Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

March 16, 2009

Cracked root and other problems with root canal tooth

Filed under: Root canals — mesasmiles @ 6:00 pm

Dr. Hall,

I had a root canal and gold crown on tooth #14 (upper left molar) many years ago. A few years ago I began to feel pain and went to an endodontist. He discovered a fourth canal and treated it. A few years later, I developed an abscess and went back to the same endodontist who performed an apicoectomy. At the time he gave me the odds of success and mentioned problems could occur if among other things, there was a cracked root. I developed another abcess shortly afterwards and he sent me to a periodontist who discovered a cracked root. Since I did not want to lose the tooth and there was already considerable money invested in it, he amputated the cracked root and did a bone graft. Now, about 9 months later, I have developed another abscess and have severe tooth pain in the same tooth. And it is tooth pain, not tissue pain. The plan now is to take antibiotics and go back in a week to see if he can discover the cause of pain in this tooth. He says one possibility is to return to the endodontist for retreatment of the root canal. Both doctors are highly respected and recommended and I believe they are very competent and I have faith in both. I am wondering if it is possible to have yet another “undiscovered” root branch or other reasons why why retreatment might be needed on this tooth. I was under the impression that once a canal is cleared of its contents there should be no pain. And I’m wondering if there are other (maybe systemic) reasons for the recurrence of abscesses.

I’m interested in any insight you might have about this situation and thank you in advance for your thoughts.
– Stephanie from Nevada

If it were my tooth, I wouldn’t go back to have the root canal re-treated. Again?

Now I am one of the biggest advocates of saving teeth that there is. I have saved teeth that were unsavable, and had three research articles published about saving teeth that over 95% of dentists think are unsavable. But I think you would be best off in this case with a dental implant. That’s my opinion.

It appears probable that when this tooth started hurting again several years after the original root canal, that no one ever discovered what was really wrong. A lot of times, with root canal treatments, the diagnosis is guesswork. It’s probability. You can’t see cracks in a root–even on x-rays. You can’t see leaky canals. And that’s why your endodontist gave you “odds of success.” You tried your odds, and the tooth didn’t make it. And what that means is that no one really knows where the problem is. It could be that every one of the roots is cracked.

Now if you’re fine with undergoing all this treatment when your chances of success are maybe one out of ten, then go for it. But dental implants are an excellent tooth replacement treatment with a much, much higher chance of success.

My opinion.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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