Failed Root Canal

Changing Your View Of Root Canals

The failed root canal is uncommon. Root canal treatments enjoy a success rate of approximately 95%. This makes root canals an extremely successful and predictable procedure.

Each year millions of teeth are saved with this non-surgical and comparatively simple procedure.
However,  the failed root canal does occur.

As an endodontist (root canal specialist) the past 20+ years I've seen patients' frustration in understanding what went wrong and what to do about it.

Let's take a closer look at the rare but frustrating root canal failure.

The Failed Root Canal

• Causes 
• Signs and symptoms 
• Treatment options 

Causes: Many times it is impossible to determine why a root canal treatment fails. A root canal infection can occur when the root canal appears to be perfect on the x-ray.

Here are some of the possible causes of a failing root canal:

1. Tooth anatomy. Sometimes there can be extra roots or extra root canals within a tooth. For the most part, teeth are very predictable. For instance, a front tooth usually has one root and one root canal space within that root.

However, sometimes a front tooth (especially a lower one) may have two root canal spaces in the one root. If this extra canal is not cleaned and filled there will be a failed root canal.

2. Fractured root. This is probably the most common reason that a root canal fails. I wrote about the fractured tooth in The Relaxed Root Canal.

3. Stubborn bacteria. Health care professionals are increasingly faced with antibiotic-resistant bacteria. This can result in a root canal infection not healing properly.

4. Incomplete treatment. If the root canal space is not adequately cleaned and filled the root canal treatment will not be effective. You may have a sensitive tooth that never improves if this occurs.

Signs and Symptoms: These may occur soon after the root canal treatment has been completed or many years later. Some of the more common ones are:

  Post root canal pain. Some discomfort is to be expected following a root canal procedure. If pain doesn’t resolve or returns some time later there may be a problem with the root canal treatment. Typically the pain will occur either spontaneously or when biting on the tooth.

  Swelling in the gum or jaw. There are other causes for swellings and you should be examined by your dentist as soon as possible.

  Appearance on x-ray. You may not have any pain or swelling but still have a failed root canal. In these cases your dentist may be able to detect the problem on a dental x-ray.

Treatment options: A failed root canal is frustrating for both the patient and the dentist. Saving the tooth becomes much more challenging. Here are the options:

1. Root canal retreatment. An opening is made through the tooth or crown. Sometimes the crown has to be remade but oftentimes it can be saved.

The root canal filling is removed from the canals. The root canal spaces are then re-filled. A permanent restoration is placed in the opening or a crown is made.

Many teeth are saved with retreatment procedures. However, the prognosis is lower than when the root canal is done the first time.

2. Apicoectomy. This is a root canal surgery procedure. It is indicated when retreatment has been unsuccessful or retreatment isn’t feasible.

The latter is usually true when the root has a post that cannot be safely removed. The procedure involves making an incision in the gum and reflecting the gum tissue away from the tooth.

The root canal infection is then cleaned from the surrounding bone. Many times the end of the root will be removed and a small filling placed in the tip of the root. Sutures are then placed to close the incision.

3. Extraction.  Dentists never like to extract a tooth. However there are those few teeth that cannot be saved with root canal treatment. Your dentist will advise you on this and may recommend replacement of the extracted tooth with an implant or bridge.

Although root canal treatment has evolved tremendously over the years and the failed root canal is rare, fear still remains.

Much of this fear is the result of misinformation and confusion about root canal treatments.

I’ve answered over 80 questions in The Relaxed Root Canal. You can read more about it by CLICKING HERE.

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