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 StoryJanuary 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!
Think you’re already an endo expert? Take my Endodontic Know-How Quiz to put your endo knowledge to the test and find out which areas could use some improvement.