Background and overview: Initial root canal treatment is highly successful, appreciated by patients, and cost-effective, but failures occur. Should a tooth with unsuccessful initial root canal treatment be treated by means of other endodontic procedures or be replaced by a single-tooth implant?
Results: Results from systematic reviews of the outcomes of nonsurgical retreatment, apical surgery, replantation, and autotransplantation show high tooth survival rates. Nonsurgical retreatment generally is prioritized before surgical endodontic treatment. Microsurgical endodontic treatment is superior to traditional surgical endodontic treatment and has high survival rates. Intentional replantation remains a viable alternative to extraction. Autotransplantation has a place, particularly in growing patients with an appropriate donor tooth. Single-tooth implants have higher survival rates, but the natural state has intrinsic value.
Conclusions: The first-line treatment option after failure of initial root canal treatment is nonsurgical retreatment. Endodontic surgery, intentional replantation, and autotransplantation should be considered before extraction and replacement by a single-tooth implant.
Practical implications: Comprehensive case assessment, evaluation of all endodontic options, and risk assessment for caries and periodontal disease are always necessary when choosing the optimal treatment for a patient when initial root canal treatment has failed to heal.
Keywords: Endodontically treated; autotransplantation; dental implant; endodontic surgery intentional replantation; outcome studies; retreatment; review.
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