Root Canal Retreatments: When to Save or Extract Your Tooth

Q: Root Canal Retreatments: When to Save or Extract Your Tooth

Hello： 1. <br>It is recommended to consult with the Department of Endodontics at a medical center to obtain a second or third opinion before making a decision. <br>2. <br>If you insist on not extracting the tooth, please have regular X-rays taken every 3 to 6 months to monitor fo

Secondary root canal treatment

Hello, Doctor.
Recently, I visited a dentist due to gum swelling and pain caused by dental calculus.
The dentist took X-rays and discovered some inflammation in the root of my lower right first molar.
It hurts slightly when tapped with instruments, but I don't feel any discomfort otherwise.
The dentist recommended redoing the root canal treatment.
During the procedure, the tooth cracked about 1/3 of the way through, but the root was not affected; the crack is on the surface.
The dentist mentioned that one of the roots is calcified and difficult to clean, but since I don't experience pain or discomfort, I would like to keep the tooth.
The dentist suggested trying to clean it two more times to see if it can be adequately treated; otherwise, I would need to consult an endodontist to evaluate the possibility of microsurgical root canal treatment.

Ten days later, I returned for another cleaning of the root canal.
The dentist said there was only a slight improvement and that the chances of cleaning it thoroughly are low.
The root is inflamed, and the dentist still recommends extracting the tooth and later placing a bridge for three teeth.
Since this tooth does not cause me pain, and the crack is only on the surface, is it absolutely necessary to extract it due to the inflammation in the root? I would prefer to preserve my natural tooth.
Thank you.

Niming, 30~39 year old female. Ask Date: 2022/05/19

Dr. Lin Jiayong reply Dentistry

Hello: 1.
It is recommended to consult with the Department of Endodontics at a medical center to obtain a second or third opinion before making a decision.
2.
If you insist on not extracting the tooth, please have regular X-rays taken every 3 to 6 months to monitor for any local lesions and to prevent them from progressing into a systemic infection or disease.
Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2022/05/19

More Info

When it comes to root canal treatments and the decision to save or extract a tooth, there are several factors to consider. Your situation involves a lower first molar that has undergone root canal treatment, has a surface crack, and is showing signs of inflammation in the root. The recommendation from your dentist to consider extraction is based on the potential for ongoing issues, including the risk of bone loss if the infection persists.

First, let's discuss the anatomy of the tooth and the implications of root canal treatment. A tooth consists of several layers: the enamel, dentin, and pulp, which contains nerves and blood vessels. When a tooth undergoes root canal treatment, the infected pulp is removed, and the root canals are cleaned and sealed. However, if the tooth is not properly cleaned or if there are complications such as calcification in the root canals, the infection can persist or recur.

In your case, the dentist has noted that one of the root canals is calcified, making it difficult to clean thoroughly. This can lead to persistent inflammation, which, if left untreated, can result in the loss of surrounding bone and potentially lead to more severe complications. The fact that you are not experiencing pain is a positive sign, but it does not necessarily mean that the tooth is healthy. As your dentist mentioned, the inflammation in the root can still cause long-term damage.

The decision to extract a tooth is not taken lightly. Dentists typically recommend extraction when there is a significant risk of infection that could lead to further complications, such as abscess formation or bone loss. If the root canal treatment is not successful, and the inflammation continues, it can compromise the integrity of the surrounding bone, leading to more extensive dental issues down the line.

However, if you are keen on preserving your natural tooth, it is essential to have a thorough discussion with your dentist about all available options. One possibility is to seek a second opinion from an endodontist, a specialist in root canal treatments. They may have advanced techniques and tools, such as a surgical microscope, that can help in cleaning the calcified canal more effectively. Additionally, they can evaluate whether a retreatment or even a surgical approach, such as apicoectomy (removing the tip of the root), could be viable options.

It's also important to consider the long-term implications of keeping the tooth versus extracting it. If the tooth can be saved, it may be beneficial for your overall dental health, as natural teeth provide better function and aesthetics compared to bridges or implants. However, if the tooth is likely to cause ongoing issues, extraction might ultimately be the more prudent choice.

In summary, while your desire to keep your natural tooth is understandable, the potential risks associated with untreated root canal issues must be weighed carefully. Consulting with a specialist and discussing all treatment options, including the possibility of advanced endodontic procedures, can provide you with a clearer understanding of your situation. Ultimately, the goal is to ensure your long-term dental health and avoid complications that could arise from an untreated infection.

Similar Q&A

Root Canal Treatment vs. Tooth Extraction: What to Do with an Infected Tooth?

I recently developed an abscess on my lower left molar, and sometimes it hurts when I bite down, while other times it doesn't. I visited a periodontal specialist at a large hospital, and she recommended extracting the tooth. However, an endodontist suggested that we could tr...

Dr. Huang Tingfang reply Dentistry
Dear Miss Nini, Hello! Based on what you described, the situation seems quite serious. The worst-case scenario is a cracked tooth root, which would require extraction. I recommend seeking a second opinion at another dental clinic. If the assessment is the same, then extraction w...

Root Canal Treatment vs. Tooth Extraction: Making the Right Choice

Hello, Doctor. Two years ago, I visited a clinic due to pain in my upper left second molar. The dentist mentioned that if it hurt again, I would need a root canal treatment. This July, the pain returned, and after researching online, I learned the correct term is root canal thera...

Dr. Zeng Guanghui reply Dentistry
Hello Ms. Chang: If there is still occlusal function, good periodontal condition, and sufficient support, it is recommended to protect the tooth with a crown after completing root canal treatment. However, if the periodontal condition is poor and the tooth is already mobile, extr...

Should I Extract My Teeth or Save Them with Root Canals?

My lower right central incisor and left lateral incisors have changed color, and I have gum inflammation. An X-ray shows that the roots of my four lower incisors are only one-third embedded in the jawbone. I also have periodontal disease, and even teeth cleaning requires anesthes...

Dr. Chen Yingfang reply Dentistry
Hello! Depending on the condition, you have mentioned various treatment options, so three different approaches can be considered. However, the prerequisite is that you must brush your teeth very thoroughly; otherwise, periodontal disease may still occur in the future. Thank you!

Should I Extract My Second Molars or Opt for Root Canal Treatment?

I recently had severe decay in my upper second molar, and my dentist recommended root canal treatment followed by a crown. However, I’ve heard that getting a crown can affect the adjacent teeth. A few years ago, I had a similar issue with my other second molar, and the dentist su...

Dr. Huang Tingfang reply Dentistry
Dear Ms. Lin, Hello! As mentioned, this is a matter of choice! If you have a third molar, you can certainly choose to have it extracted to allow space for the wisdom tooth to grow. However, we believe that every tooth is important, and if it can be saved, we should try to save i...