Clinical Research
Tooth Survival after Surgical or Nonsurgical
Endodontic Retreatment: Long-term Follow-up of
a Randomized Clinical Trial
Andreas Riis, DDS,* Silvio Taschieri, DDS, PhD,†‡§ Massimo Del Fabbro, DDS, PhD,†§
and Thomas Kvist, DDS, PhD*
Abstract
Introduction: The aim of the study was to determine
long-term tooth survival after endodontic retreatment
and whether the presence of intraradicular posts influ-
T he aim of root canal
ences the outcome. Methods: Ninety-five teeth were
randomly assigned to surgical or nonsurgical endodontic
retreatment. Forty-seven teeth in 45 patients were
treated by conventional endodontic surgery and 48
teeth (47 patients) by nonsurgical retreatment, including
the removal of intraradicular posts in 37 (77%). The
outcome was tooth survival; follow-up continued until
the tooth had been extracted, at least 10 years had
elapsed since retreatment, the patient declined further
follow-up, or the patient died. The Fisher exact test
was used to analyze differences between the groups.
Results: The median follow-up time was 10.1 years
(range, 0.0–15.6 years). The overall survival rate was
76%, with no significant differences in long-term tooth
survival between retreatment methods or the presence
of an intraradicular post. The reasons for tooth extrac-
tion were related to the retreatment method. Vertical
root fractures were significantly more frequent in the
nonsurgical group when retreatment included post
removal (P = .036). Conclusions: There was no signif-
icant difference in long-term tooth survival after surgical
or nonsurgical retreatment. The presence of intraradicu-
lar posts did not affect long-term tooth survival, but for
teeth with posts, those retreated nonsurgically were
more frequently extracted because of vertical root frac-
tures than those retreated surgically (P = .036). The ma-
jor limitations of the study were a smaller sample size
and the use of outmoded retreatment techniques. (J En-
dod 2018;44:1480–1486)
Key Words
Endodontic retreatment, long-term tooth survival, posts
From the *Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; †Department of Biomed-
ical, Surgical and Dental Sciences, Universita degli Studi di Milano, Milan, Italy; ‡Faculty of Dental Surgery, IM Sechenov First Moscow State Medical University, Moscow,
Russia; and §IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Address requests for reprints to Dr Andreas Riis, Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Box 7163,
SE 402 33 G€oteborg, Sweden. E-mail address: andreas.riis@vgregion.se
0099-2399/$ - see front matter
Copyright ª 2018 American Association of Endodontists.
https://doi.org/10.1016/j.joen.2018.06.019
1480 Riis et al.
treatment is to cure or
prevent periapical disease
Significance
Longevity is a key consideration in endodontic re-
treatment. This clinical study examined long-term
in order to promote long-
tooth survival in a randomized setup (surgical vs.
term tooth survival. Cohort
nonsurgical) and revealed valuable information on
studies, conducted mainly
10-year survival rates and on why retreated teeth
in specialist and university
may be extracted.
settings, have reported
high efficacy (1, 2).
However, cross-sectional studies of endodontic outcomes in general practice continue
to show a high prevalence of root-filled teeth with posttreatment disease (3).
In cases of posttreatment disease, tooth-preserving treatment options include sur-
gical and nonsurgical endodontic retreatment. Favorable treatment outcomes, at least in
the short-term, have been reported for both methods (4, 5). However, the method of
choice for comparing 2 or more treatment methods is the randomized controlled trial
(RCT). A recent Cochrane review of endodontic retreatment (6) identified only 2 RCTs
comparing surgical and nonsurgical retreatment (7, 8).
In a study by Kvist and Reit (8), 95 root-filled incisors and canines with posttreat-
ment disease were randomly assigned to surgical or nonsurgical intervention with
follow-up at 6, 12, 24, and 48 months. At the final follow-up assessment, attrition
was low (4.2%), and the survival rates were comparable (89% and 93% in the surgical
and nonsurgical groups, respectively). There was no statistically significant difference in
periapical healing between surgical and nonsurgical retreatment.
