1 Dariusz Borczyk Decision-making in the management of failed orthograde endodontic retreatment: A literature review with case reports Dariusz Borczyk BDS PhD Clinical Teaching Fellow in Restorative Dentistry Dentist with Special Interest in Endodontics

2 Dariusz Borczyk

3 Endodontics is the science and the art...

4 Dariusz Borczyk Endodontics is the science and the art...... of the treatment of pulpal and periapical diseases

5 Dariusz Borczyk Complications

6 Dariusz Borczyk Decision-making Initial Treatment Endodontic Retreatment Retreatment of Retreatment

7 Dariusz Borczyk Complications

8 Dariusz Borczyk Decision-making Initial Treatment Endodontic Retreatment Retreatment of Retreatment WhatI do?

9 Dariusz Borczyk Literature review Crump & Natkin, JADA 1970, 80, 1341 Cheung, Int Dent J 1996, 46, 131 Reit & Kvist, Int Endod J 1998, 31, 358 Aryanpour et al, Int Endod J 2000, 33, 208 Friedman, Aust Endod J 2000, 26, 104 Kvist, Swed Dent J, 2001, Suppl 144 Kvist & Reit, Int Endod J, 2002, 35, 359 Friedman, Endod Topics 2002, 1, 54 Farzaneh et al, J Endod 2004, 30, 627 Kvist et al, J Endod 2004, 30, 572 Paik et al, J Endod 2004, 30, 745 Saunders et al, J Endod 2004, 30, 177 Yoldas et al, OOOOE 2004, 98, 483 Al-Ali et al, Int Endod J 2005, 38, 470 Peikoff, Aust Endod J 2005, 31, 15 Lumley et al, Dent Update 2006, 33, 518 Mohammadi & Khademi, J Clin Dent 2006, 17, 131 Karabucak & Setzer, Comp Contin Educ Dent 2006, Ascend Dental Yan, Aust Endod J 2006, 32, 2 Del Fabbro et al, Cochrane Database Syst Rev 2007, 18, CD005511 Molander et al, J Endod 2007, 33, 1145

10 Dariusz Borczyk Retreatment behaviours Junior / senior student Experienced / non-experienced dentist General dentist / Specialist endodontist Differences between schools

11 Dariusz Borczyk Case reports

12 Dariusz Borczyk Case reports

13 Dariusz Borczyk Case reports

14 Dariusz Borczyk Case reports

15 Dariusz Borczyk Case reports

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17 Case reports of failed treatments

18 Dariusz Borczyk Case report 1 6 months21 months33 months

19 Dariusz Borczyk Case report 2 11 months

20 Dariusz Borczyk Case report 3 2 months

21 Dariusz Borczyk Case report 3 2 years, 3 months 6 years

22 Dariusz Borczyk Case report 4 6 months

23 Dariusz Borczyk Case report 5 4 years, 8 months

24 Dariusz Borczyk Case report 6 5 months 1 year

25 Dariusz Borczyk Case report 7 2 years, 7 months 4 years, 9 months

26 Dariusz Borczyk Case report 8 3 months 7 months

27 Dariusz Borczyk Case report 9 10 months 3 years, 8 months

28 Dariusz Borczyk Case report 10 5 months10 months 1 year, 7 months 1 year, 10 months 3 years, 1 month

29 Dariusz Borczyk Case report 11 5 years, 6 months

30 Dariusz Borczyk Case report 12 4 months 1 year, 9 months 2 years, 10 months

31 Dariusz Borczyk Case report 13 4 months2 years, 5 months

32 Dariusz Borczyk Decision-making depends upon Patients motivation and expectations Dentists and patients personalities Financial and logistic considerations Likelihood of being sued Presence of symptoms Planned restorative treatment Status of adjacent teeth etc.

33 Dariusz Borczyk Conclusions

34 Dariusz Borczyk Conclusions What I do? What will the of my decision be? 1.

35 Dariusz Borczyk Conclusions 2.

36 Dariusz Borczyk Conclusions 2.

37 Dariusz Borczyk Conclusions 2.

38 Dariusz Borczyk Conclusions 2.

39 Dariusz Borczyk Conclusions 3.Restrictions in direct application of scientific evidence into dental practice 4.Orthograde retreatment preferable to surgical 5.There can be no difference between failed endodontic retreatment and failed initial treatment 6.Endodontic retreatment of periodontically compromised teeth not always contraindicated 7.Two-year follow-up may be inaccurate to determine success vs. failure

40 Dariusz Borczyk Conclusions 8.The patient should be fully informed and participate in the clinical decision-making