4th Year Al-Azhar University Retreatment lecture.

1. Non-Surgical
Retreatment
Oh My God! I hate
that ?@!!@? dentist
he keeps sending me
those failed root
canals for me to fix!!!
Dr. Ashraf Refai
BDS Msc DD HMD
Al-Azhar University

2. Lecturer of
AshrafRefai
Samir
Endodontics
Al-Azhar University
BDS MSc DD HMD
ashraf_refai@hotmail.com
Ashraf Samir Refai
www.arefai.edublogs.org
www.idclinics.com
+20101434323

3. What
IsRetreatment?
Non-Surgical
Surgical

4. Of
Steps RCT
Non-Surgical
Finding & Removal of
Coronal
Negotiating Obturation
Disassembly
Missed Canals Materials
Managing
Removal of
Perforation blocks ledges &
Posts, Fractured
Repair apical
instruments
perforations

5. Coronal
Disassembly
Three
Possibilities
Intact Properly
Intact Properly Constructed Restoration
Constructed (Needs Extra Access)
Restoration
(No need for extra
access)
Improperly
Constructed
Restoration

6. Coronal
Disassembly
Grasping
Instrument
Percussive
Instrument
Active
Instrument

7. Coronal
Disassembly
Cementing
Removal Device Agent
Factors
Affectin
Restoration
g Design
Removal
Preparation
Type Restoration
Type

8. Coronal
Disassembly
Grasping
Instrument

9. Coronal
Disassembly
Percussive
Instruments

10. Coronal
Disassembly
Active
Instruments

11. Of
Steps RCT
Non-Surgical
Finding & Removal of
Coronal
Negotiating Obturation
Disassembly
Missed Canals Materials
Managing
Removal of
Perforation blocks ledges &
Posts, Fractured
Repair apical
instruments
perforations

12. Finding
Missed Canals
Familiarity with
Anatomy
Techniques
Armamentarium

13. Finding
Missed Canals
Radiographic Analysis
SLOB Rule
Centralization
of the
Obturation

14. Finding
Missed Canals
Vision & Microscopy

15. Finding
Missed Canals
Properly Accessed
Tooth

16. Finding
Missed Canals
Ultrasonics

17. Finding
Missed Canals Size #10 & #15
Micro-Openers
7 mm
4% & 6%
Taper
Angulated for
Comfort

18. Finding
Missed Canals
Methylene
Dyes Blue

19. Finding
Missed Canals
NaOCl Test
Bubbling at the
Suspected Area

20. Finding
Missed Canals
Transillumination
Color
Explorer
Pressure

21. Finding
Missed Canals
White Line Test
Red Line Test

22. The Road to
Hell is Paved
with Good
Intention…

23. NegotiatingThose
Canals
Molars are difficult
Conventionally done with
stainless steel instruments &
lubricants
#8, #10 & #15

24. Of Using
Conventional
Disadvantages Methods…
They take time to negotiate
Errors
Ledging
Apical zipping
Canal Transportation

25. A NiTi
Rotary
Solution…
Pathfiles

26. Review
1. What is
Retreatment?
2. Causes of
Failure
3. Steps of
Retreatment
I. Coronal
Disassembly
II. Negotiation of
Missed Canals

27. Of
Steps RCT
Non-Surgical
Finding & Removal of
Coronal
Negotiating Obturation
Disassembly
Missed Canals Materials
Managing
Removal of
Perforation blocks ledges &
Posts, Fractured
Repair apical
instruments
perforations

28. Of
Removal Obturation
Materials
Obturation
Materials
Silver Gutta Resilon Carrier
Points Percha Based
Materials

29. Of
RemovalSilver Points
Careful Removal
of Filling
Material
Use Ultrasonics &
Surgical burs

30. Of
RemovalSilver Points
Grasping
Instrument
Try to use a Fulcrum Don’t Over
Manipulate

31. Of
RemovalSilver Points
Indirect
Ultrasonics
Don’t Touch the Silver
Trough Around the Point Directly
Sivler Point

32. Of
RemovalSilver Points
Files, Solvents &
Chelators

33. Of
RemovalSilver Points
Micro Tube &
Glue

34. Of
RemovalSilver Points
Micro Tube &
Files

35. Of
RemovalSilver Points
IRS
Instrument Removal
System

36. Of
RemovalSilver Points
IRS
0.8 mm
0.6 mm
MicroTube
Instrument Removal
System
Screw Wedge

37. Of
RemovalSilver Points
Create
Staging Expose The Position The Insert The Remove The
Platform Silver Point Micro tube Screw Wedge & Apparatus
or Secure The
Instrument Silver point or
nstrument

