Can an Endodontically Failing
Tooth Be Retreated?
Even when pain and/or swelling is present, the majority of failing
endodontically-treated teeth can be successfully retreated in today's world of
clinical possibility. By using scientific information gathered from research and
clinical studies, clinicians have developed better endodontic concepts,
materials, and techniques. Additionally, there are now better-trained general
dentists and specialists alike. All of these factors translate into improved
care for patients. The significant technological breakthroughs that benefit both
doctors and patients in endodontic retreatment include:
- Magnification glasses, fiber optic lighting sources, headlamps, and
recently, the dental operating microscope have significantly improved vision
and hence elevated treatment success.
- Ultrasonic devices allow doctors to more efficiently and completely
remove old root canal filling materials and other intracanal obstructions so
that teeth may be successfully retreated.
- Computer digital radiography technology allows the doctor to better
diagnose, visualize, and treat root canal disease. Additionally, this
technology significantly reduces radiation exposure to the patient.
- Improved instruments, better materials for filling and repairing
canals, and innovative new technologies have all contributed to
significantly improved retreatment success.
Today, well-trained general dentists and specialists alike can oftentimes
perform non-surgical endodontic retreatment in a very predictable,
cost-effective, and time saving manner when compared to other treatment
alternatives. At times, however, retreatment cannot be managed with non-surgical
efforts alone. In these situations, and as an alternative to extraction, a
surgical approach may be necessary.
What Is Non-Surgical
Root Canal Treatment (NSRCT)?
Non-surgical root canal treatment is a procedure directed towards saving an
endodontically failing
tooth. At times, the patient's existing artificial
crown must be removed. In other instances, access through the crown may be
possible. The access opening is created in order to give the dentist
non-surgical access into the root canal space through the biting surface of the
tooth. Once this has been accomplished, a non-surgical retreatment procedure
oftentimes requires:
- Locating and treating previously
missed canals.
- Removing old filling materials from
the root canal space.
- Removing posts and broken
instruments.
- Enhancing existing root canal
treatment.
- Negotiating blocked canals and
bypassing canal ledges.
- Repairing mechanical and pathological
perforations in the root.
Once these objectives have been accomplished, the root canal system is
re-cleaned, re-shaped, disinfected, and three-dimensionally sealed. A protective
restoration can then be placed and the
tooth restored to a state of health and
function.
What Is Surgical Root Canal Treatment (SRCT)?
Surgical root canal treatment is a procedural effort in which it is necessary
to elevate a small flap of tissue adjacent to the involved tooth in order to
gain access to and treat root canal disease. Surgical root canal treatments are
usually minor, in-office procedures performed under local anesthesia. Once the
pathological area is exposed, the doctor performs a "curettage" to
remove the diseased tissue from around the root. This is usually followed by an
"apicoectomy," a procedure in which the diseased portion of the root
is removed. A small filling is then usually placed to seal the remaining portion
of the root. Surgical root canal treatment will oftentimes result in a good
long-term prognosis for the tooth if the cause of pathology can be effectively
eliminated.
Unfortunately, on occasion, retreatment efforts may not be possible or
cost-effective and extraction may be the only alternative. However, saving a
tooth that has been previously treated endodontically and is failing is usually
possible, can be very predictable, and is typically the most conservative option
for the patient.
