Endodontic retreatment

Why a treated tooth can hurt again

Most teeth heal well after a root canal and last for many years. Now and then one doesn’t heal as expected, or a new problem reaches it later, sometimes months or even years after treatment.

A tooth may not heal as expected when:

• a narrow or curved canal wasn’t fully treated the first time
• a canal or an unusual root shape went unnoticed
• the crown or final filling was placed late
• the filling or crown on top let saliva and bacteria seep inside

A tooth that healed well can also run into something new:

• new decay exposes the root canal filling to bacteria
• a crown or filling comes loose, cracks or breaks
• the tooth itself fractures

In most of these cases, the cause is bacteria that stayed inside the root or found their way back in. That’s why a tight seal on top of the tooth matters as much as the filling in the roots. In a study of more than 1,000 treated teeth, the quality of the crown or filling on top made at least as much difference to the health of the bone around the root as the quality of the root canal filling.

How we clean and seal the tooth again

First, Dr. Brasseale examines the tooth, takes x-rays and talks you through your options. If you choose retreatment:

1. Reopening the tooth. Once the tooth is numb, he makes an opening to reach the old root canal filling. Often the crown, and any post and core material beneath it, has to come off first.
2. Cleaning. The old filling material comes out, and each canal is cleaned again. Under the surgical operating microscope, Dr. Brasseale searches the inside of the tooth for any extra canal or unusual anatomy that needs treatment.
3. Sealing. We fill and seal the canals, and a temporary filling closes the tooth.

Magnification makes a real difference with small canals. In a laboratory study of upper molars, more of the small extra canals were found and cleaned with the microscope than could be managed without it.

If a canal turns out to be too narrow or blocked to clean from inside the tooth, Dr. Brasseale may recommend endodontic surgery, which seals the root from its tip.

Recovery feels much like your first root canal

The tooth may be sore for a few days, especially if it was infected, and over-the-counter pain relievers usually help. Avoid chewing on the tooth until your dentist has restored it.

See your dentist as soon as you can for a new crown or other restoration, which protects the tooth and keeps bacteria out. Before you leave, our team offers to schedule that visit for you, and we send your dentist a report of your treatment. At later checkups, your dentist or Dr. Brasseale may x-ray the tooth to make sure the bone around the root has healed.

Follow your aftercare instructions, and call us if you have swelling, an allergic reaction to a medicine, severe pain that lasts more than a few days, or the return of the symptoms you had before.

You decide, with every option explained

When a treated tooth has a problem, you usually have three choices: retreat the tooth, treat the root tip with surgery, or remove the tooth. When your own tooth can be saved, saving it is usually worth it. A removed tooth needs to be replaced with an implant, a bridge or a partial denture so you can chew comfortably and the teeth beside the gap don’t drift, and those options involve surgery or work on healthy neighboring teeth.

Dr. Brasseale will explain which option suits your tooth and why, so you can decide with all the facts in front of you. If you’re not sure whether a treated tooth needs attention, call us or ask your dentist.