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AIM: To determine the effectiveness of two different endodontic retreatment systems for the removal of laterally compacted gutta-percha (GP). MATERIALS AND METHODS: Sixty-three freshly extracted human maxillary central incisors were used for the study. The teeth were instrumented with K-flex files and obturated using lateral condensation technique with GP and AH Plus sealer. The teeth were divided into three retreatment groups, each group consisting of 21 teeth. Group I: D-RaCe desobturation files (D-RaCe); group II: ProTaper Universal retreatment files (PTUR); group III: Hedstrom files (H-file). After removal of GP, the teeth were split longitudinally and divided into three equal parts: Cervical, middle, and apical third. The middle and apical thirds of all root halves were examined using scanning electron microscope (SEM). The total surface area covered by the residual debris was evaluated using Motic Image plus 2.0 software. Statistical analysis was done by one-way analysis of variance (ANOVA) test with a p-value <0.05 used to determine significance and Tukey's multiple post hoc tests used for comparison between the groups, and 't' test was done for comparison between the thirds within the same group. RESULTS: The PTUR retreatment files showed overall better performance compared with D-RaCe files and H-files. The PTUR files performed better at middle third compared with others. The PTUR files and D-RaCe files performed equally at apical third better than H-files. CONCLUSION: ProTaper retreatment files are better compared with D-RaCe files and H-files for the retreatment of the previously endodontically treated teeth. CLINICAL SIGNIFICANCE: Highest efficacy for the removal of GP was shown by ProTaper Universal System followed by D-RaCe and H-file.

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AIM: To evaluate ex vivo the efficacy of ProTaper Universal Retreatment files (Dentsply Sirona, Ballaigues, Switzerland) in removing Thermafil, GuttaCore (both Dentsply Sirona) or vertically compacted gutta-percha from curved root canals using micro-CT. METHODOLOGY: Sixty curved molar roots with the same mean canal curvatures and radii in two directions were prepared using ProFile instruments (Dentsply Sirona) to size 30 with .04 taper and obturated with either Thermafil, GuttaCore or vertically compacted gutta-percha and AH Plus (n = 20). Specimens were retreated using the ProTaper Universal Retreatment files D1, D2 and D3 to working length, and root canal preparation was completed with ProTaper Next (Dentsply Sirona) to size ×4. Percentages of residual filling material and dentine removal were assessed using micro-CT imaging. Working time and procedural errors were recorded. Statistical analysis was performed using Kruskal-Wallis and Wilcoxon tests. RESULTS: No significant differences between carrier-based and warm vertical compaction regarding residual filling material (14.2-19.3%) and dentine removal (2.7-3.2 mm3 ) were detected (P > 0.05). Time to reach working length was significantly faster for canals filled with GuttaCore than that observed for Thermafil and warm vertical compaction (P < 0.05). Five lateral perforations with the D3 file occurred during retreatment, one in the Thermafil and four in the vertical compaction group. CONCLUSIONS: Remaining filling material and dentine removal were similar for all canal filling techniques. Regaining working length was significantly faster for GuttaCore compared with Thermafil and vertically compacted gutta-percha. Procedural errors occurred during retreatment of severely curved root canals with the ProTaper Universal Retreatment files in 5 of 60 canals (8%).

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AIM: The aim of the study is to compare the maximum stress distribution on the rotary retreatment instruments within the root canal at cervical, middle, and the apical one-third during retreatment of gutta-percha. MATERIALS AND METHODS: A human mandibular premolar was scanned, and three-dimensional geometry of the root was reconstructed using finite element analysis (FEA) software package (ANSYS). The basic model was kept unchanged; tooth models were created using the same dimensions and divided into two groups as follows: Group I: ProTaper Universal retreatment system and group II: Mtwo rotary retreatment system. The stress distribution on the surface and within the retreatment files was analyzed numerically in the FEA package (ANSYS). RESULTS: The FEA analysis revealed that the retreatment instruments received the greatest stress in the cervical third, followed by the apical third and the middle third. The stress generated on the ProTaper Universal retreatment system was less when compared with the Mtwo retreatment files. CONCLUSION: The study concludes that the retreatment instruments undergo higher stress in the cervical third region, and further in vivo and in vitro studies are necessary to evaluate the relationship between instrument designs, stress distribution, residual stresses after use, and the torsional fracture of the retreatment instrument. CLINICAL SIGNIFICANCE: The stress developed on the rotary retreatment instruments during retrieval of gutta-percha makes the instrument to get separated. There is no instrument system, i.e., suitable for all clinical situations and it is important to understand how the structural characteristics could influence the magnitude of stresses on the instrument to prevent its fracture in use.

