S-18 When Root Canals Fail: The Retreat-or-resect Dilemma

CE Hours: 1.5

Description: This lecture provides an evidence-based framework for choosing between nonsurgical retreatment and endodontic microsurgery in the management of apical disease. Content includes CBCT-driven diagnosis to distinguish missed anatomy from potential extra-radicular infection; assessment of restorability and retreatment feasibility in the presence of posts, cores, and iatrogenic complications; and the impact of prior treatment quality, lesion size, and patient factors on prognosis. We will discuss the data on survival, success, and complication profiles for retreatment vs microsurgery. Through real-case examples I will highlight stepwise decision making, microsurgical considerations relative to adjacent anatomic structures and how to identify high-risk scenarios, and follow-up intervals that meaningfully access healing. Attendees will leave with a practical way to select the least invasive, predictable pathway to resolution of periapical pathology.

Learning Objectives:  

• Differentiate clear indications and contraindications for nonsurgical retreatment versus endodontic microsurgery using CBCT findings, prior treatment quality, lesion size, and patient factors.
• Assess retreatment feasibility in teeth with posts, cores, or iatrogenic defects, and compare predicted outcomes-survival, success, complications-of nonsurgical retreatment versus microsurgery.
• Select and justify the least invasive, most predictable treatment pathway; outline key microsurgical considerations relative to adjacent structures when indicated; and define follow-up intervals and healing criteria.