Root canal, or endodontic treatment, is a procedure in which an inflamed or infected pulp is removed, and the inside of the tooth is cleaned, disinfected, then filled and sealed with a restorative material. The procedure has a high success rate, although persistence of symptoms or infection recurrence can occur in 10% to 15% of cases.¹ Tooth survival over two to 10 years following initial root canal treatment was shown in a systematic review to range between 86% and 93%.² In many cases of infection or symptom recurrence, a second root canal treatment (root canal re-treatment) is considered. Apicoectomy is usually needed when root canal re-treatment is not successful, and is a procedure in which the root tip, or apex, is removed along with the infected tissue, then a root end filling (retrofilling) is placed to seal the area.³ Factors associated with a better chance of success of apicoectomy include patients ≤ 45 years old, upper anterior or premolar teeth, cases without preoperative pain, lesions without periodontal involvement, absence of perforating lesions, and teeth with only one periapical surgery.^4–6 In the case of apicoectomy failure, the tooth may need to be extracted.

This Rapid Response report aims to review the clinical and cost-effectiveness of endodontic interventions (root canal re-treatment, apicoectomy and retrofilling) after failed root canal treatment, compared to initial root canal treatment alone (no treatment) or tooth extraction. Guidelines associated with the use of root canal re-treatment, apicoectomy with or without apical curettage, and retrofilling in permanent teeth will also be examined.

Contents

• Context and Policy Issues
• Research Question
• Methods
  • Literature Search Methods
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Quantity of Research Available
  • Summary of Findings
• Conclusions and Implications for Decision or Policy Making
• References
• Appendix 1. Selection of Included Studies
• Appendix 2. Additional References of Potential Interest (studies that compared different retreatment approaches)

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