Overfilled Root Canal Management — ORE Part 1 MCQ

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ModerateEndodonticsOverfilled Root Canal ManagementORE Part 1

A 30-year-old patient has completed root canal treatment of a premolar. The postoperative radiograph shows a dense root filling extending 2 mm beyond the radiographic apex. The tooth is asymptomatic, and there is no swelling, sinus tract or radiographic periapical lesion. What is the most appropriate management?

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Correct answer: C — Arrange clinical and radiographic review

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

A is correct. A small, unintentional apical extrusion in an asymptomatic tooth with a dense root filling and no evidence of periapical disease does not itself justify further operative treatment. Review clinically and radiographically to confirm continuing symptom-free function and absence of disease. Evidence from long-term follow-up studies indicates that the persistence or resorption of extruded material is not, by itself, associated with outcome, and that overfilling need not compromise outcome when the apical seal is adequate. Immediate retreatment risks further procedural damage without a current indication. Surgical endodontics is reserved for persistent disease or failure where surgery is indicated, not for an asymptomatic radiographic overextension alone. Extraction is disproportionate, and antibiotics are not indicated without spreading infection or systemic involvement.

Reference: Goldberg F, Cantarini C, Alfie D, Macchi RL, Arias A. Relationship between unintentional canal overfilling and the long-term outcome of primary root canal treatments and nonsurgical retreatments: a retrospective radiographic assessment. International Endodontic Journal. 2020;53(1):19-26. https://pubmed.ncbi.nlm.nih.gov/31454090/