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BDS(Hons) MSc FHEA FDS RCPS(Glasg) FDFTEd FCGDent GDP
The Dental Practice, 21 Rubislaw Terrace, Aberdeen; Hon Senior Clinical Lecturer, Institute of Dentistry, University of Aberdeen; Online Tutor/Clinical Lecturer, University of Edinburgh, UK.
Both the anatomical challenges of root canal treatment and the variable clinical techniques employed mean that root canal re-treatment will sometimes be necessary. The first of this two-part series aims to discuss why cases may fail, and options for re-treatment. This includes the decision between re-treatment in general dental practice and the need for referral for specialist care.
CPD/Clinical Relevance: Understanding the reasons for root canal treatment failure will reduce the likelihood of failure and enable appropriate assessment when it does happen.
Article
Root canal treatment offers a predictable outcome in the majority of cases; however, some treatments will fail, necessitating further intervention, which may include extraction. This article is the first in a two-part series and summarizes how the outcome of root canal treatment (RCT) is assessed and, in the event of failure, how to determine when re-treatment is the most appropriate option, with a focus on suitability for re-treatment in general dental practice. The second part of the series will provide practical clinical advice and solutions for the management of re-treatment, maximizing the likelihood of success.1
There may several reasons for failure, which can be categorized as technical (procedural) errors, biological factors or others.
Technical errors may occur at any stage of RCT, broadly classified as access, shaping, disinfection, obturation and restoration. Pre-operative assessment by way of a thorough history, examination and appropriate imaging is critical in identifying potential iatrogenic errors (Figure 1). This will enable appropriate planning, and if appropriate, referral for tier 2 or 3 treatment.2
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