Procedures for Re-Treatment
What is Endodontic Retreatment?
Teeth that have had endodontic (root canal) treatment can last as long as natural teeth, however, in some cases the treatment can fail or symptoms can persist. This may happen shortly after the treatment has been performed or even years following the treatment.
In these cases it may be possible to carry out the treatment again, a procedure called endodontic retreatment.
Why does the treatment fail?
Endodontic treatment can fail for a number of reasons: It was not possible to treat narrow or curved canals well enough or the canals were not fully cleaned during the initial procedure. The tooth may have additional complicated anatomy that was not found on the initial treatment.
The final restoration was not placed quickly enough or the final restoration leaked due to a poor fit, fracture or recurrent decay around it.
Is retreatment more complicated than initial root canal treatment?
Retreatment is usually more complicated than initial root canal treatment as the tooth is normally fully restored with a permanent restoration. This can range from a simple restoration to a full coverage restoration such as a crown or as part of a bridge. In addition to this a post may have been placed inside the root prior to a final restoration being placed. This creates difficulty as access to the root canals is more difficult.
Additionally the canals will have been filled with root filling material and hence this has to be removed before they can be instrumented and cleaned again. All of these obstructions make the process more complicated.
Who does the retreatment procedure?
All dentists can carry out endodontic treatment but many prefer not to carry out retreatment procedures as this can be more challenging and may require additional equipment that may not be readily available.
Your dentist may opt to refer you to another practitioner who either has greater experience and training in the procedure or to a dedicated specialist endodontist for the procedure. A specialist endodontist is a practitioner who is registered and approved by the General Dental Council to carry out all forms of endodontic treatment. The endodontist will have more additional dental equipment that may facilitate the procedure.
What will happen if I am referred to an endodontist?
The endodontist will discuss with you the treatment options for your tooth. The endodontic procedure will be explained to you as well as the costs for the treatment.
What will happen during the retreatment?
If you decide on retreatment the endodontist will gain access to the root canals of the tooth to remove the root filling and clean the canals again prior to refilling the canals. In many cases the restoration on the tooth will have to be removed, including complex restorations such as crowns and posts to allow the procedure to be carried out.
Will the retreatment be successful?
Retreated teeth can function for many years if the reasons for the initial failure can be overcome. Advances in technology have allowed retreatment to be carried out on complicate problems but like most medical and dental procedures difficulties can prevent some teeth from responding to the treatment. The endodontist can advise on the likely success of the procedure and difficulties prior to the procedure.
How much will the procedure costs?
The cost of the retreatment is usually dependant on how complex the procedure might be but would normally cost more than the original root canal treatment.
What are the alternatives to retreatment?
Usually the alternatives would be removal of the tooth or endodontic surgery. Removal of the tooth would then leave a space that may or may not be acceptable functionally or aesthetically and perhaps would require a prosthetic replacement tooth in the form of a denture, bridge or implant. Endodontic surgery involves lifting the gum or gingival tissue after a small incision to allow access to the root tip that is the cause of the persistent problem. This root tip can then be treated and sealed. Endodontic surgery would allow the existing restoration to be retained, however retreating the canals is usually the first and best option. Your endodontist can advise on the particular options for your problem.
SOURCE: https://britishendodonticsociety.org.uk/patient-public/further-information/