Persistent or recurrent apical disease after root canal treatment may involve missed anatomy, inadequate disinfection, persistent intraradicular or extraradicular infection, procedural complications, coronal leakage, cracks or vertical root fracture. Diagnosis should precede retreatment and integrate symptoms, clinical examination, periodontal findings, appropriate imaging, previous treatment quality and restorability.
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Which diagnostic finding most strongly changes your decision between nonsurgical retreatment, surgery and extraction?