Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

March 7, 2018

Can a root canal treatment be re-done a second time?


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Dr. Hall,
I have a tooth with a root canal that has been redone once, nine years ago. the tooth is bothering me again. Can the root canal be redone more than once?
– Jodie from Ohio

Jodie,
A root canal treatment can be re-done twice, three times, whatever, but that’s not the question. The question is whether or not that makes sense as a treatment.

Root canal treatment is one of the less predictable treatments in dentistry. It is accepted that even when the dentist has done everything right, there could be a failure rate of 5-15%, maybe more if the dentist is less skilled at this procedure. Let me explain the reason for this.

The living tissue inside your tooth is the pulp. There is a pulp chamber up in the crown of the tooth and a pulp canal that conducts the blood supply and the nerve to this pulp chamber. When the pulp becomes infected, the chamber and the canal have to be cleaned out and sealed against any bacteria re-entering the tooth. The problem is that the pulp canal can have branches and twists and turns inside the tooth that can, in some situations, make it difficult or even impossible to full clean out and seal. For example, in a molar, the standard number is three canals—one for each of the three roots. But often there is a small, difficult-to-find fourth canal. Furthermore, sometimes some of the canals can split off into branches at right angles. The dentist has tiny, highly flexible files that he or she inserts into the tooth and cleans out the infected tissue. There is no way this file can be manipulated to enter a side branch that comes off at a right angle.

Now these anomalies occur in a small minority of teeth, so the large majority of root canal treatments are successful. If a root canal treatment fails, re-treatment can remedy the situation, but only in somewhere around 50 to 75% of the cases. But if that re-treatment was done by a dentist skilled in root canal treatment and didn’t work, there’s a pretty slim chance that it will work if tried again.

There is another option, and that is root canal surgery. The dentist, most likely a root canal specialist, will make an opening in the bone and cut off the root tip of the infected tooth, and probably do a small filling at the end of the tooth to help ensure that it is sealed. This is called an apicoectomy and retrofill. If a root canal re-treatment has failed, this is usually the next best option and will be successful again in somewhere around 50 to 75% of the cases. Furthermore, some roots of some teeth are not surgically accessible or are in locations that would make surgery very risky, such as near the nerve that goes to the lower jaw and lip.

Another option is extraction. This isn’t the first choice, for sure, but some teeth are simply not savable.

– 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.

May 13, 2011

Gum inflammation after porcelain veneers – a big red flag.

Dr. Hall,
I got 8 veneers in December of 2010. My gums continued to be tender and slightly inflamed for several weeks and I asked my dentist if this was normal. He looked at my gums and told me I just wasn’t flossing my teeth with good enough technique, and that was why my gums were inflamed.

Then at the beginning of March, I noticed a fistula above tooth #10 so I contacted my dentist immediately. He took x-rays at that time and told me I have a root canal and needed it treated ASAP. He brought another dentist into his office to do the root canal treatment, so I assumed that the dentist was an endodontist. The root canal treatment took 4 hours and my gums remained inflamed for 3 weeks (fistula still there). When I went back to the dentist with my concern, he then told me I needed an apicoectomy. At this point I asked if the dentist who had performed the failed root canal treatment was an endodontist, and when I found out it was a general dentist I decided to seek out a second opinion from someone else.

I went to Dr. —– (a dentist on the mynewsmile.com referral list), who has referred me to an endodontist who is “the best.” Dr. —– told me that most likely the area will heal on its own and there is no need for an apicoectomy. He said my gums were inflamed because there was cement on the veneers that was causing my gums to stay chronically inflamed! After Dr. —– scraped that cement off, it has only been a few days and already my gums are less tender than they’ve been in months.

Now I’m really concerned that some major mistakes were made with my veneers because the dentist did no wax-up and was not able to address any of my concerns with the esthetic look of the veneers after the procedure. (One tooth appears chipped, and the dentist told me it was “just the anatomy of the tooth.” Another tooth feels like it is cracked. And I’m not completely sure if the teeth are all completely vertical because they look slightly slanted or off-centered. They definitely look better than my teeth looked before getting the veneers, but I can’t say that look perfect or absolutely stunning. They just look like normal teeth.)

