Clinical Outcomes of Nonsurgical Retreatment in Teeth With Persistent Apical Periodontitis - A Systematic Review

Sep 30, 2026

Uploaded by Damian

Persistent apical periodontitis is a common cause of endodontic failure, and nonsurgical retreatment (NS-ReTx) is a typical first-line option with success rates that vary by clinical, radiographic, and methodological factors. This systematic review evaluated clinical and radiographic outcomes of NS-ReTx in teeth with persistent apical periodontitis following PRISMA 2020. PubMed/MEDLINE, Embase, CENTRAL, Scopus, Web of Science, and grey literature were searched for studies (≥10 teeth) from January 1988 to September 2025. Primary outcomes were periapical healing by radiography and/or CBCT, with secondary outcomes including tooth survival and prognostic factors. Thirty studies met inclusion criteria; strict radiographic criteria and CBCT generally showed lower healing than 2D radiographs, while better prognosis correlated with no preoperative lesions, smaller lesions, adequate obturation and coronal seals, and specialist operators. Overall, NS-ReTx offers favorable outcomes, with recommendations for standardized definitions and longer uniform follow-up for robust quantitative synthesis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Abstract

Introduction And Background

Failure after primary root canal therapy

Causes of persistent apical periodontitis

Treatment options and rationale for NS-ReTx

Expected benefits and evidence variability

Review began 11/19/2025 Review ended 12/02/2025 Published 12/06/2025 © Copyright 2025 Falatah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98601 Open Access Review Article Clinical Outcomes of Nonsurgical Retreatment in Teeth With Persistent Apical Periodontitis: A Systematic Review Ali M. Falatah 1, Ammar A. AlQari 2 , MelafA. Alrwiali 3 , Lujain Altalhi 4 , Nadeen M. Alanazi 4, Abdulrahman K. Bin Othman 5, Mohammed A. Alzahrani 6, Sultan S. Alduwaysan 7 , Shurog A. Alsaif Mariam A. Ali 9, Alya J. Albalawi 10 8 , 1. Endodontics, Speciality Dental Center, King Fahad Hospital, Madinah, SAU 2. General Dentistry, Umm Al-Qura University, Mecca, SAU 3. Dentistry, Jouf University, Al-Jouf, SAU 4. Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU 5. General Dentistry, PEDS Pediatric Dentistry and Orthodontics, Riyadh, SAU 6. General Dentistry, Al Baha University, Al Baha, SAU 7. General Dentistry, King Saud University, Riyadh, SAU 8. General Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU 9. General Dentistry, Cairo University, Giza, BHR 10. General Dentistry, Al-Rabwa Medical Center, Riyadh, SAU Corresponding author: Ali M. Falatah, [dralifalatah@hotmail.com](dralifalatah@hotmail.com) Abstract Persistent apical periodontitis is a common cause of endodontic failure. While nonsurgical retreatment (NSReTx) is the typical first-line option used to manage this condition, its reported success varies depending on clinical, radiographic, and methodological factors despite recent advances that improve case management. This systematic review aimed to assess the clinical and radiographic outcomes of NS-ReTx in teeth with persistent apical periodontitis. Following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) 2020 guidelines, the databases of PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Web of Science, and grey literature were searched for randomized and non-randomized clinical studies and case series involving ≥10 teeth reporting outcomes after orthograde retreatment from January 1988 to September 2025. The primary outcome was periapical healing assessed through radiography and/or cone-beam computed tomography (CBCT), and secondary outcomes were tooth survival and prognostic factors. Risk of bias was appraised using the Cochrane Risk of Bias 2.0 (RoB 2) tool, ROBINS-I, or the Newcastle-Ottawa Scale, as appropriate, and findings were synthesized narratively due to heterogeneity in outcome definitions, imaging modalities, and follow-up intervals. Thirty studies, comprising randomized controlled trials (RCTs) and cohorts, met the inclusion criteria. Across these studies, reports using strict radiographic criteria or CBCT generally described lower apparent healing rates than those using looser criteria and 2D radiographs, although the magnitude of this difference could not be reliably quantified across studies. Additionally, a favorable prognosis was consistently associated with the absence of preoperative lesions, smaller lesion sizes, adequate obturation and coronal seals, and specialist operators. Overall, NS-ReTx provides favorable outcomes for persistent apical periodontitis. Future research should standardize outcome definitions using validated frameworks (such as periapical index (PAI)-based radiographic criteria and CBCT-specific scoring systems) and adopt longer, more uniform follow-up periods to enable robust quantitative synthesis. Categories: Dentistry Keywords: endodontics, nonsurgical retreatment, outcome assessment, root canal retreatment, treatment outcome Introduction And Background Root canal treatments aim to prevent reinfection

FAQs

What was the primary outcome assessed in this systematic review?

The primary outcome was periapical healing assessed through radiography and/or cone-beam computed tomography (CBCT).

How did study imaging and radiographic criteria affect reported healing rates?

Reports using strict radiographic criteria or CBCT generally described lower apparent healing rates than those using looser criteria and 2D radiographs, though the difference magnitude could not be reliably quantified across studies.

Which factors were consistently associated with a favorable prognosis?

A favorable prognosis was associated with absence of preoperative lesions, smaller lesion sizes, adequate obturation and coronal seals, and specialist operators.

Sep 30, 2026

Uploaded by Damian