Reentry of endodontic access cavities: composite residue and loss of tooth substance

The purpose of this study was to investigate the ability of dentists to remove composite fillings from endodontic access cavities using illumination from a conventional light source (CLS) versus the fluorescence-aided identification technique (FIT) in terms of completeness, selectivity and treatment duration. Therefore, two independent operators removed composite resin from six sets of root-filled incisors in a maxillary model under simulated clinical conditions using the CLS or FIT method (twelve teeth per operator and technique). The duration of treatment was recorded and before-after micro-CT scans were superimposed for volumetric assessment of treatment completeness and selectivity. Statistical significance was determined by t-testing and two-way ANOVA for operator comparison. Overall, there was no significant difference between FIT and CLS in terms of volume, height and area of composite residues (p=0.98 / p=0.75 / p=0.64) and regarding hard tissue loss in terms of volume, depth and area (p= 0.93 / p= 0.70 / p= 0.14). However, there was a significant difference between the two groups regarding treatment time (FIT= 428s, CLS=523s; p=0.023). Significant differences between operators regardless of method were found for volume, height and area of composite residues (p<0.05) and also for defect area (p=0.01) and time (p<0.001). Significant differences between operators including the method was only found for height of composites (p=0.037). It can be concluded, that composite remnants and tooth structure losses may occur after reentry of root-filled teeth regardless of the illumination method (conventional vs. fluorescence-aided) and operator, but preparation was less time-consuming with FIT.