Most teeth that have had root canal (endodontic) therapy can last as long as other natural teeth. In some cases, a tooth that has had endodontic treatment fails to heal. Occasionally, the tooth can become painful or diseased months or even years after successful root canal therapy. If your tooth has not healed or has developed new problems, you have a second chance at saving your tooth. Another procedure, root canal therapy retreatment may be performed by your endodontist.
As with any dental or medical procedures, occasionally, a tooth may fail to heal following the initial treatment for several reasons:
- The final restoration was delayed following endodontic treatment.
- During initial treatment, narrow or curved canals were not properly cleansed.
- The endodontist did not notice complicated canal anatomy during the first treatment.
- The restoration did not protect the central portion of the treated tooth from salivary contamination.
Sometimes a new problem can develop in a tooth that was successfully treated during the initial procedure. These include:
- A fracture occurs.
- New decay develops, exposing the canal to bacteria and a new infection.
- Infection can occur if the crown or filling becomes loose or cracked.
If retreatment is necessay, using a microscope, your endodontist will reopen the tooth. After extracting the filling material, the canals will be thoroughly cleaned and carefully examined to see if additional canals are present that require treatment.
Once the canals are comprehensively cleaned, your endodontist will place a temporary filling.
Endodontic surgery or Apicoectomy may be necessary if the canals are very narrow or calcified. Also known as a root-end resection, an apicoectomy literally means the removal of the apex of the root of the tooth. This procedure treats the bony area surrounding the end of your tooth, which has become inflamed or infected. By folding back the gum near the tooth, the doctor can access the underlying bone and extract the inflamed tissue. At the same time, the very tip of the root is removed and usually replaced with a small plug or filling.
After retreatment is completed, within two to five weeks, you will need to see your dentist for the final restoration.
If possible, preserving your natural tooth is always the best option. Teeth that have been restored with a filling or crown can last for years, even a lifetime.
Because technological and procedural methods are always changing, your endodontist may utilize new methods that were not attainable during your initial root canal treatment. Retreatment may improve the condition of your tooth.
Your endodontist will discuss your chances of successful treatment prior to the procedure.
Depending on the severity of the affected tooth, the cost for retreatment will vary. Generally, retreatment will be more complicated than the initial root canal because the permanent restoration and filling will need to be extracted to access the canal. Your doctor may also need to spend more time examining and treating unusual canal anatomy. As a result, retreatment will be more expensive.
Your insurance may pay for a portion of or the total cost of retreatment. Check with your insurance company to verify the extent of coverage.
Your endodontist may recommend an Apicoectomy if retreatment is not a suitable option. An apicoectomy may also be performed along with the retreatment.
Extraction is the only other option to nonsurgical retreatment. However, once removed the space must be filled with a bridge, implant or a removable partial denture, to hinder tooth movement and restore proper chewing function. These options are more expensive than retreatment and permanent restoration.
Tooth replacements can be effective, but nothing is better than your natural tooth. Retreatment and restoration can preserve a healthy, natural tooth for several years.