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Endodontic underfill — Clinical Guidelines

Overview

Endodontic underfill refers to incomplete obturation of the root canal system, potentially leading to persistent infection or reinfection despite initial treatment 1 2.

Diagnosis

Clinical signs include persistent or recurrent pain, swelling, and mobility 1.

Radiographic evaluation essential to identify voids or unfilled areas within the root canal system 1.

No specific laboratory tests; imaging (X-rays, CBCT) crucial for diagnosis 1.

Management

Primary Treatment: Re-evaluation and retreatment of the root canal system with meticulous cleaning, shaping, and proper obturation techniques 1.

Adjunctive Measures: Use of antimicrobial agents locally (e.g., calcium hydroxide) or systemically if systemic involvement is present 1 2.

Antibiotics: Reserved for cases with systemic signs (e.g., fever, significant swelling) to target secondary infection 2.

Special Populations

Pediatrics: Increased anxiety and cooperation issues; consider sedation options if necessary 5.

Elderly: Higher risk of comorbidities; careful assessment of systemic health before retreatment 5.

Comorbidities: Patients with compromised immune systems may require closer monitoring and more aggressive management of systemic symptoms 2.

Key Recommendations

Reevaluate and Retreat: Perform thorough reevaluation and retreatment with strict adherence to aseptic techniques to prevent further complications 1 (Evidence: Strong).

Antibiotic Use: Prescribe antibiotics selectively for patients exhibiting systemic signs of infection, aligning with current guidelines to avoid unnecessary use 2 (Evidence: Moderate).

Patient Communication: Enhance patient education and communication to manage anxiety, particularly in high-stress scenarios like endodontic emergencies 1 5 (Evidence: Moderate).

References

1 Chuy V, Matyjasik P, Devillard R, Kérourédan O. Stress and Confidence of Undergraduate Dental Students With Different Levels of Clinical Experience in Managing Endodontic Emergencies: A Cross-Sectional Study. European journal of dental education : official journal of the Association for Dental Education in Europe 2025. link 2 Yaqoob H, Naved N, Khan SA, Jabeen SF, Raza SS, Khalid T. Evaluation of dentists' clinical practices and antibiotic use in managing endodontic emergencies in Karachi, Pakistan: a cross-sectional survey. BMC oral health 2024. link 3 Kumar G, Tewari S. Acupuncture for Management of Endodontic Emergencies: a Review. Journal of acupuncture and meridian studies 2023. link 4 Silva WO, Vianna Silva Macedo RP, Nevares G, Val Rodrigues RC, Grossi Heleno JF, Braga Pintor AV et al.. Recommendations for Managing Endodontic Emergencies during Coronavirus Disease 2019 Outbreak. Journal of endodontics 2021. link 5 Huh YK, Montagnese TA, Harding J, Aminoshariae A, Mickel A. Assessment of patients' awareness and factors influencing patients' demands for sedation in endodontics. Journal of endodontics 2015. link 6 Lee RS, Alapati S, Johnson BR. Separation anxiety: Gates-Glidden drills can be hazardous to your health. Journal of endodontics 2011. link

Endodontic underfill