Surgical treatment of iatrogenic canal blockages

The endodontist of today is confronted with managing retreatment failures. Some of these can involve the retreatment of intracanal blockages. Many times, conventional endodontics cannot be redone, so a surgical approach may be needed. This article reviews four basic surgical techniques that can be used for retreatment of intracanal blockages. When the blockage cannot be removed, a standard retrograde amalgam technique or the Nygaard Ostby procedure of reverse instrumentation-obturation can be used. Two other surgical techniques used to eliminate the blockage are the apical loosening technique and a true apicoectomy procedure. Each of these procedures is reviewed, and the advantages and disadvantages are discussed.