Challenges in Finding Nerve During Root Canal Treatment: What to Do Next?

Q: Challenges in Finding Nerve During Root Canal Treatment: What to Do Next?

Hello： Since three microscopic root canal treatments have already been performed, it indicates that it is difficult to locate the nerve canal of that tooth. <br>It is recommended to discuss with the original dentist whether to refer to a medical center for further management or t

Root canal treatment cannot locate the nerve?

Hello Doctor: I have been experiencing pain in my lower seventh tooth since September and went to see a dentist, who diagnosed it as a cavity.
I underwent crown lengthening and then root canal therapy.
However, due to calcification in my tooth, the dentist had difficulty locating the nerve.
The dentist recommended microscopic root canal treatment, which I had done twice.
During the last session, it took quite a while, and the dentist mentioned that my nerve might be calcified due to the calcification, advising me to monitor it for a month.
Before the month was up, I started to feel a dull ache in my seventh tooth again.
When I returned for a follow-up after a month, the dentist said I would need to undergo microscopic root canal treatment once more.
I would like to ask if it is likely to find the nerve during the third microscopic root canal treatment, given that it was not located during the second treatment.
Each microscopic root canal treatment is quite expensive, and I still need to consider getting a prosthesis afterward.
If I undergo the third microscopic root canal treatment and still cannot locate the nerve, are there any other treatment options available besides dental implants? Thank you.

Hua, 20~29 year old female. Ask Date: 2018/12/11

Dr. Lin Jiayong reply Dentistry

Hello: Since three microscopic root canal treatments have already been performed, it indicates that it is difficult to locate the nerve canal of that tooth.
It is recommended to discuss with the original dentist whether to refer to a medical center for further management or to consider surgical removal of part of the tooth root, with the priority being to preserve the tooth.
Unless a careful assessment concludes that extraction of the tooth is necessary, the discussion of dental implants will not be considered.
Sincerely, Dr.
Lin Chia-Yung, Director of Dentistry, Ministry of Health and Welfare.

Reply Date: 2018/12/11

More Info

When it comes to the challenges faced during root canal treatment, particularly in cases where the nerve is calcified or difficult to locate, it can be a frustrating experience for both the patient and the dentist. In your situation, it appears that you have undergone multiple attempts at microscopic root canal therapy due to the calcification of the nerve, which has made it increasingly difficult to successfully complete the procedure.

Firstly, it is important to understand that calcification of the pulp can occur due to various reasons, including trauma, decay, or chronic inflammation. This calcification can lead to a narrowing of the canal, making it challenging for the dentist to locate and treat the nerve effectively. The use of a microscope during the procedure is a beneficial approach, as it allows for enhanced visibility and precision, which is crucial in such complex cases.

Regarding your question about the likelihood of successfully locating the nerve during a third attempt at microscopic root canal treatment, it is difficult to provide a definitive answer. The success of locating the nerve can depend on several factors, including the extent of calcification, the skill and experience of the dentist, and the specific anatomy of your tooth. In some cases, additional imaging techniques, such as cone-beam computed tomography (CBCT), may be utilized to provide a more detailed view of the tooth's internal structure, which can aid in locating the nerve.

If the third attempt at microscopic root canal therapy does not yield results, there are alternative treatment options to consider. One possibility is to explore the option of an apicoectomy, which is a surgical procedure that involves removing the tip of the tooth root along with any infected tissue. This procedure can sometimes provide relief when traditional root canal therapy is unsuccessful.

Another option could be to consider retreatment with a different approach, such as using specialized instruments designed for calcified canals. Some dentists may employ techniques such as ultrasonic activation or the use of specific files that can help in negotiating through calcified areas.

If all else fails and the tooth remains symptomatic, extraction may be the last resort. While this may seem daunting, it is important to remember that tooth extraction can lead to other restorative options, such as dental implants or bridges, which can effectively restore function and aesthetics.

Ultimately, the decision on how to proceed should be made in consultation with your dentist or an endodontist who specializes in root canal treatments. They can provide you with a comprehensive evaluation of your situation and discuss the potential risks and benefits of each treatment option available to you. It is essential to communicate openly with your dental care provider about your concerns and preferences, as this will help guide the treatment plan that best suits your needs.

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