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Advanced cosmetic and general dentistry

Root canal treatment again?

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In 2014, my dentist did a root canal on an upper right molar. Two months ago, the tooth started hurting, and it’s getting worse. Will I need an extraction and dental implant, or if I see a specialist, can they try a root canal treatment again and prevent an extraction? – Thanks. Noble R. from CT

Noble,

Root canal treatment is one of the least predictable treatments in dentistry. Even if a dentist performs the procedure correctly, it has a 5-15% failure rate.

Can Root Canal Treatment Be Repeated?

Root canal treatment can be repeated multiple times. But it doesn’t always make sense to do it. Still, there is an option before extracting a tooth and replacing it with a dental implant.

Why Causes Root Canal Failure?

Sometimes root canal treatment fails because the dentist could not completely remove the infection from a tooth. Canals in a tooth can twist and turn and make it difficult or impossible for a dentist to clean out the infection and seal out bacteria fully.

The pulp in your tooth contains living tissue, nerves, and blood vessels. A pulp chamber is in the crown of a tooth, and a pulp canal conducts blood supply and nerve in the chamber. If tooth pulp is infected, a dentist will clean out the chamber and canal and seal them to prevent bacteria from entering the tooth.

Molar teeth usually have three canals for each tooth root. But sometimes a tooth has a fourth canal that’s difficult to find and clean. Some canals have branches at right angles. A dentist has tiny, highly flexible files to insert in the tooth and remove the infected tissue, but the files cannot enter a side branch with a right angle. Although a minority of teeth have fourth canals and challenging angles, sometimes fourth canals exist and retreatment is needed. Retreatment has a 50 to 75% success rate. But if retreatment is completed by a dentist who is skilled in root canal treatment and it fails, a third treatment is likely to fail.

Root Canal Surgery

Root canal surgery is a procedure that enters the tooth through the root instead of the crown. A root canal specialist, or endodontist, performs root canal surgery, or an apicoectomy. The treatment is 50 to 75% successful. The specialist will take the following steps:

  • Make an opening in the bone
  • Cut off the root tip of the infected tooth
  • Place a small filling at the end of the tooth to seal it

But even with an apicoectomy, a specialist sometimes can’t access tooth roots, or a root’s location—such as near a nerve in the lower jaw and lip—makes surgery risky.

Extraction Instead of Repeat Root Canal Treatment?

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Repeat root canal treatment is an option before extraction and a dental implant

An extraction is an alternative to repeat root canal treatment. Although it’s not the first choice, sometimes even a specialist can’t save a tooth, and you’ll need an extraction and dental implant.

Schedule a follow-up appointment with your dentist to discuss your options. You can compare your dentist’s recommendation with a second opinion from a root canal specialist.

Michael Szarek, DMD, a Lowell, MA, cosmetic dentist, sponsors this post.

Three Causes of Root Canal Failure and How Your Dentist Might Treat It

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My top right upper molar is sore. I had a root canal on the tooth in 2002. I first noticed slight pain about two months ago, but now the pain is more frequent and is intense sometimes. Yesterday I saw a small sore on my gum. Pus was coming out of it in the afternoon, and at the same time, the pain was more intense than usual. I’m afraid that I’m going to lose this tooth and need a dental implant. I’m hesitant about going to the dentist in the middle of a pandemic. Is there anything I can do at home to help the tooth until I’m comfortable going to the dentist? Thanks. Jordan from Richmond, VA

Jordan,

The root canal you received in 2002 failed. And that’s not normal. Root canal treatment doesn’t fail over time. Something caused it to fail.

Causes of Root Canal Failure

  • Tooth not completely sealed – If the dentist who completed the root canal treatment didn’t fully seal your tooth, bacteria can leak in, infect the tooth, and cause significant pain.
  • Untreated canals – Some teeth have canals that, without careful observation, go unnoticed. If the dentist doesn’t remove the infection from all the canals, it can linger and cause future problems.
  • Cracked root – A cracked tooth root is painful. If a dentist can save your tooth, you’ll need some form of endodontic treatment, and the tooth will be protected with a new dental crown.
Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Dental implants fuse with the bone to provide stability.

We recommend that you schedule an appointment with an endodontist or specialist. After an examination and digital x-rays, an endodontist is skilled at accurate diagnosis or treatment options, including another root canal treatment or root canal surgery. The specialist will also explain the risks and success rates.

If there is a chance of saving your tooth, let the endodontist try to save it. If keeping the tooth isn’t an option, a dental implant is the tooth replacement option that’s closest to mimicking the look and function of your natural tooth.

Accredited cosmetic dentist Dr. Michael Szarek of Lowell, MA, sponsors this post.