For Patients: Pain in an Old Root Canal? Don’t Panic and Consider a Retreatment!
January 19, 2024
What’s Happening in That Tooth? A Middle Mesial Canal Tooth Story
January 21, 2024
Imagine you treat a tooth, but your patient comes back complaining of ongoing problems. This has probably already happened to you. I know it has happened to me! Endodontic retreatment is just a fact of life.
Admittedly, this kind of situation can be uncomfortable. No one likes to hear that they made a mistake or failed to do their job well the first time.
But one thing that really gets on my nerves is when endodontists feel their work can never fail. Look, I don’t care how good you are—you will have to retreat some of your own work! “Retreat” shouldn’t have to be a dirty word.
I’ve had to perform second treatments on some of my own root canals, and I’m not ashamed to admit it. At the end of the day, it’s how you handle it that matters.
Let’s take a look at a case involving a self-referred patient who wanted a second opinion after being treated by her endodontist. There’s a lot to be learned from a scenario like this, so read on and take note!
Case Study: Endodontic Retreatment for a Two-Year-Old Root Canal
When the patient came into my office, her root canal was already about 2 years old, and it had begun causing problems from the moment it was treated. The patient had pain to percussion and went in and out of flare-ups. Her diagnosis was Previously Treated #19 with Symptomatic Apical Periodontitis.
When I took a look at the radiographs, I could see that the root canal looked well done, but there was still a lesion.
The patient’s endodontist had referred her for an extraction, but that didn’t sit well with her. She was pretty adamant about keeping her tooth. (Which I love… #GiveTeethAChance!)
Committed to helping her find an alternative treatment plan, I kept digging to see if there was something we were missing. Sure enough, when I took the CBCT, I instantly found the problem: There was an untreated ML canal.
I will say, that canal was very hard to find, and I had to trough a good bit apically in order to find it. There was some coronal calcification, so I understand why the previous provider had trouble with it.
How I Handle Endodontic Retreatment
When something like this happens, I simply start over. I remove all the gutta percha and medicate the tooth with calcium hydroxide for one month, or until they start to feel better. This is usually indicated by the patient being able to use the tooth normally again. Believe it or not, this works 8 times out of 10!
And if it happens within the first year after treatment and the patient did everything they were supposed to do (like restore the tooth in a timely manner), I do the endodontic retreatment of the tooth for free. This not only makes for a very happy patient, since you’re offering a sort of guarantee for the quality of your work, but it also helps to restore trust in endodontics and the tooth-saving power of root canals!
Takeaway: We’re Human
Now, please don’t get me wrong—I respect the patient’s first endodontist very much. That ML canal was tricky to find.
I’m simply using this as a case study to raise the question of why some clinicians don’t consider doing endodontic retreatments of their own cases when things turn out incorrectly. I personally would never recommend a tooth extraction without retreating it first.
Sometimes it has nothing to do with making a mistake or performing a subpar root canal. There are times when my cases don’t feel 100% to my patients even after I’ve found all the canals and it looks stellar on the radiograph.
Whatever the reason, if a patient is still experiencing discomfort, we owe it to them to reassess. You just never know what you may have missed until you take a second look.
So once again, I’m here to encourage you NOT to give up on teeth! When this patient found out she didn’t need to transition to an implant, she was elated. By trusting the process and believing in your abilities, you can have the same impact on your patients, too.
I hope you see the value in these cases and they’re helping you save more teeth!
Empower yourself,
Sonia
27 Comments
sonia. there seems to be a lesion on the distal root too. Is that related to the untreated ML? Thanks. Duc
hello, would you have considered retreating without a ct?? most practises near me dont have this available for patients
This is great thing to do and great way to think also….!!!!!
Thanks for reading!
-Sonia
Of course you can, but it is so much easier to see the etiology with the CBCT and know exactly what to treat. In my opinion, it gives some predictability to the case.
-Sonia
Thank you.
-Sonia
Duc,
It could be from the ML canal and just spreading over or it could be from the distal canal. It’s definitely hard to tell, so I retreat the whole thing.
-Sonia
Why we need bite wing to be be taken Dr?
It will help you identify referred pain and other potential sources of pain.
-Sonia
Did u use ultrasonic for getting middle mesial canal
No, I typically use a Munce bur. They are my absolute favorite!
-Sonia
Which pretreatment files do you use dr sonia?
Is it a good practice contacting the previous Colleague to discuss this case? What is your approach financially wise to offer a retreatment when, to their mind, the case was finished before?
How much a preapical radiograph can help in diagnosing a missed canal?
A very knowledgeable post 🙂
Could you please tell when do we decide to retreat vs extract? I am always confused…
Thank you!
Hi Sonia,
Thanks for sharing the case- I echo the sentiment! Out of curiosity, what do you do in cases where the patient is still experiencing persistent symptoms following re-instrumentation (i.e. those 2 out of 10 cases)?
Kind Regards,
Vui
very nice !
Brava for finding the additional anatomy distal.Do you not feel that part of the success was atributed to your finding the distal add anatomy? — so finding the add mesial canal was part of the repair?
what is the time lag between X-rays ?
I am sure the pt appreciated the visit
Is there a reason you don’t use ultrasound here?
I like the retreatment files from Dentsply or I just use a Profile at a higher rpm.
-Sonia
Jack,
Unfortunately, I cannot call every provider that leaves a canal untreated, that is 50% of my practice which is unfortunate and why I am on this mission. I have to charge the patient for my time and treatment if they want to save the tooth. I am new to the tooth story and I am happy to help, but the patient does have to pay for the same treatment again, which again is unfortunate.
-Sonia
Marzia,
I think a PA is very limited in giving you the whole tooth story when you are looking for the etiology of root canal failure.
-Sonia
Gauri,
This is a very long discussion and one that I go into great detail in Eschool. I suggest you join the next session in Jan 2022.
-Sonia
Vui,
I usually retreat my cases that still have symptoms after treatment. I don’t give up, some teeth just take time and more cleaning!
-Sonia
John,
Since there is a lesion on the M and D, the success comes from retreating the whole case.
-Sonia
Xiao,
I think now I would use the GW, but at the time, I did not have that technology in my practice.
-Sonia
Sonia: how do you remove gutta percha?
I remove it with a rotary file at high speed with some C solution in the canal.