Selective Root Canal Retreatment as an Alternative Option in Patient at Risk of MRONJ: A Case Report

Jiraphak Jaturont, Thanawut Khongpreecha, Panupol Kunasarapun

Published Online: Aug 7, 2026 DOI DOI 10.12982/OSR.2026.046

Aims: This case report aims to demonstrate an alternative treatment approach of a failed endodontically treated tooth (ETT) in a patient at risk of medication-related osteonecrosis of the jaw (MRONJ), in which conventional retreatment of all canals had limited access and surgical interventions possessed osteonecrotic risk.

Methods and Results:A 65-year-old female presented with discomfort at the upper right posterior region, where a sinus tract opening was observed adjacent to maxillary right first molar. She had osteoporosis and had been taking oral Alendronate for more than five years, placing her at a higher risk of MRONJ. A preoperative radiograph of maxillary right first molar revealed prefabricated fibre posts in the palatal and distobuccal canals, and an absence of root canal filling material in the mesiobuccal root canal. The diagnosis of maxillary right first molar was previously treated with chronic apical abscess. Selective root canal retreatment was performed as one of the plans following comprehensive, patient-centred consideration. After a 1.5-year follow-up period, the patient remained asymptomatic, and both clinical and radiographic evaluations demonstrated favourable healing.

Conclusions: Selective root canal retreatment may serve as a viable and effective alternative treatment for managing failed ETTs when conventional and surgical approaches pose increased risks. Successful outcomes depend on prudent case selection, prognosis assessment, and thorough informed consent.

medication-related osteonecrosis of the jaw root canal retreatment endodontic retreatment minimal invasive approach selective root canal retreatment special care dentistry

