Treatment planning dilemmas resulting from failed root canal cases

Endodontics is one of the least forgiving branches of dentistry in terms of treatment success or failure. As a result, re-treatment has become a significant part of today's endodontic practice. In the past, it was felt that surgical treatment with root-end filling would result in the highest degree of success. It has been subsequently demonstrated that microorganisms remaining in the root canal system after treatment were the main aetiological factor in post-treatment disease. Hence, non-surgical orthograde re-treatment has become the treatment of choice. While most authors support this method of re-treatment, some feel the surgical approach is still the best, and others advocate a combination of treatments. While treatment planning may appear to be straightforward, there are many grey areas in actual practice. This paper attempts to show a number of situations where the treatment planning may not be black and white.