Amy Dukoff
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 ECIDING
whether to retreat an endodontically treated tooth can be difficult. The
best course of treatment is not always clear from radiographs or from the
patient’s symptoms. Making a careful diagnosis and discussing the
treatment options with the patient usually produces the best results.
The tooth may have a radiographic area that is asymptomatic.
If disassembly would include post removal and possibly a new crown, many
factors must be considered. First, one has to determine whether the
post can be removed without causing a lot of structural damage to the tooth
and weakening it. Then, the practitioner must determine whether the
new post and core with a new crown will be functional. The new restoration
must satisfy the patient’s needs. The type of existing post can help
determine your decision. For example, a resin/fiber post could be
more difficult to remove than a parallel post cemented with zinc phosphate.
Also, the post’s proximity to the furcation or its length could contribute
to the decision. In addition, the thickness of the post relative
to the thickness of the dentin plays a role in the decision. Besides
these concerns, the anatomical concerns must always be reviewed.
These may include the proximity to the mandibular canal or the mental foramen.
If the tooth is symptomatic, then a course of action
must be determined and executed. Sometimes the patient will benefit
from a course of antibiotics begun a few days before treatment to lessen
the potential flare-up and make the procedure more comfortable for the
patient. Because the patient will be more comfortable, removing any
post system will be easier. Furthermore, the antibiotics may allow
the effect of anesthesia to be more pronounced. Of course, the antibiotics
may decrease the symptoms for a short term, making it more difficult to
gain the input of other specialists if it is needed.
Ultimately, the patient should decide with you on
the best course of treatment. The decision to retreat an endodontically
treated tooth is dependent on many factors and is very personalized. Discussing
the risks and benefits with the patient is the best course to follow.
Advise the patient and work with the patient to establish the final retreatment
plan.
July-September 2005
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The
decision is dependent on many factors.
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