Basically, I want my money back for what he did to my teeth! It sounds like he was negligent in leaving concrete on the veneers, which caused my gums to remain inflamed. And then he did NOTHING when I told him that my gums were red, sore, and inflamed until it was too late. And then he was negligent again by bringing a general dentist into his practice to perform a root canal. According to Dr. —–, the x-rays show that the dentist did an “overfill” on the root of tooth #10 and this was why he was wanting to do an apicoectomy. Is there anything I can do to get my money back for these chipped, cracked veneers which caused me to have a root canal?
Jamie from Southern California

Jamie,
You have quite the interesting story. You’re a good example for people looking for smile makeovers – showing the need for an expert cosmetic dentist. I wish I had money to run ads on TV warning about that.

When you told me your dentist’s answer to your gum inflammation was that you should floss more, I knew you were in trouble. For anyone doing porcelain veneers, this is a huge red flag and is a big indication that the dentist did something wrong. One of the criteria I use to evaluate the cosmetic dentistry of dentists I list on this website is the health of the gums in the “after” photographs – they should be at least as healthy afterwards as they were before, if the work is done right.

Here’s the deal for your case. To get any satisfaction, you’re going to have to be willing to make the dentist worry that you’ll be trouble for him. I’m sorry to have to put it that way, but I’m basing this on the way he has treated each of your complaints so far – dismissive, not truthful. He needs to worry that this could turn into a peer review case, or could get to the dental board, or could result in a malpractice action. And if you can get him worried about this, that is what will motivate him to refund your money.

And then you need to realize that your esthetic complaints won’t go very far. Since cosmetic dentistry isn’t a legally recognized specialty, the standard of care for esthetic work is the level of quality that would be expected of an average dentist, which is pretty low.

But you do have two areas of common negligence – the cement left behind, which caused gingivitis, and the root canal overfill. Both of these caused pain and suffering, and have threatened the health of your teeth. So you need to let him know that you are aware of these problems, and also let him know that you have another dentist to back you up on these claims. If you were to bring an action against this dentist, having another dentist willing to testify to the negligence is necessary. I wouldn’t reveal the name at this point, but I would let him know that you have that “arrow in your quiver.” And the fact that a general dentist did the root canal is not of itself a problem. Many general dentists do great work with root canal treatments, especially on front teeth, which are pretty easy. But there does seem to be an issue of competence with the dentist taking four hours to do a root canal that should have taken half an hour.

So I would tell this dentist that you have been to an expert cosmetic dentist, a dentist of international prominence, who told you that he had been negligent, but that you want to make it easy for him, so all you’re asking for at this point is a refund.

I hope this is helpful.

I’d be interested to know how this turns out. Please write back and let me know your next step and what your dentist says.

Links:
Click here for a referral to a cosmetic dentist.
Click here to ask the dentist a question.

 

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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.

December 10, 2010

Healing after root canal apicoectomy.

Filed under: Root canals — Tags: , , — mesasmiles @ 9:52 am

6 weeks ago I had an “apico” done to remove infection from tooth that had both a crown and root canal. Check up this morning revealed bone was starting to rebuild, xray looked clear of infection but small pus sac on gum looked like it may have some residual infection. They gave antibiotic to take for week. Is there anything that I can do to further get rid of this residual infection?
– Ruth from Illinois

Ruth,
With any root canal treatment, including an apicoectomy like you have had, or any other apical surgery, if the dead tissue from the tooth is removed and if there is a good seal at the end of the root of the tooth, the tooth will heal and the infectiion will eventually go away. Antibiotics can speed the healing, but they key to eventual success of the case has nothing to do with antibiotics – it’s all about removing the source of the infection.

From what you’re telling me, it sounds like the bone around the tooth is healing. That would tend to indicate that the source of the infection has indeed been removed and the tooth is adequately sealed. If that is the case, the residual infection will go away eventually. The antibiotics you are taking will speed that along. There’s nothing else to do, really, but wait.

Dr. Hall

Links: Read more about dental implants.

We thank our advertisers who help fund this site.

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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