GUIDED BY:

Dr. P. Karunakar
Dr. Ranga reddy
Dr. Umrana Faizuddin
PRESENTED BY:
Dr. Ashish Jain P. Indira
CONTENTS
 INTRODUCTION
 AIM
 MATERIALS AND
METHOD
 RESULTS
 CONCLUSION
 DISCUSSION
 REVIEW OF LITERATURE
 MERITS AND DEMRITS
 TAKE HOME MESSAGE
 REFERENCES
 The major reason for persistent apical
periodontitis is intraradicular infection
(Siqueira 2001, Nair 2006, Ricucci & Siqueira 2010).

Removal
The previous contaminated filling of must be
material
pathologic
removed, allowing instruments pulp to act
and irrigants
throughout the entire canal
Cleaning &
(Stabholz & Friedman 1988).
shaping of root
canal system
This may be achieved with hand files, burs, heated
Threenickel–
instruments, solvents and more recently
dimensional
titanium (NiTi) rotary and reciprocating systems
obturation
(Imura et al. 1996, Bramante et al. 2010, Zuolo et al. 2013, 2016).
Friedman stated that “Most patients can relate to the concept
of disease-treatment-healing, whereas failure, apart from being a
negative and relative term, does not imply the necessity to pursue
treatment.”

Suggested using the term post treatment to describe those cases that
would previously have been referred to as treatment failures.

RCT: sucess rates: 86% - 98%

Success – defined by the following criteria:

1. Patient should be asymptomatic and be able to

function equally well on both sides
2. The periodontium should be healthy, including a
normal attachment apparatus
3. Radiographs should demonstrate healing or
progressive bone fill overtime
( C.J.Ruddle )
A procedure to remove root canal filling materials from the
tooth, followed by cleaning, shaping and obturating the canals.
 ( GET – AAE )

 Non surgical retreatment is an endodontic treatment procedure

used to remove materials from the root canal space and, if
present, address deficiencies or repair defects that are
pathologic or iatrogenic in origin.
 ( C.J.Ruddle )
Washington Study
• Study carried out at the University of Washington, school
of Dentistry to evaluate treated endodontic cases and
ascertain their success rate.

 Results

• Periapical repair was frequently not complete for the

middle aged and elderly patients within 1 year.
• Age of the patients also affected the failure rates.
• Higher for patients in the first decade and sixth decade of life.
• Lower for patients between second to fifth decade of life.
• No significant difference in the success rates of cases treated
surgically or non-surgically
Toronto Study
 The Toronto Study Project, established in 1993,

 This modular design provides cumulative data with

the completion of each successive phase, with the
aim of amassing a sufficient sample to study the
prognostic value of various factors
 Causes for Failure
Preoperative causes
 Incorrect oral examination & misinterpretation
 Sinus tract, pain, vitality test, periodontal problems

 Misinterpretation of radiographs
 Odontogenic, developmental lesions, anatomic
landmarks
 Physical injury

 Improper case selection

 Patient cooperation
 Technical difficulties
 Patient systemic condition
 Grossly destructed teeth
 Root resorption
 Operative causes
 Failure to obtain Biomechanical objectives

 Access preparation
 Perforation
 Underextended preparation
 Overextended preparation

 Canal preparation
 Perforations
 Ledge formation
 Canal blockage
 Instrument separation & foreign objects
Failure To Obtain Biological Objectives
Removal Of Potential Irritants From
• Coronal Portion

• Root Canal System

• Periapical Tissues

• Defective Obturation
• Overextended Filling
• Underextended Filling
• Periodontal Involvement- Lateral And
Accessory Canals
Post-Operative causes

• Trauma & fracture

• Impaired periapical healing
• Superimposed Non-endodontic involvement
• Excessive orthodontic forces, periodontal disease
• Poor post-endodontic restoration
 Gutta Percha Removal

 Initially removed from the canal in the coronal one

third, then the middle one third and finally eliminated
from apical one third.
• Following methods or combination of methods are used.
 K-files or H-files
 Gutta-percha solvent
 Combination of paper points and gutta-percha solvent
 Specialized rotary instruments designed for retreatment
 Heat transfer devices
 Soft tissue laser
 The root canal system is highly complex: it can be oval or C-
shaped; the canals sometimes divide; or an isthmus may connect
the canals (Dye and Micro CT 3D studies).

