Retreatment of Endodontic Thearpy
of a Root Canal' or
Canal Retreatment (Retreat)'
When is this
Nonsurgical retreatment of endodontic therapy is
most commonly completed when nonsurgical endodontic (root canal)
therapy is unsuccessful. Some of the more common reasons are:
Leakage. Leakage from the top part of
the tooth, typically due to decay or loss of the restoration on the
part of the tooth above the level of bone. Leakage allows
bacteria and irritants into the tooth which can get to the end of the
tooth in as little as 7 days even with the roots filled. While
gutta percha and sealer is placed into the roots seals, the problem is
it does not seal well against a deluge of liquid and bacteria!
The sealer washes out!
Cleaning and Sealing. For
root canal therapy usually to be successful, the canals must be
thoroughly cleaned and sealed. Occasionally, the initial
endodontic therapy was unable to remove enough irritants inside your
tooth that it fails to heal or pain continues. More often, the
canals are so narrow, hardened, or curved that the tiny instruments
used to clean and shape them cannot completely pass through easily and
requires specialized techniques. Other canals are so small they
are extremely difficult to find and went undetected during the first
procedure. A Surgical Operating Microscope can often help find
these small canals.
Anatomy of a Tooth with
Unsuccsessful Endodontic Therapy
Happens During Nonsurgical Endodontic Retreatment?
local anesthetic will be given. A sheet of latex called the
"rubber dam" (we've got nonlatex ones too) will be placed around
the tooth to isolate it, hence keeping it clean and dry during treatment.
The treatment consists of three or four basic steps, but the number of
visits will depend on your particular case. Many treatments take 2
visits but some are just a single visit. Occasionally 3 appointments
are needed. In any case, it depends on the degree of
infection/inflammation and degree of treatment difficulty. To me, it's
more important to do it the very best we can then to meet a specific time
criteria. Let's look at the basic steps for nonsurgical retreatment
Filling Materials Removed and Root canals Cleaned
Filling Materials Removed and Root canals Cleaned
Complete with Buildup
complicated canal anatomy, decay is found internally or restoration is
broken, the crown may be removed.
Restorative materials must be removed for access to the root canals.
the canals are unusually narrow or blocked preventing treatment to the
tip of the root, sometimes endodontic surgery is still needed.
the crown was removed, a new crown or other restoration will be placed
by your general dentist.
What kind of
Materials are placed in the process?
The resulting space inside the center
portion of your tooth is filled with a rubber like material (gutta percha)
and cement (zinc oxide + eugenol) to seal the root canals in vast majority
of cases. In a few special cases, the root canal space may be filled
with mineral trioxide aggregate (MTA) or a plastic resin . If a
filling is placed to restore an area, it will NOT contain amalgam but
usually one or more of the following: composite/glass/resin ionmer (glass
and organic acid +/or plastic resin), MTA (portland cement), +/or zinc
What if I have a
Temporary placed after treatment?
a temporary is placed after completion of treatment, it is imperative
to return to your restorative dentist for treatment. Because
a temporary filling is designed to last only a short time (about four
weeks), failing to return to your dentist as directed to have the
tooth sealed permanently with a crown can lead to the deterioration of
the seal, resulting in decay, infection, gum disease and/or the
premature loss of the tooth with additonal treatment required like
another retreatment or extraction. If your temporary comes
out, it needs to be replaced right away. You've invested in
maintaining the tooth, so return to your restorative dentist as soon
as possible (within a month)!
I need to return to your office for Additional Visits?
therapy is completed your tooth should be examined periodically,
usually every 6 - 12 months. This allows us to make sure the
tooth has healed or is healing properly. You will be sent a
notice in the mail when we feel it is appropriate to reevaluate the
area. Since an abscess may take 2 years to heal, our office will
reevaluate the tooth for at least 2 years
tooth with "Abscess"
years after treatment
do I know the Retreatment Procedure will be Successful?
are, of course, no guarantees. Nonsurgical retreatment of endodontic
therapy has a good success rate. Typically somewhere between 50 - 85%
with 70% being common! Dr. Joseph Dovgan will discuss with you the
chances of success before any endodontic procedure to help you make an
Nonsurgical Retreatment the best option for Me?
The decision to retreat should
be made by you, your dentist and your endodontist such as Dr. Joseph
Dovgan. Most of the time I will suggest which treatment option is
recommended and appropriate for you. While retreated teeth can
last a lifetime, there is no guarantee that treatment will be more
successful the second time. The treatment option for any particular
patient must be chosen on an individual basis.
much will retreatment cost?
The cost of retreatment varies
depending on the complexity of the procedure. It will probably cost
more than the initial procedure, because it is more complex then the
initial treatment frequently requiring more time searching for
problems that may have caused the initial treatment to fail..
Also, your restoration may have to be removed before the second
treatment can begin and replaced after retreatment potentially at an
Insurance pay for Endodontic Retreatment?
||Most insurance plans do cover
endodontic retreatment but with some limitations. Each
insurance plan is different, however. As a patient in our office, we
offer the courtesy of calling and confirming your insurance.
We will also inquire about it's coverage of endodontic procedures.
are the Alternatives?
alternatives to retreatment are having the tooth extracted or having it
treated surgically, if the root cannot be
accessed through the crown. If the tooth is extracted, it must be replaced
with a bridge, implant or removable partial denture. This will restore
chewing function and prevent adjacent teeth from shifting. Generally,
nonsurgical retreatment and restoration of your natural tooth is the least
expensive option. Your dentist will be happy to discuss the various
treatment options and their costs with you.
Will the tooth need
any Special Care?
||You should not chew or bite on the
treated tooth until you have had it restored by your general dentist
because your tooth could fracture. Otherwise, just practice good oral
hygiene - brushing, flossing and regular checkups and cleanings.
Endodontically treated teeth can last for many years, even a lifetime.
causes an endodontically treated tooth
need additional treatment?
||Periodontal disease or gum disease
can require the need for periodontal procedures. New trauma, deep
decay, or a loose, cracked or broken filling can cause new infection
in your tooth. In some cases, there may be very narrow or curved
canals that could not have be treated during the retreatment
procedure. You have 2 options generally, Surgical
Endodontic Therapy and Extraction.
I be able to drive myself home?
||Patients who have had endodontic
retreatment are usually able to drive themselves home. Those patients
that take oral sedative drugs will have to have transportation
arrangements made to and from our office. It is a good idea to
talk to us about this prior to your appointment if your thinking about
Endodovgan.com is provided for information and educational purposes only.
No doctor/patient relationship is established by your use of this site. No
diagnosis or treatment is being provided. The information contained here
should be used in consultation with a dentist and/or endodontist of your
choice. No guarantees or warranties are made regarding any of the
information contained within this website. This website is not
intended to offer specific medical, dental or surgical advice to anyone. Hence,
you should not rely on this information as a substitute for personal,
medical and/or dental attention, diagnosis, and care. Dr.
Dovgan takes no responsibility for the websites that hyperlink to or from
this site, and such hyperlinking does not imply any relationship or
endorsement of those sites.
Joseph S. Dovgan, D.D.S., M.S., P.C.
Practice Limited to Endodontics
10585 N. Tatum Blvd., Suite D-132
Paradise Valley, Arizona 85253 USA
"Where caring, skill, will and technology intersect while striving for endodontic excellence."
Serving Phoenix, Scottsdale & Paradise Valley, Arizona
Copyright 2000-2004 Joseph S. Dovgan, D.D.S., M.S. All rights reserved.
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