Both available RCTs were undertaken before the introduction of modern techno-
logical advances in clinical endodontic practice. The treatment methods were mainly
traditional without the use of operating microscopes, ultrasonics, nickel-titanium end-
odontic instruments, and bioceramic filling materials. However, the long-term out-
comes are still of interest, partially because of the shortage of RCTs with long-term
observation periods. Considering the extensive effort and cost involved in endodontic
retreatment, longevity is a key consideration.
As a possible consequence of the outdated methods, Kvist and Reit (8) found
that in the surgical group 4 cases, which had been classified as healed after
12 months, subsequently exhibited recurrence of the apical radiolucency or pre-
sented with clinical symptoms. Hypothetically, this sequence of events may jeopardize
long-term tooth survival because root-filled teeth with posttreatment disease are at
higher risk of extraction (9).
JOE — Volume 44, Number 10, October 2018
 Clinical Research
Intraradicular posts may also negatively affect long-term tooth sur- TABLE 1. Characteristics of Patients and Teeth in the Surgical (S) and
vival (10). The presence of posts in teeth with root fillings of poor qual- Nonsurgical (NS) Retreatment Groups
ity has been found to increase the risk of posttreatment disease (11). S NS
Moreover, post removal before retreatment in order to allow access
to the root canal system is considered a risk factor for inducing vertical Patients* n = 45 n = 47
root fractures (12–15). In the study by Kvist and Reit (8), 80% of the Sex, n (%)
included teeth had been restored with an intraradicular post. In the Male 16 (36) 22 (47)
long-term, this could lead to a systematic difference in tooth survival be- Female 29 (64) 25 (53)
Age (years)
tween the 2 retreatment methods because of a higher incidence of ver- Mean 53 52
tical root fractures in the nonsurgical retreatment group. The aim of the Range 28–75 17–74
present study was to compare long-term tooth survival after surgical or Teeth, n (%) n = 47 n = 48
nonsurgical endodontic retreatment and to investigate whether the 11, 21 10 (21) 17 (35)
12, 22 26 (55) 24 (50)
presence of intraradicular posts influenced the outcome. 13, 23 4 (9) 2 (4)
33, 43 7 (15) 5 (10)
Materials and Methods Restoration, n (%)
Crown with post 39 (83) 37 (77)
The methodology of the study design was presented in detail in the Crown without post 3 (6) 0 (0)
original study (8). A brief summary is provided here. Age of root filling, n (%)
#4 years 5 (11) 4 (8)
>4 years 42 (89) 44 (92)
Ethical Approval
The study was approved by the Committee for Research on Human *Three teeth were eligible in 1 patient, and 2 teeth were eligible in 3 patients.

Subjects at the University of Gothenburg, Gothenburg, Sweden (Dnr:

234-89).
Patients and Teeth
The subjects included 92 patients referred to the University of
Gothenburg for endodontic retreatment because of posttreatment dis-
ease. Patients fulfilling the following inclusion criteria were consecu-
tively enrolled:
1. Single-rooted maxillary and mandibular incisors and canines in
which apical radiolucency was clearly visible on x-rays
2. Root canal treatment performed more than 4 years earlier or the
presence of clinical signs and symptoms
3. No apical-marginal communication was observed
4. Randomization of retreatment options was considered to be medi-
cally as well as economically feasible
5. Patient consent was obtained
In all, 95 teeth were randomized (16) according to 3 factors (ie,
the size of the periapical lesion, the apical position of the root filling, and
the technical quality of the root filling) for either surgical or nonsurgical
retreatment. The characteristics of the 2 treatment groups after the
randomization process are presented in Table 1. Figure 1 shows a
flow diagram of the study based on the Consolidated Standards Of Re-
porting Trials. Intraradicular posts were present in 39 teeth (83%) in
the surgical group and 37 (77%) in the nonsurgical group.
Treatment Procedures
All treatments were performed through the years 1989 to 1992 by
a single operator at the Department of Endodontology, Institute of
Odontology, University of Gothenburg.
Surgical Retreatment. The root apex was exposed by the conven-
tional surgical technique. After removal of the periapical granuloma, the
root apex was resected approximately 2 mm. When possible, the root
canal was instrumented using Hedstrom files (up to ISO 40) and filled
with gutta-percha as described by Reit and Hirsh (17). In the remaining
cases, a small round bur was used to prepare a retrograde cavity of 2–
3 mm that was subsequently filled with gutta-percha, softened either in
chloroform or by heating over an open flame.
