Even when pain and/or swelling which are signs of infection are present, the majority of cases of root canal treatment failure can be successfully treated in the technologically advanced world of today. By the improved researches and the clinical trials the dental professionals have developed a lot better concepts, materials, and techniques. Also now the quality of education and exposure has produced better trained general dentists and even many specialists in the field. All these factors help in providing better care to the patient. Some of the advances which have improved the quality of work and proved to be a help for both the dentist and patient are:
Magnification glasses, fibred optic lighting system and headlamps have greatly enhanced the vision and therefore the produce a greater treatment success.
Ultrasonic devices allows the dentist to more efficiently and accurately remove old root canal materials and other intra-canal hindrances so that a success can be achieved even with most difficult root canal failure cases.
Improved instruments, better materials and medicatements for disinfecting, filling and repairing root canals and innovative new technologies have lead the dentists and the patient to get re-treatment done for the majority of the root canal failure cases.
The dentist are now able to treat the root canal cases with better diagnosis and visualization thanks to the new technology of Computer digital radiography. Also the radiation exposure has been greatly reduced due to this.
In case of root canal failure, 2 options are available. Patient can either opt for:
1. Non-surgical endodontic re-treatment or can get
2. Surgical endodontic procedure done (Apicoectomy with retrograde filling)
Today, well-trained general dentists and root canal specialists alike can most of the times perform non – surgical endodontic root canal re-treatment which is very cost effective, time saving and quite predictable as compared to other treatment alternatives like tooth extraction. But at times the root canal failure case cannot be re-treated by non-surgical methods. In these cases it’s important to use surgical endodontics to re-treat a root canal failure case preferred over tooth extraction.
The main aim of Non-surgical endodontic procedure is to save the endodontically failed tooth. But at times, patients crown given on the tooth requiring re-treatment needs to be removed. In some cases access can be made possible through the existing crown. The access opening as done in fresh case will give the dentist a non-surgical access to the root canal of the tooth through the top surface of the tooth. When the access has been effectively gained the procedure may further involve the following steps:-
Locating and treating the earlier missed or undetected canals.
Removing the earlier filled material from the root canal space. Drills or chemical agents can be used to remove the existing filling.
Post and core removal or any broken instrument from the pulp space.
Improving the quality of already present root canal treatment
Making way through the blocked canals and by-passing canal ledges.
Treating if any mechanical and pathological perforations of the root present.
Once these objectives are achieved, the root canal space is cleaned well, re-shaped, completely disinfected and finally sealed with complete accuracy. A protective restoration can then be placed in the end to restore the proper tooth form, function and aesthetics.
Mostly root canal re-treatment is done in 2 sittings. In first sitting, root canal re-treatment procedure is performed and in follow up appointment, tooth is restored with dental crown which will further restore functions of tooth.
Patient may experience some pain, soreness and tenderness for several days after root canal re-treatment procedure. For pain relief after root canal re-treatment, patient can take pain meds such as ibuprofen, Motrin or aspirin. If pain and discomfort doesn’t regress or gets worse after few days, then patient can visit his dentist. After root canal re-treatment, patient should schedule a routine follow up appointment.
1. After root canal re-treatment, patient should avoid chewing from that side of the mouth.
2. Patient should take the pain meds as directed and should take soft foods at least for 2 days after procedure.
3. Patient should avoid intake of very hot and cold food stuffs and should avoid smoking, drinking and any stressful exercise as it will interfere with healing.
4. To reduce swelling after root canal re-treatment procedure, intermittent ice pack application can be done.
Root canal re-treatment will remove the infection from the tooth and will relieve pain and discomfort of the patient. Root canal re-treatment saves natural tooth structure and treated tooth can function for years and can function throughout life.
Success rate and prognosis of root canal re-treated tooth is not as good as root canal treatment done for the first time. If root canal re-treatment is unsuccessful, then patient can get endodontic surgery done or can opt for tooth extraction with replacement of missing tooth with dental implants or dental bridge.
Root canal re-treatment is a safe procedure but complications may occur after procedure. Re-infection or tooth damage may occur after root canal re-treatment. To avoid any complications after root canal re-treatment, procedure should be done by an experienced endodontist. Patient should follow instructions of his endodontist after procedure.
Surgical method of treating a root canal failure case involves raising a small flap adjacent to the involved tooth in order to gain entry and treat the root canal infection. Surgical line of root canal treatment is a minor in office procedure done under local anesthesia. When the infected area is exposed the dentist performs curettage (the removal of diseased and infected tissue by scrapping or scooping).
Flap design Bone Removal
Curettage to separate granuloma from bone
This is usually followed by the apicoectomy procedure in which the infected root portion especially the root tip is removed. A small filling is then placed from the root end side to seal the left healthy part of the tooth root. Surgical endodontic procedure tends to give a good long term prognosis if the entire infection can be effectively eliminated.
Unfortunately at times the re-treatment efforts and surgical endodontic procedures may not be possible or cost-friendly and tooth extraction may be the only alternative. But to save a previously endodontically treated tooth which is failing is usually possible and predictable, being the most conservative option for the patient.
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