I often hear patients say, “My neighbor says don’t get a root canal because he’s had three and they’ve had every one of those teeth pulled out. Do Root Canals Work? Although root canal failure is a reality, it happens more often than it should. If the root canal fails, root canal retreatment can often solve the problem. This article examines five reasons why root canals fail and how seeking initial root canal treatment from an endodontist can reduce the risk of root canal failure.
The ultimate cause of root canal failure is bacteria. If our mouths were sterile, there would be no decay or infection, and damaged teeth could somehow repair themselves. So while we can attribute nearly all root canal failures to the presence of bacteria, I will discuss five common reasons why root canals fail and why at least four of them are mostly preventable.
Aunque el tratamiento de conducto inicial debería tener una tasa de éxito de entre el 85 % y el 97 %, dependiendo de las circunstancias, alrededor del 30 % de mi trabajo como endodoncista consists en volver a realizar un tratamiento de conducto defectuoso que fue realized por other person. They often fail for the following five reasons:
1. Lost channels.
2. Incompletely treated root canals: short treatment due to protrusions, complex anatomy, lack of experience or lack of attention to quality.
3. Remaining fabric.
5. Post-treatment bacterial leakage.
1. Lost Channels
The most common reason I see for failure is untreated anatomy in the form of lost channels. Our general understanding of dental anatomy should allow the clinician to find all the canals. Not processing a channel in a case where it is present 95% of the time is purely unacceptable.
In other cases, the additional channel may only be present 75% of the time. The most common tooth that I find failing is the maxillary first molar, especially the mesiobuccal root, which has two channels more than half the time. I usually find two canals in three out of four cases, but almost every time a patient has a defect with this tooth, it’s because the original doctor missed the MB2 canal.
Doing a root canal without a microscope greatly reduces the chances of treating the often hard-to-find MB2 canal. Also, not having the right equipment makes it difficult to find that channel. Failure to treat this channel often results in persistent symptoms and latent (long-term) failure. The use of three-dimensional cone-beam x-ray images (CBCT), like the ones we have in our practice, is of great help in identifying the presence of this channel.
If a professional performs endodontic (root canal) treatment, they must have the proper equipment to treat all of the anatomy present in a tooth.
2. Channel incompletely treated
The second most common reason I see failures is incompletely processed channels. This usually comes in the form of “being short”, which means that if a canal is 23 millimeters long, the doctor has only treated 20 millimeters.
The three reasons why a root canal was shorter than it should be can be natural anatomy that does not allow it (sharp curves or calcifications), projections (obstructs created by an inexperienced doctor.
The third reason I see for failure is the tissue that was left on the tooth at the time of the first root canal treatment. This tissue acts as a source of nutrients for bacteria that can reinfect the root canal system.
Immediately before filling a canal space that I have cleaned, I stop to inspect the canals more closely, drying them out and zooming in under the microscope to inspect the walls under high magnification and high illumination. Even when I think I’ve done a thorough job, I often find abandoned fabric along the walls.
The second reason tissue may remain in a root canalized tooth is that it was done too quickly. I am fully aware that the patient (and the doctor) wants this to happen as soon as possible, but one of the functions of the irrigator used to cleanse during treatment is to digest the tissue. If done too quickly and not completely rinsed out, tissue may remain and latent treatment failure may occur.
Another common reason for failure is root fracture. Although it may affect the tooth being treated by the root canal, it may not be directly related to the treatment itself. Cracks in the root allow bacteria to get into places they shouldn’t be.
if there is a crack better than traditional dental X-rays. I have had many cases where I decided that root canal treatment or retreatment would not solve the problem. Because the likelihood of a fracture was too high to warrant treatment to save the tooth.
The goals of root canal treatment are to remove tissue, kill bacteria, and seal the system to prevent bacteria from returning. All dental materials allow bacteria to escape; our goal is to limit the extent of leaks. At some unknown time, tipping points and infection may occur. The more steps we take to prevent leaks, the more likely we are to succeed.