Root canal treatment not working, what next?

[69 coupe]

In April I got the dreaded pain under a lower molar (2 in from the wisdom). Saw my Dentist x-rayed showed up with infection, was given a 5 day course of Amoxicilin (sp) & returned approx a week later when pain subsided.
Dentist drilled the root & filled with rubber & sealed with a white filling, all was well for a while then after approx 6 weeks started to get same pain again.

Eventually went back, x-rayed & infected again, dentist gave another course of Amoxicilin (sp) (I'm allergic to erothomycin) (sp). She also drilled out the filling & decided that a temp filling should go in & come back approx 2 weeks later, told dentist that its a-lot better but still a bit sensitive to touch & to tap test, (no gums are swollen). Dentist cleaned out with little files & rubber filled with new white filling she said if it happens again & I want to save the tooth she will refer to Dental Hospital.

Unfortunately its starting to play up again, I've also been under the weather since April I suspect bacterial infection is the cause.

I'm booked in for Thurs, & wonder what way forward, I'm thinking of getting it whipped out & having a crown or whatever to fill the gap. As for my Dentist she is fantastic & answers any questions I've ever asked, & when doing treatments you know she is doing her job very conscientiously.

Thoughts please.

[MacGee]

get it out!

[steve_bmw]

I would have it taken out, get it sorted once and for all.
Because its at the back of your mouth you wont be able to see it so I wouldnt worry about trying to save it.

[prg1]

Retreatment of a failed root canal therapy, or a root canal therapy that has not settled, has a lower success rate that the inital root canal therapy. Referral to a specialist may prove successful. A lot of dental schools do not now take on a lot of the cases referred. If so that will either leave you with a private specialist and higher costs or extraction.
The dental school can only say no though so it may be worth asking.

[Driller]

I would suggest that if you're still having problems after two goes, if she is not a complete incompetent (no reason why she should be)then it's finished.

Do as Mr MacGee says.

[69 coupe]

Thanks for relpies. Out it shall come

[buccal]

[quote=prg1]Retreatment of a failed root canal therapy, or a root canal therapy that has not settled, has a lower success rate that the inital root canal therapy.
quote]

Not according to the literature.

Referral to a specialist is a very sensible suggestion.

[MacGee]

I would def say that re RCT is less likely to work!!!!!!

[prg1]

buccal said:

prg1 said:

Retreatment of a failed root canal therapy, or a root canal therapy that has not settled, has a lower success rate that the inital root canal therapy.
quote]

Not according to the literature.

Referral to a specialist is a very sensible suggestion.

Certainly when I was trained, I was advised that a retreatment was less likey to be successful due to the bacteria that tend to cause failure. There are obviously multiple possible reasons for failure, re infection being the most likely.

[buccal]

MacGee said:

I would def say that re RCT is less likely to work!!!!!!

Success rates are the same, as the vast majority of retreatments are completed by specialists so the inherent difficulties with retreatment can managed effectively.

The definitive work in the last few years on this is here:

http://www.ncbi.nlm.nih.gov/pubmed/17931389 (the pooled success rates for strict periapical healing with the updated the figures in 2010 was 76%)

and here:

http://www.ncbi.nlm.nih.gov/pubmed/19133093

Will go and crawl back down my MB2

[prg1]

I have not read through the links but if you are comparing initial treatment with a non specialist and then re treatment with a specialist then maybe. All success rates for any treatment will be operator and case dependent.

Edited by prg1 on Monday 17th October 20:46

[MacGee]

Check also this link from same site which claims the opposite !


PMID 14603666 [PubMed - indexed for MEDLINE]

[MacGee]

Found this on wikipedia ...I rest my case! ;.)

Endodontic retreatment is technically demanding; typical 5 year success rates are around 60% compared to around 85% for initial root-canal treatment. It can be time consuming procedure also as meticulous care is required by the dentist

[pauldavies85]

Nobody else thinking midline crack, what caused problem in first place? Pretty common under an old amalgam filling, hence why out of the blue tooth ache

No treatment will not work no matter who does it - extraction has a pretty high success rate for the paper bashing crowd!!!

[MacGee]

I have yet to see an extraction be beaten by a failed RCT!!!

[dudleybloke]

if in doubt, rip it out!

[Barton]

Just been through all this including specialist referral. Had the tooth out ten days ago which didnt go well and developed "dry socket" which is not pleasant to say the least. Still suffering.......

Best of luck !