 In the face of such complexity, standard NiTi files are not

always up to the task.

 Despite their flexibility, the files make round shapes only and
thus cannot reach certain parts of the canal during treatment.
(Oval, caverns, double canal, C, 8, isthmus shape)
 Several studies involving micro CT technologies have shown
3D Micro CT : Canal morphology before instrumentation
that, on the whole, when standard NiTi files are used to prepare
(green);
the root canal
canal, walls touched
only 45-55 per using
cent ofa standard
canal wallsNiTi file
are actually
(red)
touched.
The XP-endo Shaper is the latest addition to the XP-endo® range.
It is a truly innovative shaping instrument which can be used to
radically simplify endodontic sequences.
It results from the combination of two
cutting-edge technologies:

 Made with MaxWire® alloy, like the XP-endo Finisher, it offers

remarkable flexibility and fatigue resistance, and the ability to
progress within the canals with ease and agility, expanding or
contracting according to the canal morphology.

 With an initial taper of .01, the XP-endo Shaper expands once

inside the canal, achieving a taper of at least .04
 the Booster Tip (BT), the XP-endo Shaper benefits from a
unique geometry, featuring six sharp edges at the tip. The
BT tip respects the trajectory of the canal, whilst
removing more material with each pass. It enables to start
shaping an ISO diameter smaller than the one of the
instrument.
In short
 Simplified handling
 Minimal torque
 Excellent debris removal and improved disinfection
video
In some circumstances, the canal must be retreated. As
much of the root filling material as possible must
therefore be removed before retreatment itself can begin.
 After initial filling material is removed, regardless of the
instrumentation technique used, residual material is
always present particularly in curved or oval canals.

 Like with the XP-endo Finisher the exclusive FKG

MaxWire® alloy gives to the instrument the ability to
expand and contract so as to contact difficult to reach
areas
 With its ISO 30 diameter, the XP-endo Finisher R is
slightly stiffer than the XP-endo Finisher enabling it to
eliminate Gutta Percha and sealer.

 Moreover, the XP-endo Finisher R features unparalleled

resistance to cyclic fatigue, due to its small core size and
zero taper.
 The instrument is easy to use and intended for all
dentists keen to enhance the long-term success of their
retreatment procedures
In short
 Ø ISO 30
 Taper : 0%
 Lengths : 21, 25 mm
 Recommended speed : 800 rpm
 Torque : 1 Ncm
 Delivered in a sterile blister. Single use
video
 To evaluate the efficacy of filling material removal from
oval-shaped canals after the use of supplementary files
(XP-endo Finisher and XP-endo Finisher R) through
microcomputed tomographic (micro-CT) analysis.
 A sample of seventy-five maxillary single-rooted
teeth with a single canal and similar root length was
selected

 Mesiodistal and buccolingual radiographs were

taken, oval canals were selected and canal
configurations were measured

 Root canal curvature was determined based on the

angle of curvature initiated at the coronal aspect of
the apical third of the root
 Root
The roots canals using Reciproc R25 instruments at the canal procedures
working length, which was established as being 1 mm
short of the apical foramen .

The root canals were irrigated with 25ml of NaOCL

& were checked for apical patency with a size of
15K-file

Then the smear layer was removed using 3ml of 17%

EDTA followed by 1ml of bi-distlled water

The canals were dried with R25 paper points & were
filled using 25 gutta percha cones & AH plus sealer
using continuous wave of condensation technique
 After that, the cervical & middle thirds
of the canals were filled with the aid of
a gutta percha condenser & the acess
cavities were sealed with cavit

The quality of the root fillings was confirmed

by buccolingual and mesiodistal
radiographic projections.

If voids were detected, the tooth was

discarded and replaced.

