Undergoing a root canal procedure is one of the simplest ways to remedy a tooth that is deeply decayed, infected, or traumatized. Most root canals are successful, but there are instances where a previously treated tooth does not heal as expected. Months or even years later, pain or infection can reoccur, often a result of inadequate cleaning and sealing of the original root canal. In such cases, you might need endodontic retreatment and would be necessary. Here is some of the most important information regarding retreated and complicated endodontic treatment.
Like any modern medical procedure, endodontic retreatment has many benefits when performed with precision and care. Ultimately, the question arises of whether the benefits (saving your tooth from extraction) transcend the negatives (taking your natural tooth out and replacing it with a titanium implant or the possibility that retreatment might not work), and this is primarily the dilemma that is faced when taking on this treatment.
What does Retreatment from Endodontics Entail?
Endodontic retreatment is when a tooth already treated with a root canal is opened up again, cleaned, and resealed. It is performed when a prior root canal doesn’t fully clear the infection or additional complications arise.
Root canals are highly successful, but complications can sometimes occur due to hidden canals, new decay, or reinfection. When this happens, retreatment allows an endodontist to resolve the problem and give your tooth a second chance.
Why Would a Root Canal Fail?
A failed root canal doesn’t imply something went awry during the procedure although this is often the case. It is extremely important that a first time root canal is performed with great precision and care. We are essentially cleaning the inside of the tooth of any bacteria. The higher the level of cleaning and disinfection the lower the chance of reinfection This is why we highly encourage that all root canals be performed by a caring and thoughtfully driven specialist. At Jakob Endodontics root canal care and precision in treatment is what we focus on 100% of the time. Several factors can make endodontic retreatment necessary:
Missed Canals or Infections Untested for Infection
Teeth are complex structures, some with multiple tiny canals not visible during the first treatment. If bacteria hide in these areas, the infection can live on and spreads to the immediate and surrounding bone that supports your tooth, eventually causing pain and swelling.
Improperly cleaned canals
When performing Endodontic treatment it is vital that the Endodontist or dentist activate and thoroughly replenish disinfectants inside the tooth in a safe and controlled manner. It is equally important to clean the tooth to the very end of the roots (at Jakob Endodontics we use the J Morita Root ZX 2 apex locator to help us determine the lengths of each canal with extreme accuracy and attention to detail). Often a root canal treatment not done with precision, a microscope, and other specialized equipment will be improperly treated increasing the chance for failure down the road. Improperly treated root canals typically have untreated canals, blocked canals, are not cleaned and sealed to the apex or tip of the root, or they may be over prepared during treatment resulting in a later fracture and failure.
New Decay or Infection
Even with a successful root canal, your tooth can still get new decay. When a filling or crown is cracked or fails to seal properly, bacteria can re-access the tooth and re-establish infection.
A Cracked or Fractured Tooth
Over time, teeth can crack, particularly if they’ve been compromised by prior dental work. However, even a tiny crack may permit bacteria to enter the root canal system and cause an infection. It is vital that a tooth that is suspected of having a crack or fracture be evaluated by an endodontist. We specialize in determining the chances of success with retreatment. A vertical root fracture (not to be confused with a cracked tooth) will typically indicate a need for tooth extraction, however if these VRFs (vertical root fractures) are improperly diagnosed then a tooth that could have been saved might end up being extracted.
How Do You Know If You Need Endodontic Retreatment?
However, you’ll want to look for signs that a tooth your dentist had previously treated might not be healing correctly. Here’s the most important thing to watch for that indicates something’s wrong:
Persistent or Recurring Pain
One of the most obvious signs that something is wrong is persistent pain in the treated tooth. If your tooth is still tender or sensitive long after your initial root canal, this may indicate an underlying problem.
An area of reduced density in the bone at the very tip of the roots. This is easily noticed on a CBCT or cone beam 3D Scan, while they may go undiagnosed on traditional x rays. As a standard, patients referred for retreatment have this limited and low radiation dosage scan taken to complete and confirm a diagnosis of reinfection and need for endodontic retreatment.
Pus and swelling around the tooth may generate caution about an abscess or ongoing infection. You might require retreatment if the swelling doesn’t improve with antibiotics or pain medication.