Nonsurgical Retreatment. Thirty-seven (77%) of the 48 teeth in
this group had been restored with a crown and an intraradicular post,
which had to be removed to access the root canal. A systematic
approach was used for the post removal procedure, initially using a
post extractor (Sj€odings, Kista, Sweden) supplemented if necessary
by the use of ultrasonics, burs, or a combination of these. In a clinical
protocol, the type of post, the methods used for each post removal, and
the time required for post removal were documented.
The tooth was isolated by a rubber dam, and the operation field
was disinfected by consecutive application of 30% hydrogen peroxide
and 10% iodine tincture. Existing root filling material was removed me-
chanically using Gates/Glidden drills and stainless steel hand files up to
an apical size of at least ISO 50, if possible to within 0.5–1 mm of the
radiographic apex. Chloroform was used as a supplement only when
necessary. Buffered 0.5% sodium hypochlorite was used as an irrigant.
An interappointment dressing of calcium hydroxide paste was placed
with a Lentulo spiral. After 2 weeks, the root canals were reentered
and filled with gutta-percha softened in 5% rosin chloroform using
the cold lateral condensation technique. When indicated, space for a
post was prepared directly after the root filling procedure. After retreat-
ment procedures, all teeth were referred back to the general dentist for
restoration of the tooth, including a new intraradicular post if indicated.
Follow-up
Clinical and radiographic follow-up examinations were scheduled af-
ter 6, 12, 24, and 48 months and annually thereafter until the tooth had
been extracted, at least 10 years had elapsed since retreatment, the patient
declined further follow-up, or the patient died. In case of extraction, the
reason for extraction was retrieved from the patient’s records.
Outcome
The outcome was tooth survival defined as the tooth being in situ
at follow-up examinations.
Statistical Analysis
The Fisher exact test was used to analyze differences between
groups. The tests were 2-tailed, and the level of significance was set
at 5% (P < .05).
Kaplan-Meier curves were calculated for each time series (surgical
and nonsurgical groups) using IBM SPSS 24.0 (IBM Corp, Armonk, NY)

JOE — Volume 44, Number 10, October 2018 Tooth Survival after Endodontic Retreatment 1481
Clinical Research
Figure 1. A flow diagram of the study setup according to the Consolidated Standards Of Reporting Trials guidelines.
for analysis. The cumulative tooth survival in the 2 groups was compared
using the Fisher exact test at intervals of 24 months up to 120 months.
Results
Post Removal Procedures
A post was present in 37 of 48 (77%) teeth in the nonsurgical re-
treatment group. Figure 2 depicts the post removal workflow. The over-
all mean removal time was 20 minutes (range, 8–55 minutes). One
tooth (2.7%) fractured during this procedure. All intraradicular posts
were metallic, and most had been customized to the individual root ca-
nal. Thirty-four teeth (92%) received a new intraradicular post after
nonsurgical retreatment.
Tooth Survival
The median follow-up time was 10.1 years (range, 0.0–15.6 years).
At the end of the study, 72 teeth (76%) survived. The median survival time
of the 23 teeth that had been extracted was 7.1 years (range, 0.0–
15.4 years). Twelve patients died during the follow-up period (range,
1482 Riis et al.
0.6–12.5 years after retreatment). In all cases, the retreated tooth had
been in situ at the last follow-up assessment before death (Fig. 3).
Tooth Survival with Respect to the Retreatment Method
Forty-seven teeth (49%) were surgically retreated and 48 teeth
(51%) nonsurgically retreated. The mean follow-up time was 8.7 and
9.0 years, respectively. Twelve teeth (26%) in the surgical group and
11 teeth (23%) in the nonsurgical group were extracted. The difference
was not statistically significant (P = .181). The comparison between
groups is presented in Figure 4 as a Kaplan-Meier analysis. No signifi-
cant difference between groups was found at any postoperative time in-
terval although the difference was borderline at 24 months (P = .053).