Retreatment procedures were accomplished

by using reciproc R25 & R 40 instruments
Each root canal was irrigated with 10ml of
25% NaOCL during retreatment procedure

The criteria for the completion of the

retreatment procedure were smooth
canal walls & no evident filling material
on the files
Supplementary cleaning approach

 Following the retreatment procedures, the specimens

were assigned to two groups
 XP-endo Finisher and XP-endo Finisher R.
Micro-CT imaging analysis

 The sample was scanned through a micro-CT device at

three time-points preparation, with the following
parameters:
 50 kV, 800 mA, isotropic resolution of 21.8 lm,
 360° rotation around the vertical axis with a rotation
step of 0.5°
 and frame averaging of three, using a 1.0-mm thick
aluminium filter.
 The acquired images were reconstructed into cross-
sectional slices using NRecon v.1.6.9 software
Statistical analysis
 An initial screening for data normality was performed
using Shapiro–Wilk test.

 A Wilcoxon test was used to identify further the

significance of the amount of residual material removed
after the use of each XP-endo instrument.

 The level of significance was set at a = 5%

Results
 The student’s t-test confirmed the similar configuration of
the prepared canals between the groups

 Removal of filling material at 66.8% and 59.4% in volume

and 67.3% and 61.4% in surface area was found for the
XP-endo Finisher and the XP-endo Finisher R files,
respectively
Conclusions

 The XP-endo Finisher and the XP-endo Finisher R files

were both equally effective in the removal of residual
root filling material from straight oval-shaped canals.
None of the instruments were able to remove all residual
filling material
 Removing root filling material, shaping and cleaning, and
then refilling the root canal are the main goals of a
successful retreatment
(Nair 2006, Ricucci & Siqueira 2010)

However, numerous studies have shown that regardless of

the retreatment technique used, filling material remains in
the root canal system
(Imura et al. 1996, Bramante et al. 2010, Zuolo et al. 2013, 2016).
 Therefore, a supplementary technique aiming to maximize
the amount of area covered by endodontic instruments
and irrigating solutions would be beneficial, especially for
retreatment procedures

 Both supplementary files were effective in the removal of

additional filling material, with a significant reduction in
the volume of residual filling material by 66.8% and 59.4%
after the use of the XP-endo Finisher and the XP-endo
Finisher R files, respectively (P < 0.05)
Use of reciproc files
 It is a new system of single file reciprocation without
prior use of hand files. It was developed as single file
shaping technique

 The system includes three instruments only ne

RECIPROC instrument is used for the canal preparation
depending on the initial size of the canal.
Use of XP endo finisher files

 These files has two fundamental properties :

superelasticity and shape memory, with the aim of
creating a completely new generation of instruments.
 Unlike other instruments, these are able to react to
variations in temperature and to take on a predetermined
shape inside the root canal, at body temperature.
 Their specific preset shape and their extreme flexibility
enables these instruments to contract and expand within
the canal itself, and to reach areas which conventional
instruments simply cannot access.
 Furthermore, their small ISO diameter and their narrow
taper give them extreme resistance to cyclic fatigue.
 It has the ability to start shaping at ISO diameter 15 and
to achieve ISO diameter 30, but also to increase the taper
from .01 to at least .04.
 It allows to reach a final canal preparation of minimum
30/.04 and this with only one instrument.
 The XP-endo Shaper is the instrument of choice for the
treatment of the vast majority of canals.
Remarkable benefits

 Its “snake” shape, superelasticity and extreme flexibility

combined with continuous rotation at high speed (800
rpm) and minimal torque

 Minimal stress is applied to the dentine walls and the risk

of micro-cracks in the dentine is minimised due to
support from the spring action against the walls.
 Micro-debris that are created are easily and efficiently
removed, due to the turbulence generated by the
instrument and the available space compared to
instruments with a larger core diameter.

 Adaptation to canals irregularities

 A gentle, non-aggressive and conservative treatment.

Minimal stress applied during treatment
 This process is performed on a plastic block as a way to
visualise the stress applied by the instruments during
canal treatment.

