Retrograde Root Canal Treatment

  • Thomas Kvist
  • Peter Jonasson

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This video explains the rationale and case selection for retrograde root canal treatment, illustrates the steps involved in this surgical approach, and offers guidance on follow-up. Retrograde root canal treatment represents an alternative to conventional orthograde treatment. A triangular flap is raised using marginal sulcular and papilla base incisions. Bone covering the periapical lesion is removed with round burs in a low-speed handpiece under continuous saline spray, and periradicular soft tissue is excised using curettes. Bleeding is controlled by placement of a hemostatic sponge moistened with adrenaline in the periapical bone crypt. Approximately 2 mm of the root tip is removed and the canal identified and explored with a K-file, with the handle detached and held in a hemostat. The root canal is enlarged and cleaned with Hedström files, up to size 35, with handles removed and held in the hemostat. The canal is irrigated with buffered 0.5% sodium hypochlorite. Following the instrumentation, the canal is dried with paper points and filled with sealer and gutta-percha.


This video explains the rationale and case selection for retrograde root canal treatment and describes the steps involved in this surgical approach.

About The Author

Thomas Kvist

Thomas Kvist completed specialization in endodontics in 1993 and received his PhD in 2001 at the Department of Endodontology, University of Gothenburg, Sweden. He is now head of that department and holds a position as associate professor. For several years, Dr. Kvist was director of the postgraduate program and head of the Specialist Clinic for Endodontics at the Public Dental Service in Gothenburg. He has published articles in peer-reviewed journals on decision-making and clinical outcomes in endodontics. He has also authored several textbook chapters and edited a textbook on apical periodontitis in root-filled teeth. Dr. Kvist has been an invited speaker at national and international conferences.

Peter Jonasson

Peter Jonasson received his dental degree in 1998 from the University of Gothenburg, Sweden, where he completed his PhD in 2004 and a 3-year postgraduate program in Endodontics in 2006. At present, he is a senior lecturer in the Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg and is responsible for the postgraduate endodontic program. For several years he has been giving endodontic hands-on courses nationally, and he has produced numerous instructional videos for under- and postgraduate students. He has authored or co-authored international and national articles, including book chapters in the field of endodontics. One of his special areas of interest is endodontic techniques for minimally invasive treatments.


About this video

Thomas Kvist
Peter Jonasson
Online ISBN
Total duration
15 min
Springer, Cham
Copyright information
© The Author(s) 2021

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Video Transcript


Deep caries or other injuries may develop severe inflammation or even necrosis of the dental pulp. If necrosis occurs, oral bacteria invade the root canal system. This infection will in turn, cause inflammation and bone resorption in the surrounding periapical tissues. This condition is called apical periodontitis.

Root canal treatment involves the mechanical removal of the affected pulp tissue, shaping of the root canal system, disinfection, and subsequent root filling. The procedures are performed through an access opening in the crown of the tooth. The ultimate goal is to eliminate the microorganisms, promote healing and bone reformation in order to be able to save the tooth for the foreseeable future.

Sometimes, the objective of healing of the periapical tissues may not be achieved by root canal treatment alone. By adding a surgical access to the periapical tissues, the root canal system can be cleansed from a retrograde entry, and its openings into surrounding tissues be blocked by a root end filling. The dental pulp usually remains vital after restorative treatment.

However, if the loss of tooth substance is abundant, and if the interventions include deeper parts of the dentin, the pulp may develop necrosis and subsequent infection, resulting in apical periodontitis. Also, inflammation in the pulp may cause dystrophic calcification, but eventually lead to pulp necrosis and apical periodontitis. And in both situations, root canal therapy is indicated to enable healing in the periapical tissues.

The aim of getting access in such situations, an operating microscope is of invaluable help. But still, to localize the root canal, extensive access preparations may be necessary. As a result, the loss of tooth substance may weaken the tooth.

Moreover, extensive preparation may influence the retention and provoke loosening of a cemented crown. Besides, the aesthetics may be jeopardized if cracks occur, or if pieces of the material fracture and are lost. Obviously, any artificial crown and prosthetic construction can be removed in order to optimize the preconditions for root canal treatment.

But this solution inevitably leads to a situation where the crown and/or bridge have to be replaced, which in turn, can lead to considerable costs. In such situations, an alternative approach is to use a surgical procedure to get access, and to perform root canal treatment. We use the term retrograde root canal treatment.

In this video, we will present typical cases for selection, basic procedure, and our routine treatment protocol. Some variations in the technique are mentioned. And finally, we present some cases with clinical and radiographic follow ups and available evidence.