Outcome of single- versus two-visit root canal retreatment in teeth with periapical lesions: a randomized clinical trial

Outcome of single- versus two-visit root canal retreatment in teeth with periapical lesions: A randomized clinical trial Fulya Karaoğlan | Seniha Miçooğulları Kurt | Mehmet Kemal Çalışkan © 2022 International Endodontic Journal. Published by John Wiley & Sons Ltd. Department of Endodontics, Faculty of Dentistry, Ege University, İzmir, Turkey Correspondence Seniha Miçooğulları Kurt, Department of Endodontology, School of Dentistry, Ege University, 35040, Bornova, İzmir, Turkey. Email: [email protected] Abstract Aim: The aim of the study was to evaluate the clinical and radiographic outcome of single-visit root canal retreatment and compare the results with conventional twovisit root canal retreatment as control group. Methodology: One hundred root canal-treated, single-rooted asymptomatic teeth with periapical lesion were retreated by one operator. Fifty of the teeth were randomly assigned to the single-visit group and the others were treated in two visits. In both groups, root canal filling material was removed, and re-instrumentation of the root canal was performed using step-back technique with hand files using 2.5% NaOCl and 5% EDTA as irrigants. In the single-visit group, 5 ml 2% chlorhexidine (CHX) were applied as the final irrigation and in the two-visit group, calcium hydroxide paste was placed into the root canal as an interappointment dressing. All root canal obturations were performed with lateral compaction. All patients were followed up for 24months. The success was determined depending on both healed and healing cases. The chi-square or Fisher’s exact test was used to analyse the differences between the groups for success rates and the factors affecting the outcome. Results: The recall rate was 89 (89%). At 24months, 39 teeth (88.6%) were considered as healed, three teeth (6.8%) as healing, and two teeth (4.5%) were identified as failed in the single-visit group, while in the two-visit group 39 teeth (86.7%) had healed, two teeth (4.4%) were scored as healing, and four teeth (8.9%) as failed. There was no statistically significant difference in the success rates between the two groups (p>.05). Size of the lesion and the preoperative length of root canal filling had a statistically significant impact on the outcome (p.05). Representative periapical radiographs of two cases belonging to single and two-visit groups are shown in Figure 2. Failure was observed in two teeth (4.5%) treated in a single visit, one of which was extracted with a suspect of vertical root fracture and the other one was clinically asymptomatic, but the PAI score had not changed during the follow-up periods. On the other hand, the failure rate was 8.9% (four teeth) in the two-visit group, one of which had a sinus tract, and the other three teeth were clinically asymptomatic, but the PAI score had not reduced. In teeth with large periapical lesions, the success rate was significantly lower than teeth with small lesions (p35 46 21 (47.7) 25 (55.6) Gender Female 60 32 (72.7) 28 (62.2) 1.118 .290 Male 29 12 (27.3) 17 (37.8) Location of tooth Maxilla 63 34 (77.3) 29 (64.4) 1.77 .183 Mandibula 26 10 (22.7) 16 (35.6) Preoperative lesion size (mm) 2–5.9 50 25 (56.8) 25(55.6) .014 .904 6–10 39 19 (43.2) 20 (44.4) Preoperative length of root filling Short 45 25 (56.8) 20 (44.4) 1.945 .378 Adequate 40 18 (40.9) 22 (48.9) Long 4 1 (2.3) 3 (6.7) Preoperative density of root filling Poor 63 31 (70.5) 32 (71.1) .005 .946 Good 26 13 (29.5) 13 (28.9) Intra-operative Post Absent 74 36 (81.8) 38 (84.4) .109 .741 Present 15 8 (18.2) 7 (15.6) Coronal restoration Composite 62 27 (61.4) 35 (77.8) 2.836 .092 Crown 27 17 (38.6) 10 (22.2) TABLE 1 Distribution of the relevant preoperative and intra-operative factors in both treatment groups TABLE 2 Proportion of teeth healed, healing and fKARAOĞLAN et al. 839 oval-shaped root canals (Peters et al., 2001). Considering the root canal morphologies and apical diameter of the teeth included in the current study, hand files were used to remove the existing root canal fillings and for reinstrumentation of the root canals. The outcome of the teeth that require root canal retreatment is challenging, and the success rate of single-visit root canal retreatment may differ from the primary root canal treatment due to the previous root canal filling material that makes the removal of the bacteria and inflammatory mediators difficult (Imura et al., 2000). Additionally, it has been reported that the diversity of microorganisms in root canal treated teeth is different from that in primarily infected root canals, and that resistant microorganisms such FIGURE 2 Representative periapical radiographs of (a, b) single-visit root canal retreatment case and (c, d) two-visit root canal retreatment case. (a, c) Preoperative radiographs and (b, d) 24-month follow-up radiographs showing resolution of the periapical lesions. 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hand="" ashraf="" visit="" asymptomatic="" teeth="" can="" retreated="" additionally="" eyuboglu="" performed="" lesions.="" although="" ensuring="" above-mentioned="" studies.="" however="" we="" have="" utilized="" investigation="" positive="" canals.="" only="" single-rooted="" diagnosed="" apical="" periodontitis="" included.="" explained="" exclusion="" multi="" rooted="" more="" complex="" anatomy="" inclusion="" addition="" biomechanical="" procedures="" increase="" one-visit="" current="" patients="" age="" gender="" due="" previously="" these="" had="" no="" lesion="" level="" initial="" affected="" recent="" years="" some="" prospective="" emphasized="" there="" significantly="" higher="" bacterial="" counts="" large="" than="" small="" ones="" has="" been="" treatment="" stated="" reduce="" chance="" bergenholtz="" cal="" ng="" sj="" result="" could="" attributed="" diversity="" adversely="" biological="" literature="" larger="" between="" most="" upper="" limit="" reported.="" number="" low="" specified="" sizes="" dramatically="" reference="" researchers="" reporting="" endodontic="" surgery="" lower="" while="" also="" does="" chevigny="" farzaneh="" when="" improved="" moreover="" decreases="" every="" left="" without="" instrumentation="" terminus="" olcay="" karao="" significant="" statistical="" analysis="" showed="" reduced="" initially="" overextended="" fillings.="" under="" radiographic="" examination="" demonstrates="" absence="" residual="" material="" remaining="" region="" extraradicular="" infection="" cause="" persistent="" inflammation="" since="" microorganisms="" periradicular="" tissues="" unachievable="" process="" should="" noted="" study.="" therefore="" clinically="" would="" accurate="" generalize="" finding="" all="" fillings="" limitation="" comparing="" single-="" multiple-visit="" data="" two="" separate="" published="" power="" analysis.="" calculation="" ability="" detect="" differences="" greater="" treatments="" total="" containing="" each="" according="" calculation.="" even="" though="" our="" sample="" comparable="" high-quality="" nature="" kurt="" molander="" peters="" wesselink="" appropriate="" significance="" difference="" nevertheless="" will="" prevailed="" future="" randomized="" controlled="" trials="" help="" provide="" sound="" conclusion="" about="" effects="" outcome.="" within="" limitations="" observed="" acknowledgements="" authors="" like="" thank="" prof.="" dr.="" pelin="" g="" michael="" hulsmann="" valuable="" contributions="" conflict="" interest="" declare="declare" interest.="" ethical="" approval="" carried="" out="" ethics="" committee="" school="" medicine="" accordance="" principles="" helsinki="" author="" fulya="" conceptualization="" methodology="" writing-="" original="" draft="" preparation.="" seniha="" mi="" kurt:="" conseptualization="" curation="" reviewing="" editing.="" mehmet="" kemal="" supervision="" project="" administration="" availability="" 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