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 troubles me is when endodontists feel that their work can never fail. Let me tell you, I don’t care how good you are. You will have to retreat some of your own work.

I have had to retreat 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 that was self-referred by the patient, as she wanted a second opinion.

Let’s dive into the case study.

This root canal is about 2 years old, but the patient has had problems with it ever since it was treated. She had pain to percussion, and she definitely went in and out of flareups. Her diagnosis was Previously Treated #19 with Symptomatic Apical Periodontitis.

The root canal looks well done, but there still is a lesion. She was referred for an extraction by her endodontist, but that didn’t sit well with her, since she was pretty adamant she did not want to lose this tooth.

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 don’t turn out the way they would like.

Sometimes my cases don’t feel 100% to my patients, even after I found all the canals! I would never recommend to extract a tooth without retreating it first. You just never know what you may have missed when you take a second look. We are human!

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. I will tell you that this works 8 times out of 10!

And if this happens within the first year after treatment and the patient did everything that 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 is elated that she is not transitioning 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!!

-Sonia

 

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