Root canals are generally successful but in a small percentage of cases a second root canal may be required.  This is called retreatment.  A tooth may not heal as expected after initial treatment because narrow or curved canals could not be accessed during the initial procedure; complicated root canal anatomy went undetected; the placement of the crown or other restoration was delayed following the endodontic treatment; the restoration did not prevent bacterial contamination to the inside of the tooth.  In other cases, a new problem can jeopardize a tooth that was successfully treated such as new decay exposing the root canal filling material to bacteria and causing a new infection in the tooth; a loose, cracked or broken down filling can expose the tooth to new infection and a tooth could sustain a fracture. The root canal filling material is taken out and the canal is recleaned, reshaped, and refilled.  In many cases, complex restorative materials such as a crown, post and core material must be disassembled to permit access to the root canals. 

Root Canal Surgery

An endodontist may do surgery when a regular root canal cannot be done or when it has not worked.  Root canal surgery involves making an incision to allow access to the tip of the root.  It is done to check the end of the root for cracks, to remove parts of the root that could not be cleaned during regular root canal treatment or to clear up an infection that did not heal after regular treatment.

Who will do the surgery or retreatment?

All dentists learn to do root canal treatment in dental school but because retreatment and surgery are more complex, your dentist may refer you to an endodontist. 

What are the alternatives to retreatment and surgery?

Most of the time, a tooth that has had a root canal can be saved.  There are unfortunately some cases where all efforts to save a tooth fail and then the tooth must be extracted.  The extracted tooth must then be replaced with a bridge, removable partial denture or implant to restore chewing function and to prevent adjacent teeth from shifting.  No matter how effective tooth replacements are- nothing is as good as your natural tooth.  The options of retreatment or root canal surgery can result in a healthy, functioning natural tooth for many years to come.

For more information please see www.rootcanals.ca and www.aae.org.