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Endodontics – Retreatment

Why would a tooth need Retreatment if a Root Canal has already been done?

Occasionally, a tooth may not heal as expected after initial treatment. This can occur for a variety of reasons:

  • Narrow or curved canals were not negotiable or blocked during the initial procedure
  • Complicated canal anatomy went undetected during the first procedure
  • Crown or filling not placed soon enough after the procedure resulting in contamination of the canal filling.
  • New decay exposes the root filling material to contamination, causing a new infection in the tooth.
  • Loose, cracked, broken crown or filling can expose the tooth to new infection.

Conservative ( Conventional) Retreatment
Conservative retreatment means removal of the original root canal filling, re-cleaning and refilling of the canal system. In some cases this requires Disassembly of the existing restoration. This may mean removal of a crown, posts and restorative materials to gain access to the canals. 

Once the case is retreated, a temporary material will placed to seal the opening. You will be asked to return to your General Dentist for reconstruction. The tooth will require an interim temporary restoration while the area heals. In most cases, a final, permanent restoration will not be placed until there is visible evidence of healing (minimum 6 months post treatment). Dr. Kaufmann will schedule an examination at that time to confirm that the area is ready for final reconstruction.

Prognosis
Each case is different, especially when retreatment is involved. Endodontic treatment generally has an extremely high success rate > 95 %. However, because the natural anatomy of the case has ALREADY been disturbed by previous treatment attempts, retreatment prognosis is generally less. Other factors such as broken instruments, perforation (false path resulting in a opening in the root), deviation or ledges can adversely affect the results. Even after apparently good clinical results, in some cases Surgical Endodontic treatment may be the only option. Dr. Kaufmann will review all options and help you select the best solution for your case.

Surgical Treatment
For some patients considering retreatment, Endodontic surgical treatment may be the best solution. An incision is made near the end of the root that allows for direct visualization and sealing of the root tip. Endodontic surgery is sometimes recommended in conjunction with retreatment. See Surgical Treatment for details.

Prognosis
Surgical treatment prognosis is extremely variable. Sealing the root can be difficult due to poor access, difficult anatomy or lack of physical root length. Periodontal health, smoking and post operative care also affect the results. In some cases, the root itself has a crack and cannot be sealed. Surgical exploration may be necessary to confirm this finding. See Cracked Tooth Syndrome and Vertical Root Fracture.

After Your Retreatment