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 Diagnosing an Endodontic Problem

 Cracked and/or Fractured Tooth?

 What are my Options if I need Endodontic therapy (Root Canal)?

 Nonsurgical Endodontic Therapy (Root canal)

 When Nonsurgical Endodontics (root canals) are Unsuccessful

 Nonsurgical Retreatment of Endodontic Therapy

 Surgical Endodontic Therapy

 JD's Guidelines for Chosing an Endodontist

 Do I Need to be Refered to your Office?

 

 

Nonsurgical Retreatment of Endodontic Thearpy

'Redo of a Root Canal' or

'Root Canal Retreatment (Retreat)'

 

When is this procedure done?

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!

 

Incomplete 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.

 

The Anatomy of a Tooth with

Previous Unsuccsessful Endodontic Therapy

What Happens During Nonsurgical Endodontic Retreatment?

or

What is Retreatment?

 A 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 endodontic therapy.

The Retreatment Process

Step 1

Step 2

Step 3

Step 4

Crown Opened

Buildup Removed

Post Removed

Canal Filling Materials Removed and Root canals Cleaned

Canal Filling Materials Removed and Root canals Cleaned

Retreatment Complete with Buildup

If complicated canal anatomy, decay is found internally or restoration is broken, the crown may be removed.

Complex Restorative materials must be removed for access to the root canals.

If the canals are unusually narrow or blocked preventing treatment to the tip of the root, sometimes endodontic surgery is still needed.

If the crown was removed, a new crown or other restoration will be placed by your general dentist.

 

Step 1:  A opening is into the restoration and the build up material from the previous endodontic therapy is removed.  If a post is present, it is exposed for removal.  A microscope can be very helpful during this part of the procedure since it allows substaintially better vision.
Step 2:  Post and other intracanal obstructions are removed.  Typically, either a post remover or an ultrasonic handpience is used to vibrate the post lose.  Sometimes both are used in more challenging cases.

Step 3: The old root canal filling material is removed sometimes with the help of a softening agent.  Tiny instruments are used to clean the root canals and to shape them to a form that will be easy to fill.   Instruments are worked to the very tip of the root if possible and widen the canal to remove debrie along the walls which may have been missed with the initial treatment.   Irrigants are used to disolve and flush debrie.  If this step is not completed in one visit, medication will be placed in the canals and a temporary will be placed in the opening to protect the tooth between visits.  X-rays are taken periodically during the cleaning process to check if the instruments are cleaning near the end of the root.

Step 4: When thoroughly cleaned the root canals are filled with a rubber like compound called gutta percha.  A cement is also used to help seal the canals to prevent bacteria from reentering.  In many cases, the opening in the crown of the tooth is sealed with a temporary filling.  Sometimes by request of your dentist, or when we feel it's appropriate, the access opening in the crown is filled with a build up restoration as pictured.  The restoration is matched for color if possible.  After endodontic treatment, X-rays are taken to verify that cleaning and filling of the canals is close to the end of the root

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 oxide/eugenol.

What if I have a Temporary placed after treatment?

If 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)!

Will I need to return to your office for Additional Visits?

Once endodontic 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

Immediately after treatment

on tooth with "Abscess"

2 years after treatment

with complete healing

How do I know the Retreatment Procedure will be Successful?

There 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 informed decision.

Is 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.

How 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 additional cost.

Does 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.

What are the Alternatives?

The only 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.

 

What causes an endodontically treated tooth

to 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.

 

Will 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 oral sedation. 

 

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Disclaimer: 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
480-483-9001

"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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