Non-healing after RCT

Jun 24, 2014   //   by Bituin   //   After Care  //  No Comments

Fortunately for everyone, most root canals heal with about a 95% success rate. Five (5%) percent of the procedures result in failure for a variety of reasons, some of which are unpredictable. A sign of failure is when, after the procedure, the tissues around the root remain infected and so does the inside of the tooth.

Be aware that this is not an exact science — it is a medical procedure and all medical procedures do not heal 100% of the time, including root canals.  Sometimes, pain after a root canal can be difficult to diagnose.  Typical symptoms are tooth pain (mild too severe), swelling or soreness in the gums in the area surrounding the tooth.  Sometimes other complications arise like a new infection without symptoms or warning.

Typically, the non-healing is caused by one of two things:

1.  Inflammation– The inflammation may be from the tooth being inflamed prior to treatment, or the treatment itself may elicit more inflammation.  Usually time and medication can resolve this.

2.  Infection can be from three main causes:

  • a. There is an extra canal in the tooth beyond what would normally be expected.  There can be extra canal branches deep in the pulp system of a tooth that can be difficult to detect or even impossible to reach with a dentist’s instruments.  A hidden, unattended branch could remain dormant and a constant source of infection.
  • b. There may be an obstruction that prevents the dentist from cleaning the entire canal of your tooth or problems in getting the filing instruments to move around curves.
  • c. A small, existing crack at the root of the tooth if undetected, will permit the ingress of bacteria and re-contaminate the tooth.
  • d. Gum Disease: The treated teeth are not completely resistant to tooth decay or gum disease so the tooth might be lost if proper oral hygiene is not maintained. If patient doesn’t maintain good oral hygiene, then abscess can occur years after root canal treatment and dental crown.
  • e. The original infection persists.  Certain bacteria are very resistant in nature.  Even though the pulp and/or infection of the tooth were removed, the infection may persist from surrounding tissues or outside the tooth failing to totally drain.
  • f. Although about 95% of root canals cause very little to no discomfort after the treatment is completed, there are about 5% of cases which can cause significant pain.  These are commonly referred to as “flare-ups.” They mostly occur on badly infected teeth, teeth that are extremely irritated, or teeth that have a history of prior treatment. Sometimes, however, they occur randomly, even on patients that have had several root canals done previously without any problems.   If you have a flare-up you may experience moderate to severe pain, swelling (can get as large as a golf ball), bruising, throbbing, and general discomfort, which usually begins a few hours after treatment and may last 2 to 3 days.  Please contact our office if you experience any of these symptoms and we will do everything we possibly can to get you some relief.

If the non-healing is due to infection, usually time and antibiotics will resolve this. If signs or symptoms persist, there are three options:

  • a. Retreatment may occasionally be necessary
  • b. Surgically clean the bone that surrounds the root tip and seal the tip of the root

Success rate of root canal treatment is not as high as root canal treatment done for the first time.   In the case of a failed root canal, the chance that a re-treatment or surgery will succeed is going to be 50% to 75% at best, depending on what is wrong.

  • c. If re-infection occurs after root canal re-treatment, then tooth extraction may also be required.

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