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Broken File during Root Canal Treatment
FAQs for Root Canal Treatment
Root Canal Treatment Vs Tooth Extraction
Pain after Root Canal
Is Root Canal Treatment Painful
Falsehoods and Truths about Root Canal Treatment
Root Canal Re-Treatment
What if Root Canal Treatment Fails
Alternatives to A Root Canal Treatment
Cost of Root Canal Treatment
Restoration of Root Canal Treated Tooth
Why is Root Canal Treatment RCT required
How Root Canal Treatment Is Done
Diagnosis of Root Canal Treatment
Complications if Root Canal Is Not Done
Understanding Root Canal Therapy RCT
When is Root Canal Treatment Required
Complications and Care After Root Canal Therapy
Procedure For Root Canal Therapy
Signs And Symptoms Of Root Canal Therapy
What Is Root Canal Therapy RCT

What if Root Canal Treatment Fails

Root canal treatment is done when infection reaches the pulp portion of the tooth. During root canal treatment, necrotic and infected portion of the tooth is removed and is then sealed with a filling material. If done with great precision and complete care, a root canal treated tooth can last lifelong. But in cases where root canal continues to harbor bacteria or irritants which keep the tissues surrounding the root of the teeth from being healthy (inflamed)even after the completion of the root canal treatment then the root canal treatment is taken to be a failure. Root canal failure signs and symptoms can occur month or years after root canal treatment. Pain occurs in root canal treated tooth in case of failure of root canal treatment.

Signs and symptoms of root canal failure include:

  1. Mild to severe tooth pain
  2. Slight to severe pain or edema in the gums neighboring the tooth involved can either be in a continuous or intermittent mode after the root canal treatment.

These signs can be persistent from the time of root canal treatment, be transient varying week to months or even be dormant for years making the tooth appear completely asymptomatic during this dormant period. In cases where the tooth is completely asymptomatic, the signs of root canal failure which show as persistent inflammation surrounding the infected tooth, can be identified by the dentist through the medium of x-rays.

Causes of Failure of Root Canal Treatment

1.    Shape of the Tooth’s Root Canals:  Sometimes the tooth may have root canal branches which are difficult to detect. The canals which are curved and branch out often go undetected at times. These undetected branches might be missed in the root canal treatment leading to its failure.

2.    Unexpected Number of Root Canals: There can be variation in number of canals which are present in the tooth. A tooth might have many small root canals also called as the accessory root canals which may be missed during the treatment. If a canal is missed during root canal treatment, then tooth can become infectious months or years after treatment and in such cases, root canal re-treatment is required.

3.    Bacteria in root canal:  Certain bacteria are very resistant in nature and no matter what it’s very hard to remove them therefore they easily escape the disinfection by root canal and infection persists.

4.    Cracked root: By root canal therapy, roots of the tooth become bit brittle and can fracture on chewing which can further cause failure of root canal treatment. Dental crown after root canal treatment prevents fracture of tooth on chewing. Fracture of the root may occur during root canal treatment procedure and cause root canal treatment failure. It is difficult to diagnose these cracks and these cracks can lead to pain later on.

5.    Breakage of file during root canal procedure: Accidental breakage of file during cleaning and shaping of canal during root canal treatment can cause infection in root canal treated tooth and failure of root canal treatment. If canals are sterilized and clean before breakage of file in tooth, then it doesn’t cause any symptom otherwise broken file in canal can lead to pain and infection later on. If file remains in canal before removing the necrotic pulp, then it has to be removed. File in unsterilized canals is to be removed before sealing the root canal treated tooth.  

6.    Defective or Incomplete Restoration: Defective or incomplete restoration at the end of root canal treatment fails to maintain a proper seal and this may lead to bacteria to penetrate back into the cleaned canal causing re-infection.

Inadequate filled canals and broken instrument in left lower incisor

7.    Gum Disease: The treated teeth are not completely resistant to tooth decay or gum disease so the tooth might be lost if proper oral hygiene is not maintained. If patient doesn’t maintain good oral hygiene, then abscess can occur years after root canal treatment and dental crown.

8.    Tooth Structure: The tooth structure which is damaged or broken as a result of treatment and which require restoration for stability which if not done can cause failure of root canal treatment.
The tooth filling even if accurately done at the time of treatment might break down with time due to some reason like high biting force which will again lead to seepage of bacteria into the canal and re-contaminate it

Success rate of root canal treatment is 95%. In about 5% of cases, complications may occur after root canal procedure which can lead to failure of root canal treatment.   
To avoid further infections after getting root canal treatment and dental crown, it is important that patient maintains good oral hygiene and get regular dental check ups done.

