Failed Root Canal
Can a root canal fail?Recently a patient needed a root canal on a lower premolar. He had visited a local endodontist (root canal specialist) and seemed to be out of pain. The endodontist sent me an x-ray of the tooth and I was very surprised – about 70% down the root the canal split, and the endodontist could not get past that point. So it appeared to be a failed root canal. The remaining canal had not been thoroughly cleaned out (which is what happens in a root canal). Sometimes you can get lucky with this and sometimes you can’t.So if this patient has a problem, what am I to recommend to him?
Possible Treatment for Failed Root Canals
My first choice would be to send him to another root canal specialist. Another one may have more luck negotiating these difficult canals and can get rid of the necrotic (dead) material inside the canals. But that may be impossible because of ledges placed inside the canals from the first failed attempt.Another possibility is to do an apicoectomy. This is a procedure where the end of the root is cut off and a filling material placed at the end. Depending on the location and anatomy of the area of the tooth, this can be difficult. For this patient, there is a nerve that comes out of the jaw in that area and may be quite challenging to accomplish.The last resort is to have the tooth extracted. And after that, the dentist will give the patient an option on how to replace the tooth. In 2020, the recommended choice is to have a dental implant placed for this purpose. We still do dental bridges where the teeth on either side of the space is crowned and will support a missing tooth.
Fortunately, the failed root canals are rare, especially with specialists who perform only root canal procedures in their practice.