A root canal is a procedure designed to save a tooth whose pulp has become infected or inflamed. The process involves cleaning out the infected material from the interior of the tooth and sealing the space to prevent further bacterial invasion. While many assume this treatment is a permanent solution, a tooth that has undergone a root canal can develop new problems requiring intervention. When issues like pain or recurring infection arise, the existing treatment can be reversed, or the tooth may need to be removed entirely.
Root Canal Failure and Reasons for Reversal
A tooth may require re-intervention if the initial procedure does not resolve the infection or if new issues develop over time. One common cause is the persistence of bacteria in the highly complex root canal system. This occurs if an exceptionally narrow or curved canal was missed, or if tiny lateral branches retained infected tissue, leading to symptoms months or years later.
Failure can also relate to the restoration placed after the root canal. If a crown or filling cracks, loosens, or decays, oral bacteria can leak back into the sealed system, causing recontamination and a new infection. Furthermore, a fracture in the root itself can render the tooth non-restorable, providing an irreversible pathway for bacteria to enter the jawbone.
Non-Surgical Retreatment of the Root Canal
When a root canal fails, non-surgical retreatment is the first strategy to save the tooth. This procedure involves re-entering the tooth through the existing crown or filling to access the root canal system. The endodontist removes the material placed during the first root canal, which is typically gutta-percha.
The internal anatomy is then meticulously cleaned, often using an operating microscope to locate and treat any previously missed canals or complex branches. The canals are disinfected with specialized solutions, refilled, and sealed with new material to prevent bacterial re-entry. This option is preferred because it preserves the natural tooth structure. Studies indicate that non-surgical retreatment achieves success rates ranging from 78% to 87%.
Surgical Options for Saving the Tooth
If non-surgical retreatment is unsuccessful, a specialized minor surgical procedure known as an apicoectomy can be performed to save the tooth. This approach accesses the infected area from outside the tooth structure, through the gum and bone, rather than through the crown. An apicoectomy is recommended when there is a persistent infection at the tip of the tooth’s root, or apex.
During the procedure, a small incision is made in the gum tissue to expose the bone and the root tip. The endodontist then removes a few millimeters of the root tip, along with the surrounding infected tissue. A small filling is placed to seal the end of the remaining root canal, preventing future bacterial leakage. This method clears the infection and seals the root end when traditional access is blocked by internal posts or calcified canals.
Extraction and Replacement Options
The most literal interpretation of getting a root canal “removed” involves the complete extraction of the tooth. This option becomes necessary when the tooth structure is severely compromised by a large fracture, extensive decay below the gumline, or an infection that failed to resolve after multiple attempts at retreatment and surgery. Once the tooth is removed, the loss of the natural root can lead to a gradual deterioration of the jawbone in that area. Replacing the missing tooth is strongly advised to maintain jawbone density and the alignment of surrounding teeth.
Replacement Options
The most durable replacement is a dental implant, which involves surgically placing a titanium post into the jawbone to act as an artificial root for a prosthetic crown. Implants are favored because they do not rely on adjacent teeth for support and stimulate the bone, reducing loss over time. Alternatives include a fixed bridge or a removable partial denture.
A fixed bridge consists of artificial teeth anchored to the natural teeth on either side of the gap, requiring adjacent teeth to be prepared. A removable partial denture is the most economical choice, using clasps to attach to surrounding teeth. Consulting with a specialist is important to thoroughly evaluate the tooth and determine the most appropriate course of action for long-term health and function.