Root Canal Retreatment

Why do I need Root Canal Retreatment?

As with any dental or medical procedure, it’s possible your tooth won’t heal as expected after initial treatment for a variety of reasons, including:

  • Narrow or curved canals that were not treated during the initial procedure.
  • Complicated canal anatomy that went undetected in the first procedure.
  • The placement of the crown or other final restoration was delayed following the endodontic treatment.
  • The restoration did not prevent salivary contamination to the inside of the tooth.
  • New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
  • A loose, cracked or broken crown or filling can expose the tooth to new infection.
  • A tooth develops a crack or fracture.

Root Canal Retreatment Explained

A root canal retreatment is similar to the initial root canal treatment, but with a few extra steps. During a retreatment, your tooth will be opened to gain access to the root canal filling material. In many cases, the restorative materials must be disassembled and removed to permit access to the root canals.

After removing the canal filling, the inside of your tooth is carefully disinfected and inspected using a surgical microscope. The high-power magnification of a microscope allows for better visualization of any untreated canals, unusual anatomy, biofilms, or fractures. If needed, an antimicrobial/antibiotic medication will be placed inside your tooth for some time for additional disinfection and a temporary filling will be placed. In these cases, you will need to return for a second visit to complete the retreatment.

Once the retreatment is complete, after one or two visits depending on your tooth, it is re-filled with a biocompatible material called gutta-percha and an anti-microbial cement. The opening in your tooth will then be closed with a restoration. This restoration is usually temporary and your general dentist will remove it and replace it with a final restoration. The final restoration can vary as follows:

  • A new final composite restoration (if a crown is not needed)
  • If the crown was removed and can be replaced, a new composite build up can be placed and the crown re-cemented
  • If the crown had to be drilled into, a final composite restoration can be placed in the access cavity
  • Or a new composite build up and crown (if a new crown is needed)

Based on current recommendations from the American Association of Endodontists, more and more general dentists are asking their endodontists to place the final composite or composite build-up. This is because your tooth is the most bacterial free immediately following the treatment, so placing the final composite restoration or build up at that time makes the most sense. Your general dentist will still place the crown when needed. After the tooth has the final restoration placed, it will continue to function like any other tooth.

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