Tooth Survival with Respect to the Presence of a Post
Before retreatment, posts were present in 76 teeth (80%). The
mean follow-up time for these teeth was 9.2 years. The remaining 19
teeth without posts (20%) had a mean follow-up time of 7.7 years. At
the end of the study, 20 teeth with preoperative posts (26%) and 3 teeth
JOE — Volume 44, Number 10, October 2018
 Clinical Research
Total number of posts: 37 Root fracture during post (P = .062). When the reason for extraction of teeth with posts was eval-
removal procedure, 1 case uated (Table 3), “vertical root fracture” was significantly more
frequently recorded in nonsurgically retreated teeth (P = .036), and
“failure to heal” was significantly more frequent in surgically retreated
Removal of crown or bridge Hold for post extractor not
available. Post removed by
teeth (P = .004).
ultrasonic alone, 1 case;
Preparation of the post with 43min
high-speed
Discussion
This prospective randomized study showed that after a median
Threading of post for
adaptation of post-extractor, 2 follow-up time of 10.1 years, the overall survival rate of retreated inci-
cases; mean removal time: 22
Post-extractor: 27 cases sors and canines was 76%. The analysis did not reveal any systematic
minutes
difference in survival rates between teeth retreated surgically or nonsur-
Post-extractor, 25 cases; gically (74% and 77%, respectively). Kaplan-Meier analysis showed a
mean removal time: 14 minutes
trend toward a better outcome for the surgical approach in the first
Supplementary actions: eight cases
years after retreatment, but over time this trend tended to reverse. How-
ever, the difference was not significant up to 10 years and beyond
Post extractor
(Fig. 4). Unfortunately, the low number of cases at the final follow-up
Post extractor did not
loosen the post.
caused fracture of Post extractor precluded more precise estimation of the actual tooth survival in rela-
the post. caused fracture of
Ultrasonics was added
Ultrasonics was the post.
tion to the type of retreatment.
after which the extractor
loosened the post,
used to remove the A bur was used to There are few studies on long-term tooth survival after endodontic
post, 2 cases; mean remove the post,
5 cases; mean removal
removal time: 28 1 case; 45min
retreatment procedures (6). However, our results corresponded well
time: 31 minutes
minutes with the pooled weighted success rate for secondary root canal treat-
ments reported in a systematic review by Ng et al (4) (77.2%) and in
Figure 2. Workflow for the post removal procedure before nonsurgical end- reviews of survival after endodontic surgery by Torabinejad et al (18)
odontic retreatment. and Chercoles-Ruiz et al (19), reporting respective survival rates of
88% at 4 to 6 years and 59.1%–93% after 1 to 10 years. The long-
term survival rate in the present study was also similar to that of a retro-
spective 10-year follow-up including both surgical and nonsurgical pro-
without posts (16%) had been extracted. The difference was not signif-
cedures from our specialist endodontic clinic (81.5%) reported by
icant (P = .162).
Landys Boren et al (20).
Follow-up rates and continuity are important aspects of long-term
Reasons for Extractions studies. In the present study, 11 (12%) of the patients died before and 1
The specific reasons for most of the extractions of teeth during the patient after 10 years of follow-up. In all cases, the treated tooth had
follow-up period could be identified from the patients’ records been in situ at the last follow-up visit. As shown in Figure 3, follow-
(Table 2). In the surgical retreatment group, 7 (58.3%) teeth were ex- up was less than 10 years in 15 patients (16%) but less than 7 years
tracted because of “failure to heal,” whereas none (0%) of the teeth in in only 5 (5%). De Chevigny et al (21) assessed the outcome 4 to 6 years
the nonsurgical group was extracted for this reason. The difference be- after nonsurgical retreatment, reporting 93% functional teeth although
tween groups was significant (P = .003). In the nonsurgical group “ver- a very large proportion of cases (nearly 70%) were lost to follow-up.
tical root fracture” was stated as the reason for extraction in 6 (54.5%) Barone et al (22) prospectively assessed the 4- to 10-year outcomes
of the teeth, whereas the corresponding number in the surgical group of endodontic surgery of 261 treated teeth in a pooled sample; 96
was 2 (16.7%). The difference was not statistically significant (37%) were lost to follow-up and 31 were extracted. Of the remaining

Figure 3. Survival time; each bar represents 1 patient, and the y-axis depicts years of survival.

