Endodontic Information Menu Page

 Toothache and Tooth Pain Guide

 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 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.

Step 1

Step 2

Step 3

Crown Opened

Buildup Removed

Post Removed

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 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.

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)!

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

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.

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.

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