Sensitivity to Hot or Cold
A root canal usually removes the nerve from the tooth, so you shouldn’t typically have prolonged temperature sensitivity. If you do, it may mean the infection remains.
A Pimple or Bump on the Gums
A small pimple-like bump (a sinus tract) on the gum near the treated tooth is a warning sign. This is frequently indicative of a persistent infection that should be treated.
A Strange Taste or Smell in Your Mouth
If you experience an unusual taste or have persistent bad breath that doesn’t improve with dental hygiene, this could be due to bacteria from an untreated infection.
What Does Endodontic Retreatment Involve?
Like the initial root canal, endodontic retreatment generally includes the same process but with extra steps to address the underlying issue. It is uncommon for a general dentist to retreat a tooth so don’t be surprised if you get referred to an endodontist for this specialized procedure.
Here’s what you can expect:
The process starts with an examination and a diagnosis
First, your endodontist will take X-rays and a scan of your tooth to assess its healing condition and determine if retreatment is needed.
Step 2: Reopening the Tooth
After getting you properly numb,the endodontist entist gently removes the existing filling or crown to reach the canals of the tooth. If there is an existing crown, we can carefully make a small access opening to the inside of the tooth through the crown while allowing you to keep it.This has a tremendous cost saving benefit as it typically does not require replacement of the crown.
Step 3: Flushing theCanals
The existing filling material in the root canal is removed, and the canals are recleaned, disinfected, and reshaped. Additionally, we will locate and treat any canals that might have been missed in the first treatment.
Step 4: Filling and Sealing
Once the canals are cleaned, they are sealed with a biocompatible bioceramic sealer and new gutta percha filling material to prevent reinfection.
Step 5: Restoration
After the procedure, the tooth will require a crown or filling to restore its function and strength. Based on how extensive the treatment is, your dentist will give you some guidance.
The Benefits of Endodontic Retreatment
Many patients ask if they should take the tooth out instead of retreatment. Preserving your natural tooth is always the preferred option when possible. Here’s how endodontic retreatment helps:
- Saves Your Natural Tooth — Extractions are a last resort. Your natural tooth, anchored to your jawbone, helps you chew normally and maintains proper jawbone structure.
- Reduces the Need for Bridges or Implants – A missing tooth requires replacement, which may incur expensive procedures over many long appointments Retreatment is more often than not the less costly and less invasive choice. Additionally most retreaments can be completed in a single 1 hour visit.
- Stops Infection and Alleviates Pain – Retreatment clears the persistent infection and re-establishes your tooth’s health. The previously damaged bone will heal over the course of a few months ( a very strong indicator that root canal retreament is an essential procedure in not just saving your tooth, but also in repairing damage to the surrounding bone).
- Delivers Low Maintenance – Once a retreated tooth is fixed, it should remain for life with minimal restriction.
Do I perform endodontic retreatment every time?
Endodontic retreatment is usually the most effective option for saving a tooth, though this is not always the case, and other treatments may be suggested. If the tooth is too damaged, your dentist may recommend an apicoectomy (surgical root-end removal) or extraction and a dental implant instead.
To find out what to do next, you should visit an experienced endodontist such as Chaim Jakob, DMD to assess your condition and then suggest the proper treatment for you.
How to Avoid Having to Treat You Again
Here are some key oral health practices to reduce the need for retreatment down the road:
- Take Good Care of Your Dental Hygiene – You should brush your teeth at least twice daily, floss once daily, and use an antibacterial mouthwash to decrease the chance of decay and infection.
- Get Regular Dental Checkups – Regular visits help to identify potential issues before they become serious.
- Preserve Your Dental Work — If you have a crown or filling, keep it healthy and have it replaced if necessary.
Takeaway: When to Visit a Dentist
If you have any of the above-listed symptoms, don’t write them off. Early intervention can be the difference between saving and losing a tooth. Endodontic retreatment offers a second chance to return your tooth and bone to health and function.
The key to ensuring your dental work lasts and that you hold onto a healthy, pain-free smile is to listen to the warning signs — and seek treatment promptly. If you feel that something is off with a tooth that has already undergone treatment, book an appointment with your dentist or endodontist as soon as possible.