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INTRODUCTION: Although success of endodontic therapy has significantly improved in the last few decades due to the introduction of novel materials and techniques, failures of endodontic therapy requiring re-treatment still comprise a significant percentage of patients requiring root canal treatment. AIM: To evaluate and compare the effective removal of gutta percha and sealer, amount of apical debris extrusion and time required for gutta percha removal using various endodontic files. MATERIALS AND METHODS: Total 48 extracted mandibular premolars were mounted on acrylic blocks and endodontic procedure was carried out using size 40 K file and obturated using guttapercha and zinc oxide eugenol sealer. After one month storage, samples were decoronated, mounted on screw capped vials and subjected to removal of obturated material by four instruments: H files, safe sided H files, protaper universal retreatment rotary system and ultrasonic retreatment tip, grouped as 1, 2, 3, and 4 respectively. Only 2mm of obturated material from the coronal part was removed using no. 3 Gates Glidden drill, guttapercha was softened with a drop of xylene for 2 mins for each canal and retreatment was performed. The retreatment procedure was said to be complete when no visible debris were observed on the instrument flutes. The samples split into two halves and examined under stereomicroscope, photographed, assessed using AUTOCAD software and percentage of remaining filling material in coronal, middle, apical thirds of the canal was calculated in mm(2). Retreatment time was recorded in seconds and apically extruded debris was assessed by microbalance in grams for each tooth. The data was analyzed by using descriptive statistics, ANOVA and Scheffe's post hoc test through SPSS for windows (v 16.0). RESULTS: The ultrasonic retreatment tip had less percentage of residual guttapercha/sealer, shorter mean operating time and little apical extrusion with a significant difference (p<0.05) between the other groups. CONCLUSION: All techniques retained guttapercha/sealer remnants within the root canal. The ultrasonic retreatment tip proved to be an efficient method of removing obturated material. It was fastest with least apical debris extrusion.

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Cuando la terapia endodóntica fracasa, las opciones para solucionar este problema incluyen preservar el diente a través del retratamiento ortógrado o cirugía apical. Siempre que sea posible, el retratamiento endodóntico no quirúrgico debe ser la opción elegida. Diferentes sistemas rotatorios han sido propuestos como una alternativa a la instrumentación manual para la remoción de la gutapercha.El objetivo de este trabajo fue comparar la eficacia y la eficiencia en la desobturación total del canal radicular, utilizando dos tipos de instrumentos rotatorios: limas Protaper Universal® y limas Protaper Retratamiento® con limas manuales tipo K. Se instrumentaron 45 canales radiculares, con limas mecanizadas del sistema Mtwo®, hasta la 25/06 y terminados de conformar con lima K #40 e irrigados con hipoclorito de sodio al 2,5 % entre cada instrumento. Los dientes fueron obturados con técnica de condensación lateral, utilizando conos de gutapercha y cemento Tubliseal®.La muestra se dividió al azar en tres grupos A, B y C, de 15 canales cada uno, el grupo A se desobturó con limas Protaper Universal. El grupo B se desobturó con limas Protaper retratamiento y el grupo C se desobturó totalmente con limas K. Se cronometró cada procedimiento de desobturación y al término de esta, se tomó una radiografía en sentido buco-lingual y otra en sentido mesio-distal para cuantificar la remoción de gutapercha en cada grupo. Los resultados muestran que no existe diferencia significativa en la eliminación total del relleno endodóntico entre los tres grupos (p= 0,271) pero que los tiempos empleados en la desobturación total de los canales entre los grupos, muestra diferencias significativas entre Protaper Retratamiento y limas K, y entre Protaper Universal y limas K (p <0,05). Bajo las condiciones de este estudio, ningún sistema fue capaz de remover toda la gutapercha del interior del canal radicular.

When primary endodontic treatment fails, the treatment alternatives for root preservation are orthograde retreatment or apical surgery. Whenever possible, orthograde retreatment must be the first option. Different rotary systems have been proposed as an alternative to manual instrumentation for the removal of gutta-percha. The aim of this study was to compare the efficacy and efficiency of the total removal of gutta-percha from root canals, using two types of rotary instruments: Protaper Universal Files® and Protaper Retreatment Files®, compared to manual K type Files. A total of forty-five canals were instrumented with Mtwo files® up to a 25.06 file and the shaping was completed with a 40 K-type File and irrigated with 2.5 % Sodium Hypochlorite between each instrument. The teeth were obturated with Lateral Condensation Technique, using gutta-percha and Tubliseal® sealer. Samples were divided in groups A, B and C, 15 canals each, and gutta-percha was removed using the following protocols: group A with Protaper Universal; Group B using Protaper Retreatment and Group C using K type Files. Each procedure was timed and at the end of it, two periapical radiographs were taken: one buccolingual and one mesiodistal, in order to quantify the amount of gutta-percha removed. The results analysis show that there is no significant difference in the amount of gutta-percha removed between the three groups (p= 0.271) but that the time invested to perform the removal of the gutta-percha was significantly less between for the rotary systems, when compared to manual instrumentation (p <0.05). Under the conditions of this study, no system was able to remove all gutta percha inside the root canal.