Treatment after Failed Root Canal Therapy

In case of root canal failure, re-root canal treatment, Apicoectomy or tooth extraction may also be required to remove the infection from the tooth. Dentist will evaluate the condition of the tooth and will decide that whether tooth can be saved or not. If he thinks that prognosis of tooth after root canal treatment or Apicoectomy is not good, then he will pull the tooth out. If tooth extraction is required, then missing tooth can be replaced with dental implants, dental bridges or partial dentures. Dental implants are the best option for replacement of missing tooth.   

Dental Implants after Tooth Extraction   

Root canal retreatment can be done to save the tooth and tooth and remove the infection in root canal treated tooth. Procedure of root canal re-treatment is somewhat similar to root canal treatment and is mainly performed by an endodontist who is specialist in performing root canal procedure.

Apicoectomy that is surgical removal of root apex may be required to remove the infection from the tooth. To seal the root, small filling (retrofill) is used.

Bone Removal for Apicoectomy

Success rate of root canal treatment is not as high as root canal treatment done for the first time. Root canal treatment success rate is 50%-75%. If re-infection occurs after root canal re-treatment, then tooth extraction may also be required.
 

 User Comments on  What if Root Canal Treatment Fails
Posted By : Dr Carl on 2/2/2012 2:38:15 AM
Stacey, Tooth can become non-vital after root canal so it can get discolored after root canal therapy. Discoloration is because of entry of hemosiderin pigment which is formed from hemoglobin into dentinal tubules. Tooth can appear longer because of infection in tooth or because of gum infection. Without clinical examination, it is difficult to give definite diagnosis. You can visit your dentist for evaluation of root canal treated tooth.
Posted By : Stacey on 2/1/2012 9:44:08 PM
I had a root canal done on my front tooth about 14 years ago. Just recently the tooth has a rough texture on the front surface. It is also turning a darker colour than my other teeth and is slightly longer than it use to be. Is this normal with aging root canals?
Posted By : Dr Ritz on 1/17/2012 2:37:21 AM
Marilyn, In case of poor case selection or if root canal treatment is not done properly, then failure of root canal treatment takes place. In case of root canal treatment failure, re-root canal treatment or surgical endodontic procedure can be done to save the tooth. Prognosis of root canal retreatment is not as good as root canal treatment done for the first time and if the prognosis of tooth is poor, then surgical endodontic therapy or tooth extraction is done. In case of Apicoectomy, surgical removal of apex is done to remove the infection and then retrofilling is done. Without clinical examination and without seeing the x-rays, it is difficult to comment that whether extraction or apicoectomy is better for you. If tooth can be saved, then better save it with Apicoectomy procedure but if the prognosis of procedure is poor, then extraction followed by replacement of missing tooth with dental implants can be done.
Posted By : Marilyn on 1/16/2012 4:50:04 PM
I had a root canal done in #9 tooth one year ago and complained right away to the dentist that it was sensitive and uncomfortable to bite and continued at every appt to tell dentist it didn't feel right (have had several other root canals). Finally it is infected and has a lateral lesion and infection goes to the apex. Also have a fistula in gum close under nose. Saw an endodontist and he said it was poor prognosis for repeat root canal due to lateral lesion. He recommended an implant. Saw dentist today to have a "flipper" made and he is now suggesting that the oral surgeon may do a apicoectomy. I have lost trust in the dentist due to his inability or inattentiveness to my complaints for one year that the procedure had failed. By the way, there was no infection in this tooth detected before the root canal was done. I was have randon, periodic waves of pain in the vicinity of this tooth which become worse over months and dentist decided to so root canal (the waves of pain have subsided). He had trouble doing the procedure but in the end he was confident he successfully completed in. Yet is is infected not. What is your recommendation as far as choice between implant or apicoectomy. Thanks, Marilyn
Posted By : Dr Ritz on 12/31/2011 2:34:50 AM
Lalit, If root canal treatment has failed, then re-root canal treatment or surgical endodontic procedure can be done to save the tooth. If the affected tooth has poor prognosis, then tooth extraction may also be required. If tooth needs to be pulled out, then the missing tooth can be replaced with dental implants or dental bridge. You can visit an endodontist who is specialist in root canal treatment for evaluation.
Posted By : LALIT ARYA on 12/29/2011 10:51:54 PM
dearsir ihad rootcanal 4 years ago upper front 2 teeths it failed in x-ray it seem black dark portion in upper side. One teeth fill well but in teeth pain n swelling also on upper lip dr. said that teeth come to end and pulled out that infected teeth what i have do? pls.....
Posted By : Dr Ritz on 11/18/2011 11:03:10 PM
Girish, Gutta percha which is used for filling of the root canals is a non-toxic, inert and bio-compatible material and causes no toxic effects. Gutta percha itself is a natural non-elastic latex from sap and can't cause any systemic side effect. Dental crown are made of metal or porcelain and they also don't cause any systemic effects. Still if you are apprehensive, then you can consult your dentist.
Posted By : girish on 11/18/2011 10:43:28 PM
