Effectiveness of 1-Visit and 2-Visit Endodontic Retreatment of Teeth with Persistent/Secondary Endodontic Infection: A Randomized Clinical Trial with 18 Months of Follow-up

Cassia Cestari Toia; Rayana Duarte Khoury; Bruna Jordão Motta Corazza; Esteban Isai Flores Orozco; Marcia Carneiro Valera

doi:10.1016/j.joen.2021.09.004

Effectiveness of 1-Visit and 2-Visit Endodontic Retreatment of Teeth with Persistent/Secondary Endodontic Infection: A Randomized Clinical Trial with 18 Months of Follow-up

J Endod. 2022 Jan;48(1):4-14. doi: 10.1016/j.joen.2021.09.004. Epub 2021 Sep 20.

Authors

Cassia Cestari Toia¹, Rayana Duarte Khoury¹, Bruna Jordão Motta Corazza¹, Esteban Isai Flores Orozco¹, Marcia Carneiro Valera²

Affiliations

¹ Department of Operative Dentistry, Endodontics Division, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil.
² Department of Operative Dentistry, Endodontics Division, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil. Electronic address: marcia.valera@unesp.br.

PMID: 34555421
DOI: 10.1016/j.joen.2021.09.004

Abstract

Introduction: This randomized clinical trial aimed to compare the effectiveness of endodontic retreatment of teeth with posttreatment apical periodontitis (PTAP) performed in 1 visit versus 2 visits on the reduction of cultivable bacteria (colony-forming units [CFUs]), lipopolysaccharides (LPSs), lipoteichoic acid (LTA), and the periapical lesion volume (mm³) after 18 months of follow-up.

Methods: Forty patients diagnosed with PTAP were selected and randomly divided into the following 2 groups: 1-visit retreatment and 2-visit retreatment with the placement of calcium hydroxide medication for 14 days. Cone-beam computed tomographic scans were performed at 2 stages: preoperatively and after 18 months of follow-up. Samples were collected before and after root canal procedures. A chromogenic limulus amebocyte lysate assay test was used to quantify endotoxins (EU/mL). LTA levels were measured using the enzyme-linked immunosorbent assay (pg/mL). Culture techniques were used to determine cultivable bacteria by counting the CFU (CFU/mL). The volume of the periapical lesions at the onset of the trial and at the 18-month posttreatment follow-up was obtained by the ITK-SNAP program (Cognitica, Philadelphia, PA).

Results: All samples showed baseline values greater than those collected after the retreatment protocol for all investigated parameters. A higher bacterial load and lower LTA level were found in the 2-visit group after the retreatment protocol (P < .05), with no statistical differences between the groups regarding endotoxin levels and periapical lesion volume (mm³) at the 18-month follow-up analyzed by cone-beam computed tomographic imaging (P > .05).

Conclusions: Endodontic retreatment in 1 or 2 visits exhibited equally favorable periapical healing at 18 months, with no statistically significant differences between groups.

Keywords: Cone-beam computed tomography; lipopolysaccharides; lipoteichoic acid; periapical periodontitis; root canal therapy.

Publication types

Randomized Controlled Trial

MeSH terms

Follow-Up Studies*
Humans
Retreatment