JOE — Volume 44, Number 10, October 2018 Tooth Survival after Endodontic Retreatment 1483
Clinical Research
Figure 4. The Kaplan-Meier curve.
134 teeth examined for outcome, 126 teeth (94%) were functional. Un-
fortunately, the high attrition rates in these studies detract from the val-
idity of the results.
As an outcome measure, healing of apical periodontitis is a major
objective in root canal treatment. However, many recent studies have
focused instead on tooth survival (2, 20, 23, 24), probably because
many teeth remain asymptomatic despite signs of posttreatment
disease (25). The outcome measure “tooth survival” is sometimes
used also when data are extracted from insurance records, and, conse-
quently, no clinical information is available (23). The term “functional
retention” has been suggested to be used if clinical examination reveals
an asymptomatic tooth in function regardless of any radiographic
finding of persistent apical pathology (26).
A major disadvantage of clinical research with long-term follow-
up times is that the treatment methods under evaluation may become
outdated before long-term results are available. Paradoxically, new
methods may have been implemented in the absence of any long-
term evaluations, and, conversely, the available long-term studies
are regarded as obsolete because of “old-fashioned” methods. With
such rapid technological developments in modern medicine and
dentistry, there is a risk that methods and materials may be intro-
duced, applied, and then superseded so quickly that long-term eval-
uations become problematic. However, some technological
TABLE 2. Reason for Extraction with Respect to Retreatment Method
Surgical (n = 12)
Reason for extraction n (%)
Vertical root fracture 2 (16.7)
Failure to heal 7 (58.3)
Intentional in general 2 (16.7)
treatment plan
Unknown 1 (8.3)
Bold typeface highlights statistical significance (P < .05).
1484 Riis et al.
developments may also be of such magnitude that their advantage is
beyond every reasonable doubt. Indeed, this holds true for endodon-
tic retreatment techniques, with enhanced visualization through the
use of operating microscopes or loupes, rotary endodontic instru-
ments for nonsurgical retreatment, and microsurgery with ultrasonic
preparation and mineral trioxide aggregate retrograde fillings for sur-
gical retreatment.
Several studies have reported a significantly higher success rate us-
ing endodontic microsurgery (27, 28). This is of relevance to the
present study, which reports a high rate of “failure to heal” as a
reason for tooth extraction in the surgical retreatment group
(Tables 2 and 3). However, in accordance with the trend found in
the present study, some studies using up-to-date technologies have
also reported some reversal of healing in the long-term (29–31).
Therefore, it is important that long-term follow-up is included in the de-
signs of future studies comparing surgical and nonsurgical endodontic
procedures.
However, extending the follow-up period increases the risk that
factors other than the retreatment procedure will determine tooth sur-
vival. In the present study, 4 teeth (2 in each retreatment group) were
extracted as part of a subsequent, general treatment plan executed by
the patient’s general dentist (Table 2). Likewise, we cannot rule out
that a tooth that according to the patient’s record was extracted for
Nonsurgical (n = 11) Total (n = 23)
n (%) n (%) P value
6 (54.4) 8 (34.8) .062
0 (.0) 7 (30.4) .003
2 (18.2) 4 (17.4) .410
3 (27.3) 4 (17.4) .224
JOE — Volume 44, Number 10, October 2018

TABLE 3. Reason for Extraction in Teeth with an Intraradicular Post
Surgical (n = 11)
Reason for extraction n (%)
Vertical root fracture 1 (9.1)
Failure to heal 7 (63.6)
Intentional in general 2 (18.2)
treatment plan
Unknown 1 (9.1)
Bold typeface highlights statistical significance (P < .05).
another reason could not also have had a vertical root fracture or that a
tooth with a (minor) vertical root fracture would stay asymptomatic and
thereby survive for a longer period.
The presence of intraradicular posts in root-filled teeth may
also influence long-term tooth survival (32, 33). Although the
results of the present study did not reveal a significant difference
(P = .162) in survival rates between teeth with or without posts,
the relatively large numeric difference in the extraction rate (26%
vs 16%, respectively) indicates an increased risk of failure when a
post is present. The lack of statistical significance may be caused
by the relatively small sample size. Because only 3 teeth were left
without a new post after the retreatment procedure and all 3 were
extracted within 2 years after the treatment (1 had a vertical root
fracture during the post removal procedure), this study could not
reveal information on the effect of a second post preparation and
placement.