References

  1. Lopez-Valverde N, Vignoletti F, Vignoletti G, Martin C, Sanz M. Long-term tooth survival and success following primary root canal treatment: a 5- to 37-year retrospective observation. Clin Oral Investig. 2023;27(6):3233-44.
  2. Tabassum S, Khan FR. Failure of endodontic treatment: the usual suspects. Eur J Dent. 2016;10(1):144-7.
  3. Nair PN, Sjogren U, Krey G, Kahnberg KE, Sundqvist G. Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: a long-term light and electron microscopic follow-up study. J Endod. 1990;16(12):580-8.
  4. European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006;39(12):921-30.
  5. Orstavik D. Time-course and risk analyses of the development and healing of chronic apical periodontitis in man. Int Endod J. 1996;29(3):150-5.
  6. Friedman S, Mor C. The success of endodontic therapy--healing and functionality. J Calif Dent Assoc. 2004;32(6):493-503.
  7. Friedman S. Prognosis of initial endodontic therapy. Endod Topics. 2002;2(1):59-88.
  8. Fristad I, Molven O, Halse A. Nonsurgically retreated root filled teeth--radiographic findings after 20-27 years. Int Endod J. 2004;37(1):12-8.
  9. Abbott PV. Diagnosis and management planning for root-filled teeth with persisting or new apical pathosis. Endod Topics. 2008;19(1):1-21.
  10. Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004;30(1):1-4.
  11. Friedman S, Stabholz A. Endodontic retreatment--case selection and technique. Part 1: criteria for case selection. J Endod. 1986;12(1):28-33.
  12. Cunliffe J, Ayub K, Darcey J, Foster-Thomas E. Intentional replantation - a clinical review of cases undertaken at a major UK dental school. Br Dent J. 2020;229(4):230-8.
  13. Blum JS. Management options and outcomes for root-filled teeth that have a periapical radiolucency. Aust Endod J. 2025;51(1):10-6.
  14. Nudera WJ. Selective Root Retreatment: a novel approach. J Endod. 2015;41(8):1382-8.
  15. Chee W, Aloum A. Restoration of the anterior maxilla after thermal trauma as a sequela to post removal: a clinical report. J Prosthet Dent. 2011;106(3):141-4.
  16. Alshehri MD, Alqahtani WM, Asiri EM, Asiri MN. Awareness to consequences of teeth missing and prosthodontics treatment options among people of Aseer region, Saudi Arabia. J Family Med Prim Care. 2021;10(1):307-11.
  17. Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes. 2010;8:126.
  18. Watson S, McGowan L, McCrum LA, Cardwell CR, McGuinness B, Moore C, et al. The impact of dental status on perceived ability to eat certain foods and nutrient intakes in older adults: cross-sectional analysis of the UK National Diet and Nutrition Survey 2008-2014. Int J Behav Nutr Phys Act. 2019;16(1):43.
  19. Sheiham A, Steele JG, Marcenes W, Finch S, Walls AW. The impact of oral health on stated ability to eat certain foods; findings from the National Diet and Nutrition Survey of Older People in Great Britain. Gerodontology. 1999;16(1):11-20.
  20. Daly B, Thompsell A, Sharpling J, Rooney YM, Hillman L, Wanyonyi KL, et al. Evidence summary: the relationship between oral health and dementia. Br Dent J. 2018;223(11):846-53.
  21. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681-92.
  22. Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw: Dental Clinical Guidance Dundee, Scotland. 2024 [Available from: https://www.sdcep.org.uk/media/xtlp2uqx/sdcep-mron....
  23. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' position paper on medication-related osteonecrosis of the jaws-2022 update. J Oral Maxillofac Surg. 2022;80(5):920-43.
  24. Aghaloo T, Hazboun R, Tetradis S. Pathophysiology of osteonecrosis of the jaws. Oral Maxillofac Surg Clin North Am. 2015;27(4):489-96.
  25. Gaudin E, Seidel L, Bacevic M, Rompen E, Lambert F. Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis. J Clin Periodontol. 2015;42(10):922-32.
  26. Lee SH, Choi SY, Bae MS, Kwon TG. Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment. Maxillofac Plast Reconstr Surg. 2021;43(1):24.
  27. McGowan K, McGowan T, Ivanovski S. Risk factors for medication-related osteonecrosis of the jaws: a systematic review. Oral Dis. 2018;24(4):527-36.
  28. Bedogni A, Bettini G, Totola A, Saia G, Nocini PF. Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg. 2010;68(7):1662-6.
  29. Zavalloni G, Spinelli A, Coppini M, Mauceri R, Campisi G, Lenzi J, et al. Endodontic treatment and management of patients under antiresorptive treatment a scoping review on MRONJ risk. Clin Oral Investig. 2025;29(10):466.
  30. Brochado Martins JF, Guerreiro Viegas O, Cristescu R, Diogo P, Shemesh H. Outcome of selective root canal retreatment-a retrospective study. Int Endod J. 2023;56(3):345-55.
  31. Glickman GN. AAE consensus conference on diagnostic terminology: background and perspectives. J Endod. 2009;35(12):1619-20.
  32. Pai SF, Yang SF, Sue WL, Chueh LH, Rivera EM. Microleakage between endodontic temporary restorative materials placed at different times. J Endod. 1999;25(6):453-6.
  33. Zou X, Zheng X, Liang Y, Zhang C, Fan B, Liang J, et al. Expert consensus on irrigation and intracanal medication in root canal therapy. Int J Oral Sci. 2024;16(1):23.
  34. Rud J, Andreasen JO, Jensen JE. Radiographic criteria for the assessment of healing after endodontic surgery. Int J Oral Surg. 1972;1(4):195-214.
  35. Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986;2(1):20-34.
  36. Turky M, Mortada Abd Elfatah YA, Hamdy S. Does selective root canal retreatment preserve the tooth's fracture resistance? an ex vivo study. BMC Oral Health. 2024;24(1):1251.
  37. Dickie J, McCrosson J. Post removal techniques part 1. Dent Update. 2014;41(6):490-2, 495-8.
  38. Brochado Martins JF, Hagay S, Herbst SR, Falk S. Cost-effectiveness analysis of full versus selective root canal retreatment. Int Endod J. 2023;56(11):1319-27.
  39. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009;35(7):930-7.
  40. Sathorn C, Parashos P. Monitoring the outcomes of root canal re-treatments. Endod Topics. 2008;19(1):153-62.
  41. Hilmi A, Patel S, Mirza K, Galicia JC. Efficacy of imaging techniques for the diagnosis of apical periodontitis: a systematic review. Int Endod J. 2023;56 (Suppl 3):326-39.
  42. Special Committee to Revise the Joint AAE and AAOMR Position Statement on use of CBCT in Endodontics. AAE and AAOMR joint position statement: use of cone beam computed tomography in endodontics 2015 update. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(4):508-12.
  43. Hoen MM, Pink FE. Contemporary endodontic retreatments: an analysis based on clinical treatment findings. J Endod. 2002;28(12):834-6.
  44. de Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, et al. Treatment outcome in endodontics: the Toronto study--phases 3 and 4: orthograde retreatment. J Endod. 2008;34(2):131-7.
  45. Karaoglan F, Micoogullari Kurt S, Caliskan MK. Outcome of single- versus two-visit root canal retreatment in teeth with periapical lesions: a randomized clinical trial. Int Endod J. 2022;55(8):833-43.

Jaturont J, Khongpreecha T, Kunasarapun P. Selective Root Canal Retreatment as an Alternative Option in Patient at Risk of MRONJ: A Case Report: A case reports/series. Oral Sci Rep [Internet]. 2026 Aug 07 [cited 2026 Aug 08];47(3):433-439. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=570

Jaturont, J., Khongpreecha, T. & Kunasarapun, P. (2026). Selective Root Canal Retreatment as an Alternative Option in Patient at Risk of MRONJ: A Case Report. Oral Sci Rep, 47(3), 433-439. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=570

Jaturont, J., Thanawut Khongpreecha and Panupol Kunasarapun. 2026. "Selective Root Canal Retreatment as an Alternative Option in Patient at Risk of MRONJ: A Case Report." Oral Sci Rep, 47(3), 433-439. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=570

Jaturont, J. et al. 2026. 'Selective Root Canal Retreatment as an Alternative Option in Patient at Risk of MRONJ: A Case Report', Oral Sci Rep, 47(3), 433-439. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=570

Jaturont, J., Khongpreecha, T. and Kunasarapun, P. "Selective Root Canal Retreatment as an Alternative Option in Patient at Risk of MRONJ: A Case Report", Oral Sci Rep, vol.47, no. 3, pp. 433-439, Aug. 2026.

Jiraphak Jaturont, Thanawut Khongpreecha, Panupol Kunasarapun "Selective Root Canal Retreatment as an Alternative Option in Patient at Risk of MRONJ: A Case Report." Oral Sci Rep, vol.47, no. 3, Aug. 2026, pp. 433-439, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=570