Endodontic Retreatment

With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal or pain may continue to exist. Sometimes, the pain may occur months or years after treatment. If so, Endodontic Retreatment may be needed.

Improper healing may be caused by:

• Curved or narrow canals that were not treated during the initial treatment.
• Complicated canals that went undetected during the initial treatment.
• The crown or restoration was not placed within the appropriate amount of time following the procedure.
• The crown or restoration that did not prevent saliva from contaminating the inside of the tooth.

Inflamed Tissue

Filling Removed

Canals Cleaned

Root Material Placed

Filling Restored

Healed Tooth

In some cases, new problems can influence a tooth that was successfully treated:

• New decay can expose a root canal filling material, causing infection.
• A cracked or loose filling or crown can expose the tooth to new infection.

Once retreatment has been selected as a solution to your problem, the doctors will reopen your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctors will now clean your canals and carefully examine the inside of the problematic tooth. Once cleaned, the doctors will fill and seal the canals and place a temporary filling in the tooth.

At this point, you will need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.

With proper care, most teeth that have had endodontic (root canal) treatment can last as long as other natural teeth. In some cases, however, a tooth that has received endodontic treatment fails to heal. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment. If your tooth has not healed or has developed new problems, you have a second chance. Another procedure, endodontic retreatment, may be able to save your tooth.

Who performs endodontic retreatment?

All dentists receive basic training in root canal treatment in dental school. However, because endodontic retreatment can be more challenging than providing first-time treatment, most dentists refer patients needing endodontic retreatment to endodontists. Endodontists are dentists with at least two additional years of advanced specialty education in diagnosis and endodontic therapy. Because they limit their practices to endodontics, they treat these types of problems every day. Endodontists are experts in performing non-surgical and surgical retreatment. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals or unusual anatomy. Your endodontists use advanced technology, such as operating microscopes, ultrasonics and digital imaging to perform these specialized procedures.

Why do I need another endodontic procedure?

As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

• Narrow or curved canals were not treated during the initial procedure.
• Complicated canal anatomy went undetected in the first procedure.
• The placement of the crown or other restoration was delayed following the initial endodontic treatment.
• The restoration did not prevent salivary contamination to the inside of the tooth.
• New decay which exposes the root canal filling material to bacteria, causing a new infection in the tooth.
• A loose, cracked or broken crown or filling can expose the tooth to new infection.
• A tooth sustains a fracture.

What will happen during retreatment?

First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material.In many cases, extensive restorative materials, such as posts and cores must be disassembled and removed to permit access to the root canals.

After removing the root canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination (using an operating microscope), searching for any additional canals or unusual anatomy that requires additional treatment.

After cleaning the canals, the endodontist will fill and seal the canals. It is usually advantageous for the endodontist to place the build-up or final restoration during to retreatment visit to insure the coronal seal. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery, although this is infrequent.

After your endodontist completes retreatment, you may need to return to your dentist to have a new crown placed on the tooth to protect and restore it to its full function.

Is retreatment the best choice for me?

Whenever possible, it is best to save your natural tooth. There are new techniques and a dramatic improvement in the equipment now available to your endodontists, for example, the operating microscope. These advancements now allow your endodontists to now save teeth previously considered hopeless. As with any dental or medical procedure, there are no guarantees. Your endodontist will discuss your options and the chances of success before beginning retreatment.

How much will the procedure cost?

The cost varies depending on how complicated the procedure will be. The procedure will probably be more complex than your first root canal treatment, because your restoration and filling material may need to be removed to accomplish the new procedure. In addition, your endodontist may need to spend extra time searching for unusual canal anatomy. Therefore, you can generally expect retreatment to cost more than the initial endodontic treatment.

While dental insurance may cover part or all of the cost for retreatment, some policies limit coverage to a single procedure on a tooth in a given period of time. Check with your employer or insurance company prior to retreatment to be sure of your coverage.

What are the alternatives to retreatment?

If non-surgical retreatment is not an option, then endodontic surgery should be considered. This surgery involves making an incision to allow access to the tip of the root. Endodontic surgery may also be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.

What are the alternatives to endodontic retreatment and/or endodontic surgery?

The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.

No matter how effective tooth replacements are nothing is as good as your own natural tooth. You have already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.