sir, i had my front upper teeth broken and done rootcanal treatment 13 yars ago. noe i otally a healthy person develops coronory blockage , my naturopathy doctor doubted this with the guttapurcha and the metal used in that teeth. i want to replace these materials with nature friendly material to keep the teeth as it is my frontal uppr teeth please advice
Posted By : Dr Ritz on 11/14/2011 10:55:24 PM
John, your tooth can get infected and can cause pain. If your tooth fell out, then you have to get it restored. You can get it restored with dental crown. If there is much of tooth structure loss, then post and core followed by dental crown is required. Post will provide strength to the tooth. If quite a lot of tooth structure is lost and tooth is unrestorable, then tooth extraction may also be required. Vist your dentist to get treatment done of affected tooth. By that time, you can avoid eating from that side of the tooth and keep that area clean to avoid any infections.
Posted By : John on 11/14/2011 7:44:03 PM
I had a root canal done on my right upper back tooth less than a year ago. Lately a piece of the filling fell off and i've been spitting blood every morning. Today the whole tooth just fell out. Am I in danger of an infection?
Posted By : Dr Ritz on 11/11/2011 1:48:04 AM
Joe, If there is no bone in tooth with dental implant, then you can’t keep it exposed. You have to get bone grafting procedure done. After bone grafting, you can get dental implant procedure again. Infection, less bone mass, smoking, systemic condition like smoking, high blood pressure, fixing dental implant too soon can cause failure of dental implants. Get dental implants procedure and bone grafting done from an implantologist who is specialist in dental implants. For your other tooth, to remove the infection which is left in the tooth, reroot canal treatment or Apicoectomy can be done. Prognosis of root canal retreatment or Apicoectomy is not as good as root canal procedure done for the first time. If your dentist thinks that prognosis of tooth will be good with re- root canal, then you can save the tooth than extracting it. If prognosis of tooth is poor after root canal procedure, then you can get it pulled out and after tooth extraction, you can get dental implant.
Posted By : joe on 11/10/2011 10:09:24 PM
Dear doctor I had a failed root canal today on the number 3 tooth upper right side. The dentist succeed in cleaning out three of the roots but the forth one he “missed by a mile” as I heard him say under his breath as he looked at the xray. So after his frustration he just finished with the operation and told me he would have to preform an apicoectomy on the root he missed. I have had an apicoectomy before on a lower front tooth, and lost bone after it. It eventually was pulled and I had an implant placed there and that is failing now. It seems there is no bone in front. The gum has failed and you can see the whole implant. My current dentist wants to remove the implant and do a bone graft and skin graft and then another implant. Although He says when he removes the implant it may compromise the adjoining teeth and I may lose them too. But then he says it will be better so he can add more bone and do 2 implants with 1 cantilever. I have had bone grafts done twice in my mouth and none have been successful. Though I think they were done very sloppy. One didn’t even last a day till the stitches fell out. So I guess I have two questions. On the lower front tooth, since its not really bothering me, can I leave it exposed and keep it as clean as possible and hope I don’t lose any more bone? And on the upper right tooth. Can they redo the root canal, find the problem root and fix it that way or is a apicoectomy the only answer. or............................. should I just have it pulled and put in another implant? Please help with any advice. Thank you for your time Sincerely Joe
Posted By : eric wanjohi on 9/26/2011 12:51:18 AM
thanks 4ur information its really helpful.
Posted By : Dr Ritz on 9/1/2011 10:57:22 PM
Geetanshu, Small overfilling of the material beyond root apex seldom affects the outcome of the treatment. The root canal materials are often well tolerated by the periapical tissues if the overfilling is mild. The symptoms of overfilling can range from none to discomfort on application of biting pressure to swelling and development of fistula on gum adjacent to the tooth. If the overfilling is more and causes pain to the patient, than for the management of overfilling of the canal, you can go for root canal re-treatment or apicoectomy.
Posted By : geetanshu on 9/1/2011 11:53:09 AM
i had done overfilling of mesiobuccal n mesiolingual root canal wrt 37 can u pls tell the management n consequences of it....do i need 2 reapeat the rct or wait for the pt until he complain 4 the pain wrt to the referred tooth . i m doing intern as i am in my learning stage so wanna know it asso that i dont reapeat it again ....... i know that pt will complain of pain pls help me now what to do....... i wll be very thank ful to u ..
Posted By : hemat on 8/12/2011 11:50:34 AM
i think you have an exposed root of a djacent tooth
Posted By : Dr. Ritz on 7/3/2011 5:07:35 AM
It can be either some necrosed pulp is left in one of the canals which is causing hot n cold sensation as necrosed pulp has nociceptors which can cause hot n cold sensation or it can be that the patient is not having pain in that tooth but some adjacent tooth is involved or it is the referred pain. You can find the cause with thorough clinical examination.
Posted By : amit on 7/3/2011 5:07:35 AM
i have treated a patient with rct. But after a month ,patient is complaining of sensitivity on having hot or cold .why

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