Restor Dent Endod.  2021 May;46(2):e27. 10.5395/rde.2021.46.e27.

The fate of overfilling in root canal treatments with long-term follow-up: a case series

• Malagnino VA
• Pappalardo A
• Plotino G
• Carlesi T

• KMID: 2548071
• DOI: http://doi.org/10.5395/rde.2021.46.e27

Abstract

This study describes 6 cases of endodontic overfilling with successful clinical outcomes during long-term (up to 35 years) radiographic follow-up. Successful endodontic treatment depends on proper shaping, disinfection, and obturation of root canals. Filling materials should completely fill the root canal space without exceeding the anatomical apex. Overfilling may occur when the filling material extrudes into the periapical tissues beyond the apex. The present case series describes 6 root canal treatments in which overfilling of root canal sealer and gutta-percha accidentally occurred. Patients’ teeth were periodically checked with periapical radiographs in order to evaluate the outcomes during long-term follow-up. All cases showed healing and progressive resorption of the extruded materials in the periapex. The present cases showed that if a 3-dimensional seal was present at the apical level, overfilling did not negatively affect the long-term outcomes of root canal treatment.

Keyword

Root canal treatment; Obturation; Overfilling; Long-term follow-up

Figure

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  Figure 1 Case 1, lower right second premolar. (A) Preoperative radiograph of the lower right second premolar. (B) Intraoperative radiograph after removal of the old filling material. (C) Postoperative radiograph showing slight overfilling. (D) Radiograph after 10 years of follow-up.

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  Figure 2 Case 2, lower left second premolar. (A) Preoperative radiograph of the lower left second premolar. (B) Intraoperative radiograph working length determination. (C) Postoperative radiograph showing a slight overfilling. (D) Radiograph after 10 years of follow-up.

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  Figure 3 Case 3, lower right canine and premolar. (A) Preoperative radiograph of the lower right canine. (B) Postoperative radiograph showing slight overfilling of the canine. (C) Postoperative radiograph (5 years), showing the lower right premolar, which was part of a porcelain fused to metal (PFM) bridge with the first molar on the preoperative radiograph. (D) Postoperative radiograph of the lower right premolar showing a slightly short root canal filling. (E) Radiographic follow-up 10 years after the canine was restored with radiolucent composite resin and 5 years after the first premolar was covered by the crown of the PFM bridge.

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  Figure 4 Case 4, calcified right lower first molar. (A) Preoperative radiograph showing a calcified pulp chamber with narrow root canals and a large area of radiolucency. (B) Intraoperative clinical image taken during access of the pulp chamber and root canal location. (C and D) Intraoperative radiograph of working length determination in the mesial and distal canals, respectively. (E) Postoperative radiograph with overfilling. (F) Follow-up after 10 years.

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  Figure 5 Microseal technique. (A) Preoperative radiograph. (B) Radiograph after removing the old root canal filling and measuring the working length. (C) Radiograph of trying the master cone of gutta-percha at a 1 mm working length without sealer. (D) Amount of sealer used with the gutta-percha master cone. (E) Radiograph after inserting the master cone of gutta-percha with sealer into the canal and lateral compaction with a spreader. (F) Microflow of preheated preplasticized gutta-percha and the PacMac instrument. (G) Postoperative radiograph after placement of preplasticized gutta-percha.

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  Figure 6 Case 5, lower first premolar. (A) Lower left first premolar, part of a porcelain fused to metal bridge: intraoperative radiograph during working length determination. (B) Postoperative radiograph showing accidental overfilling. (C) Follow-up radiograph after 1 year. (D) Follow-up radiograph at 10 years. (E) Follow-up radiograph after 20 years.

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  Figure 7 Case 6, upper right central and lateral incisor. (A) Preoperative radiograph of the upper right central and lateral incisor. (B) Postoperative radiograph showing overfilling on both teeth. (C) Follow-up radiograph after 20 months. (D) Follow-up radiograph after 10 years. (E) Follow-up radiograph after 25 years. (F) Follow-up radiograph after 30 years. (G) Follow-up radiograph after 35 years; healing of the central incisor appeared to be stable, while a new periapical lesion seemed to have appeared in the latter incisor.

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