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INTRODUCTION: The aim of this in vitro study was to compare the efficacy of ProTaper retreatment (ProTaper R) and Mtwo retreatment (Mtwo R) files in removing gutta-percha and GuttaFlow from endodontically treated straight root canals. METHODS AND MATERIALS: The root canals of 60 human mandibular single-rooted premolars were prepared and randomly divided into two groups (n=30). In groups A and B the root canals were obturated using lateral condensation of gutta-percha plus AH 26 and GuttaFlow, respectively. The canal orifices were temporarily sealed and the roots were incubated for 3 months at 37(º)C and 100% humidity. Primary cone-beam computed tomography (CBCT) images were taken after incubation period. The specimens in each group were randomly divided into two subgroups (n=15). ProTaper R files (D1, D2, and D3) were used in groups A1 and B1 while Mtwo R files (25/0.05 and 15/0.05) were used in groups A2 and B2. The time required to extirpate the root filling was also recorded. After retreatment, another CBCT scan was taken at the same position. The volume of remaining filling materials inside the canals was calculated before and after retreatment. The data was analyzed using the two-way ANOVA and independent t-test. RESULTS: The remaining filling materials in the canals treated with ProTaper were less than Mtwo. The remaining volume of GuttaFlow was less than gutta-percha regardless of the system applied. Mtwo R files removed root fillings faster than ProTaper R. CONCLUSION: ProTaper R removed filling material more efficiently compared to Mtwo R which required less time to remove root filling material.

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AIM: This study evaluated whether using supplementary files for removing root canal filling residues after ProTaper Universal Retreatment files (RFs) increased the debris extrusion apically. MATERIALS AND METHODS: Eighty mandibular premolars with single root and canal were instrumented with ProTaper Universal rotary system (SX-F3) and obturated. The samples were divided randomly into four groups (n = 20). Group 1 served as a control; only ProTaper Universal RFs D1-D3 were used, and the extruded debris was weighed. Groups 2, 3, and 4 were the experimental groups, receiving a twofold retreatment protocol: Removal of the bulk, followed by the use of supplementary files. The bulk was removed by RFs, followed by the use of ProTaper NEXT (PTN), WaveOne (WO), and Self-Adjusting File (SAF) for removal of the remaining root filling residues. Debris extruded apically were weighed and compared to the control group. Statistical analysis was performed using one-way analysis of variance (ANOVA) and post hoc Tukey's test. RESULTS: All the three experimental groups presented significant difference (P < .01). The post hoc Tukey's test confirmed that Group 4 (SAF) exhibited significantly less (P < .01) debris extrusion between the three groups tested. CONCLUSION: SAF results in less extrusion of debris when used as supplementary file to remove root-filling residues, compared to WO and PTN.

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AIM: The current ex vivo study compared the efficacy of removing root fillings using ProTaper retreatment files followed by either WaveOne reciprocating file or the Self-Adjusting File (SAF). MATERIALS AND METHODS: Forty maxillary canines with single oval root canal were selected and sectioned to obtain 18-mm root segments. The root canals were instrumented with WaveOne primary files, followed by obturation using warm lateral compaction, and the sealer was allowed to fully set. The teeth were then divided into two equal groups (N = 20). Initial removal of the bulk of root filling material was performed with ProTaper retreatment files, followed by either WaveOne files (Group 1) or SAF (Group 2). Endosolv R was used as a gutta-percha softener. Preoperative and postoperative high-resolution cone-beam computed tomography (CBCT) was used to measure the volume of the root filling residue that was left after the procedure. Statistical analysis was performed using t-test. RESULTS: The mean volume of root filling residue in Group 1 was 9.4 (±0.5) mm(3), whereas in Group 2 the residue volume was 2.6 (±0.4) mm(3), (P < 0.001; t-test). CONCLUSIONS: When SAF was used after ProTaper retreatment files, significantly less root filling residue was left in the canals compared to when WaveOne was used.