With proper care, most teeth that have
had root canal (endodontic) 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, many dentists refer
patients needing endodontic retreatment to
endodontists.
Endodontists are dentists with at least
two additional years of advanced specialty
education in diagnosis and root canal
treatment. Because they limit their
practices to endodontics, they treat these
types of problems every day. Endodontists
are experts in performing nonsurgical 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.
Endodontists may use advanced technology,
such as operating microscopes, ultrasonics
and digital imaging to perform these special
services.
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
endodontic treatment.
- The restoration did not prevent
salivary contamination to the inside of
the tooth.
In other cases, a new problem can
jeopardize a tooth that was successfully
treated. For example:
- New decay can expose 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, complex restorative
materials—crown, post and core material—must
be disassembled and removed to permit access
to the root canals.
After removing the canal filling, the
endodontist can clean the canals and
carefully examine the inside of your tooth
using magnification and illumination,
searching for any additional canals or
unusual anatomy that requires treatment.
After cleaning the canals, the
endodontist will fill and seal the canals
and place a temporary filling in the tooth.
If the canals are unusually narrow or
blocked, your endodontist may recommend
endodontic surgery. This surgery involves
making an incision to allow the other end of
the root to be sealed.
After your endodontist completes
retreatment, you will need to return to your
dentist as soon as possible to have a new
crown or other restoration 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. Retreated teeth can
function well for years, even for a
lifetime.
Advances in technology are constantly
changing the way root canal treatment is
performed, so your endodontist may use new
techniques that were not available when you
had your first procedure. Your endodontist
may be able to resolve your problem with
retreatment.
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 nonsurgical 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’ve 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.
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