Case Selection for Endodontic Retreatment

History
Careful history taken to know nature of the case, pathogenesis, urgency of treatment

History of pain or worsened. Spontaneous pain, pain on biting. History of episode of facial swelling or swelling in the mucobuccal fold.

 Clinical findings:
Swelling
Percussion and palpation sensitivity Defective or missing coronal restoration Active reccurent caries Present of draining sinus tract Periodontal status

 Radiographic findings:
Evaluate anatomy of root canal in relation to canal curvature, calcifications, unusual configurations Evaluate quality of obturation of primary endodontic treament Check for iatrogenic complications like seperated instruments, ledges, perforations and canal blockages Presence of one or more untreated root canals Canals not prepared or not obturated to appropriate length Recurrent caries that were not noted clinically. Present of apical lesion or enlargement of pre-existing apical radiolucency. Bony support of the tooth

 Patients factor
exhibit good oral hygiene have motivation to retain his/her natural dentition financial capability must understand procedure complexity and time consuming

Factors affecting prognosis of endodontic treatment

Presence of any periapical radiolucency Quality of obturation Apical extension of the obturation canal Bacterial status of the canal Post-endodontic coronal restoration Iatrogenic complication

Contraindications of Retreatment
Unfavorable root anatomy: shape, taper, remaining dentin thickness Presence of untreatable root resorption or perforations Presence of root bifurcation caries Inaccessible root canal space due to calcification or large well-fitting post and core restorations Root fracture Insufficient crown/root ratio Remaining tooth structure for restorability Periodontal disease Patient lack motivation to maintain oral hygiene