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Amy Beth Dukoff, D.M.D.
To Retreat or Not to Retreat?
Amy Dukoff

Amy Dukoff

RETREATMENT today is the standard of care . . . in the right cases. What used to be an easy decision to retreat today is more complex. Each case must be evaluated radiographically and symptomatically in order to decide whether retreatment is appropriate. In every case, the patient has to be well informed of his or her options. The risks that are involved must be explained as well as the prognosis and costs.
    The retreatment decision is made on a case-by-case basis. If symptoms and disease are present, retreatment is usually indicated. Even without symptoms, retreatment may be indicated to prevent a future emergency. A common clinical finding that favors retreatment would be the presence of an incompletely obturated root canal system. Sometimes, a history of sporadic symptoms pointing to the tooth in question will indicate the need for retreatment. In rare cases, even the most perfectly executed non-surgical root canal therapy may need to be redone if the patient continually complains, “it just never felt right.”  Sometimes, it’s hard to understand why the tooth hurts, but if the tooth does hurt, it’s important to listen to the patient and decide whether retreatment is indicative from a clinical or patient management perspective.
    The success rate for retreatment is lower than the rate for initial treatment. Moreover, there can be obstacles that compromise retreatment. These obstacles may be calcifications, complex morphology, ledges, blocks, separated instruments, and the thinness of the root dentin. In addition, the periodontal condition of the surrounding bone can affect the prognosis.
    The patient must be advised of alternative treatment options with their respective costs and success rates. Given the success rates for implants, they are often the preferred alternative to retreatment.
    In any discussion of  retreatment with patients, it’s important to emphasize that a tooth’s requiring retreatment is not a treatment failure. If symptoms and disease are present, then treatment of the apical periodontitis is necessary. It may be the case that the root canal procedure went well but disease pathology is present. It may also be the case that radiographs show a treatment that was less than “textbook” perfect, requiring retreatment even though the patient considers the procedure successful and is not experiencing symptoms. Therefore, the need for retreatment is usually not caused by the failure of a root canal procedure and should not be presented to the patient from that perspective.
 
November-December 2003
In discussing retreatment with patients it’s important to emphasize that a tooth’s requiring retreatment is not a treatment failure. 

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