Re-treatment Root Canal Therapy

Understanding the need for re-treating a tooth that has had root canal therapy:

With appropriate care, endodontically treated teeth may last as long as other natural teeth.  However, occasionally root canal treated teeth may become re-infected.  Some are teeth that were treated many years ago and are failing because of 1) new decay or leakage under an existing old crown or old filling, 2) a cracked or loose filling or crown or 3) a fractured root.  All of these scenarios involve bacterial invasion and re-contamination of the root canal spaces.  These teeth become symptomatic when the infection reaches the jaw bone beyond the root canal spaces.

A very small percentage of teeth remain infected or continue to be symptomatic after recent root canal treatment.  Incomplete healing may be caused by 1) curved or narrow canals that were not treated appropriately during the initial treatment, 2) complicated canals went undetected during initial treatment, 3) the crown or permanent restoration was not placed within the appropriate amount of time following the procedure, 4) leakage around the crown or filling allowed continued bacterial re-contamination of the root canal spaces.  For these types of situations, endodontic re-treatment may be needed.

Understanding the re-treatment procedure:

After removing the old filling and gaining access to the root canal spaces, the old root canal fillings are removed from the canal spaces using state of the art equipment.  This involves warming and softening the old root canal fillings to facilitate their removal.  Once these have been removed the procedure is very much like standard root canal therapy.  The canals are thoroughly cleansed and disinfected to our satisfaction with our cleaning instruments and chemical disinfecting agents.  The canals are then re-sealed with new root canal filling materials.  The access and old filling is replaced with a temporary filling.  There is no discomfort during this procedure as it is performed under a generous amount of local anesthesia.

Re-treatment root canal therapy generally takes more time to complete than standard root canal therapy.  In fact, approximately 30% of our re-treatment cases require two separate appointment to complete.  This is due to the complexity or time needed to complete many of these procedures.  Or, many of these cases require an interim medication in the canals for a period of two-to-three weeks to greatly improve the overall prognosis.  Please note that generally most, if not all, of the symptoms subside after the first appointment.

Understanding what to do following treatment:

• After re-treatment root canal treatment is completed we will thoroughly explain all post-operative instructions and needed use of post-treatment medications.  Please see section on Home Care Instructions: After Endodontic Treatment.  We will send your dentist a letter detailing your procedure and prognosis.  We will also send x-rays of your procedure to your dentist.  You should then contact your dentist’s office for a follow-up visit to address permanently restoring your tooth.  This will be accomplished with a new permanent filling and maybe a crown or bridge.  Your general dentist will decide on how best to restore your tooth.  Your tooth may be very brittle during this time so it is very important to not chew on your tooth and try and schedule an appointment with your dentist within two-to-six weeks.
• It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond.  Please contact our office immediately.  To prevent further future decay, please continue to practice good dental hygiene.

Understanding the cost involved:

• Many factors affect cost associated with endodontic treatment, such as the severity of damage associated the tooth and which tooth is affected.  Some teeth are more complicated (more canals to clean and seal) and time-consuming than others and the cost is reflective of the time generally needed to complete such procedures.  In general, endodontic treatment with appropriate restoration of the tooth, is less expensive than removing a tooth and replacing it with an implant or bridge.