Strategies to deal with endodontic post-treatment disease

Objectives: The management of endodontic post-treatment diseases has become a significant part of endodontic practice. Root infection contributes to the total burden of dental infection and bad dental infection increases the risk of coronary heart disease. This Paper is aimed to investigate the strategies to deal with endodontic post-treatment disease. Methods: Review of the relevant literatures. Results: Of the endodontically treated teeth where the radiolucency decreased in size at 4 years more than 88% had the same outcome already after 1 year. Thus, teeth where the radiolucency does not decrease within 1 year should receive further treatment at 1 year. Of the treated teeth that “completely healed” at 4 years more than 85% already “completely healed” at 2 years. Thus, teeth with a periapical radiolucency after 2 years should be treated without delay. The common problems which may cause endodontic post-treatment disease include infection remaining in the apical inaccessible areas, extraradicular infection including apically extruded dentine debris where bacteria present in dentinal tubules, radicular true cyst, foreign body reaction, poor root canal therapies with or without iatrogenically altered root canal-morphology, and vertical root fractures. Poor root canal therapies may be corrected non-surgically; the other problems have to be solved surgically. Ninety-seven percent of the lesions including large ones of 10 mm in diameter completely healed within one year after apical surgery with the use of a surgical operation microscope. Conclusions: It is concluded that endodontic post-treatment disease should be effectively treated within 2 years after the previous treatment. Most problems that cause post-treatment disease can be solved surgically and non-surgically. Dentist should receive more surgical training.