Despite the limited number of patients presented, it is inter-
esting to observe the difference in the reasons for extraction be-
tween the 2 retreatment groups (ie, predominantly “failure to
heal” in the surgical group and “vertical root fracture” in the
nonsurgical group) (Table 2). Only 2 teeth (16.7%) in the surgical
group were extracted because of vertical root fractures. Similarly,
in a study by Karygianni et al (13), only 6.5% of 200 retreated teeth
extracted because of vertical root fractures had undergone surgical
retreatment alone, whereas the remaining teeth had been retreated
nonsurgically. In the present study, comparing the retreatment
method in extracted teeth that had posts (Table 3) disclosed a sta-
tistically significant difference between teeth extracted because of a
vertical root fracture and teeth extracted for all other reasons
(P = .036).
In the future, randomized studies will require a sufficient num-
ber of patients for adequate statistical power in order to clarify
whether newer retreatment techniques can promote better long-
term tooth survival and whether there are any systematic differences
related to surgical or nonsurgical retreatment. In the context of
recent technological advances in endodontic surgery, the findings
of the present study indicate that in teeth with intraradicular posts,
the long-term prognosis for tooth survival is likely to be more favor-
able after surgical retreatment than after post removal and nonsur-
gical retreatment.
Conclusions
In the present study, 76% of the endodontically retreated inci-
sors and canines survived for a period of approximately 10 years.
There was no significant difference between teeth treated surgically
or nonsurgically or the presence of an intraradicular post. Vertical
root fractures were the major reason for tooth extraction, primarily
in the nonsurgical group, when retreatment included the removal
of a post.
JOE — Volume 44, Number 10, October 2018
Clinical Research
Nonsurgical (n = 9) Total (n = 20)
n (%) n (%) P value
5 (55.6) 6 (30.0) .036
0 (0.0) 7 (35.0) .004
1 (11.1) 3 (15.0) .434
3 (33.3) 4 (20.0) .191
Acknowledgments
The authors would like to thank Professor Shimon Friedman,
DMD, Faculty of Dentistry, University of Toronto, Canada, for his
valuable critique and support in finalizing the manuscript. The au-
thors deny any conflicts of interest related to this study.
References
1. Ng YL, Mann V, Rahbaran S, et al. Outcome of primary root canal treatment: system-
atic review of the literature - part 1. Effects of study characteristics on probability of
success. Int Endod J 2007;40:921–39.
2. Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treat-
ment: a systematic review of the literature. Int Endod J 2010;43:171–89.
3. Pak JG, Fayazi S, White SN. Prevalence of periapical radiolucency and root canal
treatment: a systematic review of cross-sectional studies. J Endod 2012;38:1170–6.
4. Ng YL, Mann V, Gulabivala K. Outcome of secondary root canal treatment: a system-
atic review of the literature. Int Endod J 2008;41:1026–46.
5. Tsesis I, Rosen E, Taschieri S, et al. Outcomes of surgical endodontic treatment per-
formed by a modern technique: an updated meta-analysis of the literature. J Endod
2013;39:332–9.
6. Del Fabbro M, Corbella S, Sequeira-Byron P, et al. Endodontic procedures for re-
treatment of periapical lesions. Cochrane Database Syst Rev 2016;10:CD005511.
7. Danin J, Stromberg T, Forsgren H, et al. Clinical management of nonhealing peri-
radicular pathosis. Surgery versus endodontic retreatment. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 1996;82:213–7.
8. Kvist T, Reit C. Results of endodontic retreatment: a randomized clinical study
comparing surgical and nonsurgical procedures. J Endod 1999;25:814–7.
9. Kirkevang LL, Vaeth M, Wenzel A. Ten-year follow-up observations of periapical and
endodontic status in a Danish population. Int Endod J 2012;45:829–39.
10. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of
non-surgical root canal treatment: part 2: tooth survival. Int Endod J 2011;44:610–25.
