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When considering performing root canal re-treatment, we must first consider why the original treatment failed. Failure of root canal treatments can occur when ideal technical standards for control of the root canal infection are not achieved. Sometimes, extra-radicular infection may prevent a successful treatment outcome. Teeth with post-treatment peri-apical infection can be managed by either non-surgical or surgical root canal re-treatment, both of which aim to restore health to the peri-apical tissues and prolong the survival of the tooth in the oral cavity.
CPD/Clinical Relevance: Examples of different clinical circumstances that were considered for root canal re-treatment are presented.
Article
Before deciding whether root canal re-treatment is warranted, we must first consider why the original treatment may have failed. Root canal treatment is ultimately the management of a bacterial infection,1 and post-treatment disease can be managed when the causative factors are eliminated or controlled.2 When root canal treatment is performed adequately, healing of the peri-apical lesion usually occurs with a gradual reduction and resolution of the radiolucency on subsequent examination.3 Root canal treatment may not always succeed, however, and patients may request re-treatment to resolve persistent infection4 or other reasons, such as a cyst, foreign body reaction, residual infection, or new infection.3 Root canal treatment failures are associated with clinical procedures that have not reached a satisfactory standard for managing or eradicating bacterial infection,5 resulting in an inflammatory process in the peri-apical tissue of the affected tooth.6 Unsuccessful root canal treatments may be attributed to both technical and biological failures, which include infection/re-infection/cyst formation/foreign body reaction, etc. Technical failures may include aspects of treatment procedures that failed to achieve the intended objective or fell short of the accepted level of care. Biological failures are associated with an inflammatory process in the peri-apical tissues and bacteria persisting in the root canal system. Less often, bacteria established outside the root canal may cause the post-treatment apical periodontitis.7 Either way, bacteria residing in the root canal system and/or micro-organisms in the peri-apical tissue compartment support this pathological process8 and undermine the treatment from achieving an ideal outcome.9
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