.
Barbosa S V, Burkard DH, Spångberg LS. Cytotoxic effects of gutta-percha solvents. Journal of endodontics. 1994 Jan;20(1):6–8.
Guneser MB, Arslan D, Dincer A. The Effect of Various Gutta-percha Solvents on Root Canal Dentin Microhardness. Turkiye Klinikleri Journal of Dental Sciences. 2016;22.