Imagine you treat a tooth, but your patient comes back complaining of ongoing problems. This has probably already happened to you. I know it’s happened to me! When considering a previously treated tooth, “retreat” shouldn’t have to be a dirty word.
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.
I’ve had to perform second treatments on some of my own root canals, and I am not ashamed to admit it. It’s how you handle it that matters.
Here is a case that was done by an endodontist which was self-referred by the patient, as she wanted a second opinion.
Let’s dive into the case study.
For starters, this root canal is about 2 years old, but the patient had problems from the moment it was treated. She had pain to percussion, and went in and out of flare-ups. Her diagnosis was Previously Treated #19 with Symptomatic Apical Periodontitis.
The root canal looks well done, but there’s still a lesion. She was referred for an extraction by her endodontist, but that didn’t sit well with her. She was pretty adamant about keeping this tooth (and I mean, that’s fair)!
When I took the CBCT, I instantly found the problem: There was a missed ML canal.
So I explained to the patient exactly what was going on and how I was going to do it differently.
I will say, that canal was very hard to find, and I had to trough a good bit apically in order to find it.
Remember, we’re human.
Now, please don’t get me wrong, I respect this endodontist very much. I’m simply using this as a case study. What I don’t understand (and what I want to shine a light on in this post) is why some clinicians don’t consider retreating their own cases when things turn out incorrectly.
Sometimes my cases don’t feel 100% to my patients, even after I found all the canals! I would never recommend a tooth extraction without retreating it first. You just never know what you may have missed when you take a second look.
Here’s how I handle retreatment.
When this happens, I 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 being able to function on the tooth again. Believe it or not, this works 8 times out of 10!
And if this 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 retreat the tooth for free. That makes for a very happy patient!
So once again, I am here to encourage you NOT to give up on teeth. This patient was elated that she didn’t need to transition to an implant, and you can have positive outcomes for your patients, too. I hope you see the value in these cases, and you are saving more teeth!!
Empower yourself,
Sonia
sonia. there seems to be a lesion on the distal root too. Is that related to the untreated ML? Thanks. Duc
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
A very knowledgeable post 🙂
Could you please tell when do we decide to retreat vs extract? I am always confused…
Thank you!
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
hello, would you have considered retreating without a ct?? most practises near me dont have this available for patients
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
This is great thing to do and great way to think also….!!!!!
Thanks for reading!
-Sonia
Thank you.
-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
Is there a reason you don’t use ultrasound here?
Xiao,
I think now I would use the GW, but at the time, I did not have that technology in my practice.
-Sonia
Which pretreatment files do you use dr sonia?
I like the retreatment files from Dentsply or I just use a Profile at a higher rpm.
-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?
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
How much a preapical radiograph can help in diagnosing a missed canal?
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
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
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
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
John,
Since there is a lesion on the M and D, the success comes from retreating the whole case.
-Sonia