Amy Dukoff
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 ETREATMENT
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
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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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