 The greater the stress, the higher the risk of micro-

cracks.
Minimal torque
 The XP-endo Shaper generates an average torque 47%
lower than the Race instrument, and 88% lower than the
competitor instruments.
Excellent debris removal and improved
disinfection
 The XP-endo Shaper has a smaller core than conventional
instruments reaching the same final dimensions.
 This facilitates debris removal, making it more efficient
without occluding the dentinal tubules
 Additionally, the turbulence generated by the XP-endo
Shaper, by its continuous rotation at high speed, keeps
debris in the solution limiting the appearance of the
smear layer and enhances the penetration of irrigants in
all dentinal tubules
XP-endo® Finisher R
 The XP-endo Finisher R has a core diameter larger than
the XP-endo Finisher, making it slightly stiffer and also
more efficient in removing root filling materials adhering
to the canal walls, especially in the curvature and oval
areas.
Unique characteristics
 Mechanical cleaning of the canal in areas previously
impossible to reach due to its incredible flexibility and
capacity to expand.
 Unprecedented resistance to instrument fatigue due to its
zero taper
When and??the ability of the file to work in mixed M
to use
and A phases (exclusive FKG MaxWire® alloy).
Universal instrument that should be used following
 Adaptation to canal morphology and preservation of the
any root canal preparation of diameter ISO 30 or
dentine.
more.
 Thorough removal of debris.
 Removal of residual obturation material during
retreatment
Clinical cases
 To compare the efficacy of the XP-endo finisher file (XP) (FKG
Dentaire, La Chaux de Fonds, Switzerland) to that of passive
ultrasonic irrigation (PUI) and conventional syringe and needle
irrigation (SNI) in the removal of calcium hydroxide paste from an
artificial standardized groove in the apical third of root canals.

 XP and PUI were more effective in removing Ca(OH)2 from

artificial standardized grooves in the apical third of root canals than
SNI.
 The aim of this study was to evaluate using SEM analysis the
effectiveness of a new instrument XP-endo Finisher in cleaning
root canal walls after instrumentation with BioRaCe NiTi
rotary instruments

 XP-endo Finisher after canal instrumentation with NiTi rotary

instruments effectively cleaned canal walls and removed smear
layer.
 This study evaluates and compares the efficiency of XP-endo Finisher
EndoActivator and Passive Ultrasonic Irrigation in removing dentin debris
and to compare percentage of remaining dentin debris for each irrigation
system.

 None of the tested irrigation devices was able to completely remove

dentin debris from approximately straight root canals.

 Using the XP-endo Finisher or the passive ultrasonic irrigation (PUI) was
more effective than EndoActivator sonic irrigation.

 The apical level showed greater amount of debris than the middle and
coronal levels, regardless of the irrigation device used
 Has show  Single use
significant removal  Cost effective
of gutta percha  Delicate usage
 second study on
retreatment
 As we know, it is very difficult to fully eliminate the filling
material during retreatment.

 Regardless of the technique used, there is some debris

left behind after canal cleaning - in particular in curved or
oval canals.
 The XP-endo Finisher R has a core diameter larger than the
XP-endo Finisher, making it slightly stiffer and also more
efficient in removing root filling materials adhering to the canal
walls.

 Due to its expansion capacity, the XP-endo Finisher R can

reach areas of the canal wall which conventional files cannot
reach, thereby considerably improving canal cleaning.
References
 Ruddle CJ. Cleaning and shaping root canal system. In: Cohen S,
Burns RC, editors. Pathways of the pulp. 8th ed. St. Louis: Mosby;
2002. p.231-91.
 Violich DR, Chandler NP. The smear layer in endodontics – a review.
Int Endod J. 2010; 43(1):2-15. [DOI: 10.1111/j.1365-
2591.2009.01627.x] [PMID: 20002799]
 3. Živković S, Brkanić T, Dačić D, Opačić V, Pavlović V, Medojević M.
Smear layer in endodontics. Stomatološki glasnik Srbije. 2005;
52(1):7-19. [DOI: 10.2298/SGS0501007Z]
 4. Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical
implications of the smear layer in endodontics: a review. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2002; 94(6):658-66. [DOI:
10.1067/moe.2002.128962] [PMID: 12464887]
 5. Ruddle CJ. Nickel-titanium rotary systems: review of existing
instruments and geometries. Dent Today. 2000; 19(10):86-8, 90-5.
[PMID: 12524811]