11. Kvist T, Rydin E, Reit C. The relative frequency of periapical lesions in teeth with root
canal-retained posts. J Endod 1989;15:578–80.
12. Abbott PV. Incidence of root fractures and methods used for post removal. Int En-
dod J 2002;35:63–7.
13. Karygianni L, Krengel M, Winter M, et al. Comparative assessment of the incidence of
vertical root fractures between conventional versus surgical endodontic retreatment.
Clin Oral Investig 2014;18:2015–21.
14. Kishen A. Mechanisms and risk factors for fracture predilection in endodontically
treated teeth. Endod Topics 2006;13:57–83.
15. Sathorn C, Palamara JE, Palamara D, Messer HH. Effect of root canal size and
external root surface morphology on fracture susceptibility and pattern: a finite
element analysis. J Endod 2005;31:288–92.
16. Pocock SJ. Clinical Trials. A Practical Approach. Chichester, UK: John Wiley &
Sons; 1983.
17. Reit C, Hirsch J. Surgical endodontic retreatment. Int Endod J 1986;19:107–12.
18. Torabinejad M, Landaez M, Milan M, et al. Tooth retention through endodontic
microsurgery or tooth replacement using single implants: a systematic review of
treatment outcomes. J Endod 2015;41:1–10.
19. Chercoles-Ruiz A, Sanchez-Torres A, Gay-Escoda C. Endodontics, endodontic re-
treatment, and apical surgery versus tooth extraction and implant placement: a sys-
tematic review. J Endod 2017;43:679–86.
20. Landys Boren D, Jonasson P, Kvist T. Long-term survival of endodontically treated
teeth at a public dental specialist clinic. J Endod 2015;41:176–81.
21. de Chevigny C, Dao TT, Basrani BR, et al. Treatment outcome in endodontics: the
Toronto study–phases 3 and 4: orthograde retreatment. J Endod 2008;34:131–7.
22. Barone C, Dao TT, Basrani BB, et al. Treatment outcome in endodontics: the Tor-
onto study–phases 3, 4, and 5: apical surgery. J Endod 2010;36:28–35.
Tooth Survival after Endodontic Retreatment 1485
Clinical Research
23. Fransson H, Dawson VS, Frisk F, et al. Survival of root-filled teeth in the Swedish
adult population. J Endod 2016;42:216–20.
24. Salehrabi R, Rotstein I. Endodontic treatment outcomes in a large patient population
in the USA: an epidemiological study. J Endod 2004;30:846–50.
25. Yu VS, Messer HH, Yee R, Shen L. Incidence and impact of painful exacerbations in a
cohort with post-treatment persistent endodontic lesions. J Endod 2012;38:41–6.
26. Friedman S, Mor C. The success of endodontic therapy–healing and functionality.
J Calif Dent Assoc 2004;32:493–503.
27. Setzer FC, Shah SB, Kohli MR, et al. Outcome of endodontic surgery: a meta-analysis
of the literature–part 1: comparison of traditional root-end surgery and endodontic
microsurgery. J Endod 2010;36:1757–65.
28. Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z. Retrospective evaluation of surgical
endodontic treatment: traditional versus modern technique. J Endod 2006;32:
412–6.
1486 Riis et al.
29. Kim S, Song M, Shin SJ, Kim E. A randomized controlled study of mineral
trioxide aggregate and super ethoxybenzoic acid as root-end filling materials
in endodontic microsurgery: long-term outcomes. J Endod 2016;42:
997–1002.
30. Rubinstein RA, Kim S. Long-term follow-up of cases considered healed one year af-
ter apical microsurgery. J Endod 2002;28:378–83.
31. von Arx T, Jensen SS, Hanni S, Friedman S. Five-year longitudinal assessment of the
prognosis of apical microsurgery. J Endod 2012;38:570–9.
32. Goodacre CJ, Spolnik KJ. The prosthodontic management of endodontically treated
teeth: a literature review. Part I. Success and failure data, treatment concepts.
J Prosthodont 1994;3:243–50.
33. Mireku AS, Romberg E, Fouad AF, Arola D. Vertical fracture of root filled teeth
restored with posts: the effects of patient age and dentine thickness. Int Endod J
2010;43:218–25.
JOE — Volume 44, Number 10, October 2018