Is Microsurgery the Only Option for Incomplete Root Canals?

Q: Is Microsurgery the Only Option for Incomplete Root Canals?

Hello： It is recommended that you return to the original clinic (the one where you had the root canal and dentures done) and have the original dentist address your concerns until you are satisfied with the outcome. <br>If the clinic is unable to resolve the issue, please request

If the root canal treatment does not reach the apex, is it necessary to perform a microscopic root canal procedure?

After experiencing tooth decay in my molars in 2019, I underwent root canal treatment and received a crown at a certain clinic.
After the crown was placed, I still felt some pain when lightly tapping on it.
When I returned for a follow-up, the dentist assured me that it was impossible for the root canal to be incomplete and suggested that it might be an issue with the periodontal ligament or something similar.
Since the discomfort was minimal, I didn't pursue it further.
However, six months ago, I experienced pain when consuming hot and cold foods, so I went back for another consultation.
This time, the dentist indicated that the adjacent molar also had decay and required a root canal, but they did not place a crown initially.
To this day, I still feel slight pain when consuming hot foods.
I then visited another clinic for an X-ray, which revealed that both molars had a root canal that did not extend to the end.
My question is whether I can only use microscopic root canal treatment and cannot utilize the general root canal treatment covered by insurance anymore.
The original clinic's dentist also mentioned that even if the root canal was not completely cleaned out, it should not cause sensitivity to hot and cold.
Is this really the case?

Lin Xiansheng, 30~39 year old female. Ask Date: 2021/08/08

Dr. Lin Jiayong reply Dentistry

Hello: It is recommended that you return to the original clinic (the one where you had the root canal and dentures done) and have the original dentist address your concerns until you are satisfied with the outcome.
If the clinic is unable to resolve the issue, please request a referral to a medical center.
This will help confirm whether the root canal was adequately cleaned and if a microscope is necessary.
Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2021/08/08

More Info

When it comes to the treatment of incomplete root canals, microsurgery is often considered a viable option, but it is not the only one. The situation you described, where you have experienced persistent pain after root canal treatment, suggests that there may be issues with the initial procedure, such as incomplete cleaning of the root canal system or the presence of additional canals that were not treated.

Root canal therapy aims to remove infected or inflamed pulp tissue from the tooth, clean and shape the root canals, and then fill them to prevent reinfection. However, the anatomy of the root canal system can be complex, especially in molars, which often have multiple canals and variations in their shapes. If any part of the canal system is left untreated, it can lead to ongoing pain and infection.

In your case, the X-ray findings indicating that some canals are not fully treated suggest that the initial root canal therapy may not have been successful. While some dentists may argue that incomplete cleaning should not cause sensitivity to temperature, this is not universally accepted. Many practitioners recognize that even minor remnants of pulp tissue or bacteria can lead to discomfort, especially when exposed to temperature changes.

If the initial root canal treatment was inadequate, there are a few options available:
1. Retreatment: This involves reopening the tooth, removing the existing filling material, and cleaning the canals again. This can be done using conventional techniques, and in some cases, it may be sufficient to resolve the issue without the need for microsurgery.

2. Microsurgery (Apicoectomy): If retreatment is not feasible or if the tooth has complex anatomy that makes it difficult to access the canals, microsurgery may be necessary. This procedure involves making an incision in the gum tissue to access the root tip and removing any infected tissue or the tip of the root itself. It is a more invasive procedure but can be very effective in resolving persistent issues.

3. Extraction: In cases where the tooth cannot be saved, extraction may be the last resort. This is typically considered when the tooth is severely compromised or if the infection cannot be controlled.

Regarding your concern about whether you can still use general insurance for root canal treatment, this may depend on the specific policies of your insurance provider. Many insurance plans cover retreatment under certain conditions, but it is essential to verify this with your provider.

In conclusion, while microsurgery is a valuable option for treating incomplete root canals, it is not the only solution. Retreatment is often the first step, and if that fails, then microsurgery may be considered. It is crucial to consult with an endodontist or a dentist who specializes in root canal treatments to evaluate your specific situation and determine the best course of action. They can provide a thorough assessment and discuss the potential for retreatment versus the need for more invasive procedures.

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