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)!
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!!