Endodontic therapy enjoys a high survival rate of 97 per cent when properly performed. With proper care, even teeth that have had root canal treatment can last a lifetime. However, as in any medical procedure, a certain percentage of treated cases will fail. Deciding on whether to pursue re-treatment or not depends on a variety of factors. The patient's needs, age, and clinical expectations are all important considerations. Tooth retention is the best treatment when possible, and re-treatment can ultimately be the most time and cost-effective option. Time, cost, and more flexible clinical management indicate that endodontic re-treatment procedures should always be performed first unless the tooth is judged to be untreatable. If you have pain or discomfort in a previously treated tooth, talk to an endodontist about re-treatment.
As with any dental or medical procedure, healing of the tooth may not respond as expected after initial treatment for a variety of reasons:
• Complex anatomy with narrow or curved canals that were not treated during the initial procedure.
• Secondary decay or new decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
• The placement of the crown or other restoration was delayed following the endodontic treatment.
• The restoration did not prevent salivary contamination to the inside of the tooth.
• A cracked tooth or broken crown or filling can expose the tooth to new infection.
• A complete or incomplete fracture of the tooth.
Whenever possible, it is best to save a natural tooth. Re-treated teeth can function well for years, even for a lifetime. Advances in technology are constantly changing the way root canal treatment is performed. Endodontics uses new techniques that were not available a decade ago. If the tooth has been damaged or infected beyond the scope of repair, alternative option will be discussed with the chances of success before planning any retreatment.
The cost of the treatment varies depending on how complicated the procedure will be. A re-RCT will probably be more complex than the first root canal treatment, because the restoration and filling material may need to be removed, mishaps and obstructions bypassed to accomplish the new procedure.
In addition, the endodontist may need to spend extra time searching for unusual canal anatomy using microscopes and ultrasonics. Therefore, you can generally expect re-treatment to cost more than the initial endodontic treatment.
If non-surgical re-treatment is not an option, then endodontic surgery should be considered. In cases where it’s difficult to perform endodontic surgery, extraction of the tooth and rehabilitation of the edentulous area can always be done. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than re-treatment and restoration of the natural tooth.
No matter how effective tooth replacements are — nothing is as good as your own natural tooth. You’ve already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.
(Dr Prashant is specialist dental surgeon and endodontist at Wassan Specialty Dental Clinic)