Endodontic Retreatment

A second chance to save your tooth

With proper care, most teeth that have had endodontic (root canal) treatment can last as long as other natural teeth. 

In some cases, however, a tooth that has received endodontic treatment fails to heal or the pain continues. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment.

If your tooth has failed to heal or has developed new problems, you have a second chance. Another endodontic procedure may be able to save your tooth.

All dentists are educated in endodontic treatment in dental school. However, because retreatment can be more challenging than providing initial treatment, many dentists refer patients needing retreatment to endodontists.

Endodontists are dentists with at least two additional years of advanced education in root canal techniques and procedures. Because they limit their practices to endodontic cases, they have concentrated experience in endodontic treatment. In addition to treating routine cases, they are experts in performing complicated procedures, such as surgery, and in treating difficult cases, such as teeth with narrow, blocked, or unusually positioned canals. This special training and experience can be valuable if retreatment is necessary.

As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

Narrow or curved canals were not treated during the initial procedure.  Complicated canal anatomy went undetected in the first procedure.

	The crown or other restoration was not placed soon enough after the procedure.
	The restoration did not prevent saliva from contaminating the inside of the tooth.
	In other cases, a new problem can jeopardize a tooth that was successfully  treated. For example:

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.

First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials-crown, post, and core material-must be disassembled and removed to permit access to the root canals.

After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth, searching for any additional canals or unusual anatomy that requires treatment.

After cleaning the canal(s,) the endodontist will fill and seal the canal(s) and place a temporary filling in the tooth.* Post space may also be prepared at this time. *If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed.

After the final visit with your endodontist, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to full function.

Retreated teeth can function well for years, even for a lifetime. It's always best to save the tooth if your endodontist believes retreatment is the best option for you.  

Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may even be able to use a new technique that was not available when you had your first procedure. If your tooth has unusual anatomy that was not cleaned and sealed during the first procedure, your endodontist may be able to resolve this problem with a second treatment.

Of course, there are no guarantees with any dental or medical procedure. Your endodontist will discuss your options and the chances of success before beginning retreatment.

The cost varies depending on how complicated the procedure will be. The procedure will probably be more complex than your first root canal treatment, because your restoration and filling material may need to be removed to accomplish the new procedure. In addition, your endodontist may need to spend extra time searching for unusual canal anatomy. Therefore, you can generally expect retreatment to cost more than the initial endodontic treatment.

While dental insurance may cover part or all of the cost for retreatment, some policies limit coverage to a single procedure on a tooth in a given period of time. Check -with your employer or insurance company prior to treatment to be sure of your coverage.

For some patients considering retreatment, endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed. Endodontic surgery may be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.

The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.

No matter how effective modern tooth replacements are—and they can be very effective—nothing is as good as your natural tooth. You've already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.