38. Of
Removal Obturation
Materials
Obturation
Materials
Silver Gutta Resilon Carrier
Points Percha Based
Materials

39. Of
RemovalGutta Percha
Files & Solvent

40. Of
RemovalGutta Percha
Heat &
Instrument
Removal

41. Of
RemovalGutta Percha
Heat Removal of
Gutta Percha

42. Of
RemovalGutta Percha
Ultrasonic
Removal

43. Of
RemovalGutta Percha
Paper Points &
Solvent
(Wicking)

44. Of
RemovalGutta Percha
Rotary Niti
Instrument
Removal
ProTaper
Retreatment

45. Of
Removal Obturation
Materials
Obturation
Materials
Silver Gutta Resilon Carrier
Points Percha Based
Materials

46. Of
RemovalResilon & Co.
Similar to
Gutta Percha
Techniques

47. Of
RemovalCarrier Based
Obturation
Fulcrum
Mechanics
IRS
Files & Solvent
Ultrasonics
Rotary Instrument
Removal

48. Of
Steps RCT
Non-Surgical
Finding & Removal of
Coronal
Negotiating Obturation
Disassembly
Missed Canals Materials
Managing
Removal of
Perforation blocks ledges &
Posts, Fractured
Repair apical
instruments
perforations

49. Of
RemovalPosts & Fractured
Instruments
Post Removal
Type of Post Type of
Cement
Factors
Affecting Anatomy
Removal
Material of
Accessibilit
Make
y

50. Of
RemovalPosts & Fractured
Instruments
Post Removal
1. Gain SLA
2. Remove Material
From Around Post
3. Apply Method of
Removal

51. Of
RemovalPosts & Fractured
Instruments
Post Removal Rotosonic
Vibration
Ultrasonic
Vibration
Mechanical
Method

52. Of
RemovalPosts & Fractured
Instruments
Post Removal

53. Of
RemovalPosts & Fractured
Instruments
Fractured
Instrument St. St. vs NiTi Size of the
Removal Instrument
Bound vs
Unbound
Factors Instrument
Affecting Design
Level of
Removal
Fracture

54. Of
RemovalPosts & Fractured
Instruments
Fractured
Instrument
1. Gain SLA
Removal
2. Create Staging
Platform
3. Apply Method of
Removal

55. Of
RemovalPosts & Fractured
Instruments
Fractured Microtubes &
Instrument IRS
Removal
Ultrasonic
Vibration

56. Of
Steps RCT
Non-Surgical
Finding & Removal of
Coronal
Negotiating Obturation
Disassembly
Missed Canals Materials
Managing
Removal of
Perforation blocks ledges &
Posts, Fractured
Repair apical
instruments
perforations

57. Blocks &
Managing Ledges
Managing Causes?
Blocks Take
Radiographs
Precurve
Instruments
Copious
Irrigation &
Pecking & Lubrication
Watch Winding
Motion

58. Blocks &
Managing Ledges
Managing
Ledges
Causes? Take
Radiographs
Precurve Scratch out
Instruments the ledge

59. Blocks &
Managing Ledges
Managing Apical
Transportation
Type I: Type II: Type III:
Obturate Retreated Surgical
Retreatment
MTA

60. Of
Steps RCT
Non-Surgical
Finding & Removal of
Coronal
Negotiating Obturation
Disassembly
Missed Canals Materials
Managing
Removal of
Perforation blocks ledges &
Posts, Fractured
Repair apical
instruments
perforations

61. Review
3. Steps of
Retreatment
III. Methods of
Removal of
Obturation
Materials
IV. ProTaper
Retreatment
V. Fractured
Instrument Removal
VI. Post Removal
VII. Managing
Blockages & Ledges

62. Non-Surgical Perforation
Repair
Before
After

63. Non-Surgical Perforation
Repair
Considerations
Timing
Location
Size
Level

64. Non-Surgical Perforation
Repair
Considerations Timing
Good Bad
Prognosis Prognosis
Immediate
1 Week 1 Month 6 Months 1 Year
Repair

65. Non-Surgical Perforation
Repair
Considerations Location
Buccal
Lingual
Surgical vs
Mesial
Distal
Non-Surgical
Furcal
Accessibility

