Question:
Soon, I'm planning to undergo root canal re-treatment in two cases
because the X-ray indicates inflammation next to the end of the canals.
The original treatment took place about 7 years ago.
Is there a good chance (>80%) that the inflammation / bacterial
infection will really go away ? I read that due to the many
accessory micro-canals that a tooth has, it is very likely (!) that
the infection will continue, and persistent bacterial infection
may be the cause for chronic disease later in life (I'm 37).
I've read that such an infection may stay as an undetected, persistent
health hazard.
So, should I get these teeth extracted ?
Is surgery (removal of part of the root) a better alternative ?
Is there any other alternative ?
Answer:
Seeing a scan of the x-rays would be helpful.
When I see an obviously failed root canal treatment and the root canal
looks poorly done, I naturally think that re-treating it has a
significant chance of improving the outcome. If the root canal
treatment is gorgeous and it fails anyway, I'm naturally more
circumspect with regard to the chances of success. If there is a nice
post and crown on the tooth, I am more inclined to recommend surgical
treatment, since it will leave the crown intact--particularly if it is
an incisor or upper premolar tooth where surgical treatment is easiest.
Some of these teeth have hidden cracks in the roots and will fail
whatever you do. An endodontist with an operating microscope is more
likely to be able to diagnose these fractures, find previously missed
canals,etc.
Incidentally, I do not retreat any root canals myself. If a root canal
has been treated and subsequently failed (whether I've done the root
canal myself or not), I feel it deserves the expertise and armamentarium
of an endodontist.
I'll retreat if the problem is obvious ie short fill or obvious
unfilled canal, if it is anything else and that tooth is important for
restorative success, I too will refer those out to an endodontist who
has a surgical microscope, does these every day etc...
Imagine there is a 10% personal risk, considering that my immune system
deteriorates as time goes by, that the mainstrean opinion "root canals
are safe" turns out to be incorrect, and some chronic disease develops
e.g. due to constant low-level inflammation. I believe I can only
tolerate such risk if a similar risk exists if teeth are extracted. So,
what are the risks of careful tooth extraction followed by bridging the
gap ? (As before, please ask me for the X-Ray via email. I don't want
to post the URL here because it's a free Web-hosting service that will
only accept three downloads per hour since the file is quite large (and
I also don't want the image floating around)).
After some intensive literature review, my impression is that a risk is
also seen in the peer-reviewed literature, eg
Murray CA, Saunders WP.
Root canal treatment and general health: a review of the literature.
Int Endod J. 2000 Jan;33(1):1-18.
who conclude:
"With an enhanced awareness amongst the population toward their general
health and an increasing concern that disturbance of the periradicular
tissues may potentially cause systemic upset, it is necessary to
ascertain whether root canal therapy is indeed exacerbating or causing
ill health. There is currently an international body of dental
practitioners who refuse to perform root canal treatment, reciting the
research performed 70-80 years ago to justify this stance. However,
there is neither recent scientific evidence nor studies to support this
view. Further scientific research is required to establish the
relationship between pulpally induced or treatment-fostered
periradicular disease and systemic health."
