General considerations about the revision (repetition) of a root canal treatment

grafische Wurzelbehandlung Komplikationbelsky

Wurzelbehandlung Komplikationen

The objective of the revision lies in the elimination or prevention of clinical symptoms through a renewed preparation.

Like every medical procedure, a root canal is associated with a high, but nevertheless, limited probability of success. Due to the complexity of the cavity system, possible bacterial contamination of the dental nerves, limitations of available instruments, medications, and treatment techniques, as well as mistakes made during treatment, a root canal may initially be unsuccessful.

The objective of the revision lies in the elimination or prevention of clinical symptoms through a renewed preparation that includes permanently bacteria-proof closing the endodontic system. An exact diagnosis of the cause of root canal failure should be performed prior to the decision to go through with revision, but this is sometimes not possible.

Among the most important causes of root canal failures are:

  • The persistence of microorganisms after initial treatment
  • Untreated root canals or root canal sections
  • Leaky fillings
  • Reactions to foreign bodies

When should a root canal treatment be renewed?

  • Teeth with a previous root canal treatment that show radiological symptoms of a persisting or newly developed infection at the end of the root
  • Teeth with a previous root canal treatment that show clinical symptoms of an infection at the end of the root
  • Teeth with a previous root canal treatment with a radiologically or clinically insufficient filling of the root canal (e.g. insufficient homogeneity of the filling, untreated root canals, areas of the endodontic system that were not filled, questionable and no longer indicated filling materials, etc.), but even without any clinical or radiological indications of an infection at the end of the root
  • Root canal fillings with exposure to the environment of the oral cavity
  • Teeth treated with root canals with progressively developing root resorptions

Contraindications to a Revision

  • A non-endodontic cause of disease
  • The questionable benefit of conserving the tooth
  • If an improvement of the initial condition and the elimination of the possible cause can’t be expected

Sometimes, it makes sense to seal the root canal from the rear. This is referred to as a root end surgery with apex sealing. The decision to perform a purely “apical surgical” procedure rather than a classic root canal only makes sense if sufficient access into the cavity system of the tooth using the classic method is impossible, or if an improvement of the condition appears to be improbable through this method.

In case of purely apical surgical revisions, a bacteria-proof, retrograde root canal sealing should be the goal. More on that in the video "Tooth Root Resection with Retrograde Filling".

Click here to see the video: Root Canal Treatment

This post is also available in: German

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