Dental Retreatment (part 1): Root Canal Treatment (endodontic treatment)

Visit to a dentist is never a pleasant thought, specially when the previous experience was unfavorable. Dental pain is a common cause to seek treatment, therefore helplessly we go to a dentist to cure the pain. The pain is usually an indication of loss of pulp vitality, so the dentist plans a root canal treatment. The treatment goes well as per the dentist and you go home happy....

Like every form of treatment (dental/medical), there are instances where a  retreatment may be necessary. Not all the procedures are perfect, after all a human is treating.


Failures in Root Canal Treatment.
Occasionally, a dentist faces difficulty in executing root canal treatment. In some or other way, the treatment is completed and the patient is sent away.
In due course of time, in unfortunate situations, pain is experienced in the region of the root canal treated tooth. The patient manages this kind of pain by taking over the counted pain medication without understanding the actual reason. Some visit the dentist again and show their worries. The dentist shoots a radiograph (X-Ray) to investigate the cause.
The frequent causes for root canal retreatment can be enlisted as
1) Inadequate biomechanical preparation of root canal.
2) Incomplete root canal filling.
3) Contamination of root canal during root canal filing procedure.
4) Operator missing on one of the root canals.
5) Dislodgement of debries beyond the root apex.
6) Instrument breakage in the root canal.

The above mentioned causes are frequently encountered, not always the operator is to blame, but the teeth that need root canal treatment may be tricky at times. A curved root canal becomes a challenge for the operator to negotiate with an instrument, at times operator over comes the difficulty, fails to reach the apex of the root, or out of negligence the operator ignores the situation and fills the root canal. In haste the operators performs the root canal treatment, this leaves high chances of failure in the treatment.
Every instrument made of metal has a specified life span of service beyond which the instrument becomes susceptible to breakage due to cold working. Similarly an endodontic file repetitively used or faulty instrument handling will lead to breakage of the instrument in the root canal.

Depending on the cause of failure, an intraoral radiograph (X-ray) is best to diagnose the pathology associated with the tooth. A foci of infection is hard to miss on a radiograph as well as a broken endodontic instrument. Also incomplete rootcanal filling is clearly visible. A missed root canal may be difficult to distinguish on a radiograph as it provides information in 2 dimension (2D). In situations where the information is difficult to interpret from a radiograph, advanced imaging technology must be relied on. CBCT (cone beam computer tomography) imaging system provides information in a 3 dimensions (3D), a high detailed information can be interpreted.

Once the problem has been diagnosed, the dentist makes a decision on the kind retreatment procedure is to be followed.
Negligence by the operator is not tolerable, but unfortunately mistakes do happen. We all are susceptible to commit mistakes, skillful management of a complication is where a true clinician will perform well. Extreme cases where the tooth has a periappical lesion, an endodontic surgery is indicated. In some situations the condition can't be handled in a conservative fashion, extraction of the tooth is necessary
It is mandatory to cap/ crown a root canal treated tooth to have an extended life of service and reduce the chances of tooth fracture. 

Broken instrument

Incorrect root canal treatment and periapical lesion