66. Non-Surgical Perforation
Repair
Considerations Level
Causes
Coronal
Intraoral
Middle
Communication
Apical
Prognosis

67. Non-Surgical Perforation
Repair
Size
Considerations
Surface Area
Prognosis

68. Non-Surgical Perforation
Repair
Repair Materials Amalgam Tattoo
Difficult to
Manipulate
No Longer
Reccomended
Amalgam

69. Non-Surgical Perforation
Repair
Repair Materials 1985
Reinforced ZOE
White in Color
Amalgam Seals Better
Super EBA

70. Non-Surgical Perforation
Repair
Repair Materials Early 1990’s
Moisture
Sensitive
Tooth Colored
Soluble: Leaching
Glass Ionomer

71. Non-Surgical Perforation
Repair
Repair Materials Tooth Colored
Complex
Technique
Sensitive To Moisture
Bonded Composites

72. Non-Surgical Perforation
Repair
Repair Materials
All other Materials are
Sensitive To Moisture MTA

73. Non-Surgical Perforation
Repair
What Is it?
1990’s Torbindejad LomaLinda MTA

74. Non-Surgical Perforation
Repair
Chemical •Calcium Oxide 65%
Compostion •Silicon Dioxide 21%
•Ferric Oxide 5%
•Aluminum Oxide 4%
•Calcium Suflate 2.5%
•Magnesium Oxide 2%
MTA

75. Non-Surgical Perforation
Repair
pH: 12.5
Properties
Working Time: 5-6 min
Setting Time: 4-6 hrs
Radioopaque
Biocompatible
Needs Moisture To Set MTA

76. Non-Surgical Perforation
Repair
Biocompatible
Advantages
Highly
Inductive
Sealing Ability
MTA

77. Calcific
Barrier

78. Non-Surgical Perforation
Repair
Long Setting
Disadvantages Time
Difficult to
Handle
Grey Color
MTA

79. Non-Surgical Perforation
Repair
Uses Apexification
Perforation
Repair Pulpotomy
Root End
Filling
Pulp Capping
MTA

80. Non-Surgical Perforation
Repair
Basic Steps
Hemostasis
Applications of Barrier
Material
Repair of Perforation

81. Non-Surgical Perforation
Repair
Hemostasis
Calcium Hydroxide
(4 to5 Min in the Canal)
MTA
Calcium
Sulfate
Freeze Dried Bone
Collagen

82. Non-Surgical Perforation
Repair
Application of
Barrier Material
Absorbable Non-Absorbable
Collagen (CollaCote)
Calcium Sulfate MTA
(Capset)

83. Non-Surgical Perforation
Repair
Repair Of
Furcation Or
Coronal
Perforation
Step #1
Prepare &
Obturate The
Canals Fresh or Long Standing

84. Non-Surgical Perforation
Repair
Repair Of
Furcation Or
Coronal
Perforation
Step #2
Prepare the
Perforation
Fresh or Long Standing

85. Non-Surgical Perforation
Repair
Repair Of
Furcation Or
Coronal
Perforation
Step #3
Hemostasis

86. Non-Surgical Perforation
Repair
Repair Of
Furcation Or MTA is the
Coronal Material of Choice
Perforation
Step #4 •If There is a Sulcular
Communication MTA Can’t
be Used
Apply Barrier
•Choice Depends on
& Repair Esthetics (Old Gery)
Material

87. Non-Surgical Perforation
Repair
MTA is Difficult
to Handle
MAP System: Micro Apical Placement System

92. 2 Years

93. Non-Surgical Perforation
Repair
More Difficult to
Repair Of Reach
Middle & Apical
1/3 Perforations
Possibility of
Canal Blockage
Principles
are the
Same If you Can’t Acquire Hemostasis Repair
Perforation First (Maintain Canal)

94. AStory
Success

98. Success
Another
Story

102. Use For
Another
MTA

103. Pre Op

104. Post Op

105. 1 Years

106. Review
1. What is
Retreatment?
2. Causes of
Failure
3. Steps of
Retreatment
I. Coronal
Disassembly
II. Negotiation of
Missed Canals

107. Review
3. Steps of
Retreatment
III. Methods of
Removal of
Obturation
Materials
IV. ProTaper
Retreatment
V. Fractured
Instrument Removal
VI. Post Removal
VII. Managing
Blockages & Ledges

108. Review
3. Steps of
Retreatment
IX. Non-Surgical
Perforation
Repair

109. That’s Enough!!!

110. Lecturer of
AshrafRefai
Samir
Endodontics
Al-Azhar University
BDS MSc DD HMD
ashraf_refai@hotmail.com
Ashraf Samir Refai
www.arefai.edublogs.org
www.idclinics.com
+20101434323