Root canal treatment (RCT) is a commonly done dental procedure. When the cavity is too deep to be restored with filling, RCT is indicated. Even though this is a routine dental procedure, it needs the expertise of an experienced Endodontist to perform it correctly and thoroughly. However, sometimes Re-RCT may be needed when the symptoms persist on a RCT treated tooth.
What is Re-RCT?
A tooth that has been RCT treated can last many years, particularly if it is appropriately restored followed by a crown or capping of the tooth. But sometimes, teeth that have had a root canal treatment can fail to heal or become infected again. This can happen months or years after the original treatment is done.
If a root canal treatment has failed it may be noticeable as the tooth becomes painful, sore and/or a sinus tract (gum boil) may appear with pus discharge. Sometimes, there may be no symptoms at all and the failure of the treatment can be detected on taking an X-ray.
Why is re-treatment needed for the previously RCT treated tooth?
The previous treatment may not have healed the area completely and some amount of infection may still be persistent. So without further treatment, failure of the tooth will happen for the following reasons:
- Incomplete removal of the bacteria in the root canal and hence the infection never subsides.
- Missed root canals.
- Incompletely filled root canals.
- Instrument breakage and non-retrieval of the broken instruments from the root canals.
- Entry of new bacteria into the root canals through broken fillings, crowns or bridge.
- Infection has spread from within the root canal and into the surrounding tissues.
- A reaction to filling materials placed beyond the root canal apex into the tissues surrounding the root.
- Development of cyst at the tip of tooth roots.
How is Re-RCT done?
Steps are similar to the initial RCT therapy. However, single sitting RCT is not recommended in these cases since thorough healing of the root canals with multiple placement of medicaments are recommended.
- The first step would be numbing the area around the tooth with a local anesthetic.
- If there is a permanent filling in the tooth crown, a small access cavity is made through this. If there is a bridge or a crown on the tooth, this may need removal to gain easy access to the root canal filling. Sometimes this may be possible by keeping the crowns or bridge intact.
- Then the previous root filling is removed to allow any infected parts of the root system to be accessed, cleaned and irrigated thoroughly. Any other complications which were previously missed or not taken care of such as missed canals, blocked canals, broken instruments can be addressed at the same time.
- Once the root canals are as clean as possible, medicaments are placed in order to heal the area. This step may be repeated 2-3 times till complete healing is observed.
- X-rays are repeated to cross-check the treatment progress and only if satisfied with the healing progress the root canals are refilled and covered to protect them from further bacterial infection.
- As soon as the Re-RCT is complete, a permanent restoration is placed. During this time, it is important to reduce the time of temporary restorations as these will again allow the bacteria to re-enter into the root canals and cause re-infection.
- Crown may be indicated in most of the cases in order to provide extra support that the tooth needs.
What will happen if I do not get the tooth re-treated?
The infection may become severe and we may not be able to save the tooth and ultimately, extraction would be the only option.
Remember, carrying out Re-RCT can give a tooth a second chance.
So when in doubt, do get a consultation done by Dr. Anitha Alageshan from Zen Dental and Health Care.
For appointments, call us at: 080-48655431
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