The only realistic alternative is pulling the diseased tooth and replacing it with a bridge, implant or partial denture. Fortunately, a root canal procedure almost always saves the tooth and permits it to remain in place for the remainder of the patient’s life. More than 95% of all procedures are successful.
Unfortunately, things do occasionally take a wrong turn despite the dentist’s best efforts. Remember, the procedure includes the removal of the tooth’s nerve and pulp. The resulting hollow area inside the tooth (the “root canal”) is then cleansed, sterilized and sealed. Along with taking out all the damaged, unhealthy nerve tissue, your dentist will attempt to remove all the bacteria, toxins and other contaminants existing within the tooth. The hollow space once occupied by the nerve is then filled in and sealed off so that bacteria and other irritants are unable to occupy any physical location that is beyond the reach of your body’s natural defenses. Sometimes, though, the original infection flares back up or a new infection of the tooth begins. There are a few reasons why this might occur:
- A tiny crack in the root of the tooth may have gone undetected and now provides an entryway for bacteria and other contaminants;
- The shape of a root canal can vary greatly from patient to patient, and some shapes are more difficult for the dentist to thoroughly cleanse;
- If more than the anticipated number of root canals (or unanticipated forks or branches of the same root canal) are within the tooth, your dentist might have inadvertently skipped cleansing one of them;
- The dental restoration (a crown, for example) applied after the root canal procedure may fail and allow bacteria to re-enter the inner cavity of the tooth (we address this particular process, known as “coronal leakage,” in more detail in a separate article); and
- The sealant used in the procedure may degrade and fail over time, once again allowing bacteria to contaminate the root canal.
The procedure is considered a failure if the treated tooth continues to harbor bacteria or contaminants which cause inflammation of the tissues surrounding the root of the tooth. In some cases, root canal complications can exist without any symptoms, even though dental X-rays reveal signs of inflammation. In other cases, the patient might experience tooth pain and/or gum swelling or tenderness.
If your root canal procedure fails, a second treatment might be appropriate. In some cases this repeat treatment succeeds. In other cases, however, a second procedure may not be possible. Even if it is, however, the second treatment might also fail. Only a couple of options remain if you’re in this situation: extraction of the tooth or endodontic surgery to try to save it.
A root-end resection (called an “apicoectomy” by endodontists) is the most common type of endodontic surgery performed if a pocket of infection remains in the bone following a procedure. During this procedure, which is almost always performed by an endodontist or oral surgeon, he or she will make a small incision in the gum around the tooth, remove the infected tissue (and in some cases, the tip of the root) and then sterilize the area. A small filling is sometimes placed to seal off the tooth’s root canal. Apicoectomies are not performed very often, but they boast a high success rate.
In fewer than 5% of all root canal procedures, within three days the tooth becomes painful and the surrounding gum may swell and become tender. This complication is caused by bacterial toxins being released into the jaw by dying bacteria. An antibiotic will take care of this temporary problem. Usually, however, patients feel little or no pain after a root canal treatment. Many patients report almost immediate relief from their symptoms. If the tooth infection was advanced, there may be some moderate to severe pain after the procedure, but it will slowly improve every day.
Source by Virginia Jacobs