Face 
Dentistry You’ve already been through root canal treatment.
So discovering that there is now another problem with the same tooth can be particularly disheartening.
Perhaps it has started hurting again.
Perhaps your dentist has noticed something on an X-ray.
Or perhaps you’ve simply been told:
“The root canal hasn’t worked.”
It is very easy to translate that into:
“The tooth has to come out.”
But that isn’t necessarily the case.
A previously root-treated tooth can sometimes be assessed for further treatment.
The first question isn’t:
“Can we redo the root canal?”
It is:
“What has happened to this tooth?”
You may not know.
Some people develop symptoms.
Others have no obvious symptoms and a concern is identified during a dental examination or on an X-ray.
Possible reasons for reassessing a previously treated tooth include:
These don’t all mean the same thing.
Assessment is needed to establish the cause.
There are several possibilities.
The British Endodontic Society explains that problems can occur where anatomy was not addressed during the original treatment or where new problems develop after treatment.
Teeth can have complicated internal anatomy.
There may also be changes affecting the tooth after the original treatment, such as new decay, damage or problems associated with the restoration.
So a later problem does not automatically prove that the original treatment was carried out incorrectly.
That distinction matters.
The aim of the assessment is to understand what is happening now, not to assign blame without evidence.
No – not automatically.
Extraction is one possible outcome, but it isn’t the only possible pathway.
Depending on the findings, options may include:
In some circumstances, observation and review may be appropriate.
The existing root canal treatment may be removed and the root canal system treated again.
In selected cases, a surgical approach involving the end of the root may be considered.
Sometimes the problem involves another aspect of the tooth that needs to be considered.
If further treatment isn’t appropriate, extraction may be recommended.
The existence of these options doesn’t mean they all apply to you.
Alex will look at the entire tooth rather than the root filling in isolation.
He may consider:
Additional investigations may be recommended where appropriate.
Possibly.
A conventional dental X-ray provides a two-dimensional image.
CBCT can provide three-dimensional information about a tooth and surrounding structures and may be helpful in selected complex endodontic cases.
Evolve has CBCT scanning available.
However:
A CBCT scan isn’t automatically required because a previous root canal has developed a problem.
Alex will recommend it if the additional information is clinically useful.
Retreatment involves accessing a previously treated root canal system again.
Existing root-filling material may need to be removed so that the canals can be reassessed, cleaned and treated.
Because the tooth has already been treated and restored, this can be technically more complicated than initial root canal treatment.
Read our complete guide: What is root canal retreatment?
Existing posts or other restorations can affect access to the root canal system.
In selected cases, post removal may be considered.
Alex provides specialist file and post removal, but whether it is appropriate depends on the individual tooth and the risks and benefits of attempting removal.
Sometimes the problem may be approached from the end of the root rather than entirely through the top of the tooth.
Apical microsurgery is a surgical endodontic procedure involving the root tip and surrounding area.
It may be considered in selected circumstances.
It is not automatically required when retreatment isn’t possible, nor is it appropriate for every tooth.
Yes.
And this is an important part of genuine specialist care.
The purpose of seeing a Specialist Endodontist isn’t to find a way to perform root canal treatment at all costs.
It is to understand the problem and determine whether further endodontic treatment represents a reasonable option.
Sometimes Alex may advise that it does not.
In that situation, he will explain his findings and the alternatives that should be considered.
We wouldn’t promise that.
Alex’s specialist training and focus are relevant to assessing and treating endodontic problems, particularly complex cases.
But specialist status doesn’t create a guaranteed outcome.
Some teeth cannot appropriately be retained regardless of who treats them.
Tell Alex.
Your priorities matter.
Wanting to retain a natural tooth is completely understandable.
Alex can explain whether there are reasonable options for attempting this, what those options involve and their limitations.
If he doesn’t believe further endodontic treatment is appropriate, he can also explain why.
Shared decision-making doesn’t mean every option a patient would like is clinically available.
It means making sure you understand the options that are reasonable.
No.
If you’re worried about a previously root-treated tooth, you can self-refer to Dr Alex Brett at Evolve.
If you already have a dentist, there is no need to transfer your general dental care.
We can communicate appropriately with your usual dentist and you can return to them for ongoing care.
Specialist endodontic consultation – £x
If further treatment is recommended:
Root canal retreatment – from £x
Apical microsurgery – from £x
Other fees depend on the treatment required.
You’ll receive an explanation of the proposed treatment and associated costs before deciding whether to proceed.
Reality: Further treatment may sometimes be possible. Assessment is needed before the options can be determined.
Reality: Problems can arise for different reasons. You cannot establish the cause simply from the fact that further treatment is now being considered.
Reality: No endodontic procedure can guarantee a particular outcome.
Reality: Specialist assessment may sometimes conclude that further endodontic treatment isn’t appropriate.
A previously treated root canal system may sometimes be treated again. Whether retreatment is appropriate depends on the tooth and previous treatment.
No. Depending on the findings, other possibilities may include monitoring, apical microsurgery, another restorative approach or extraction.
There are several possible reasons, including changes affecting the tooth or restoration. An examination is needed to determine the cause.
Yes. You can self-refer for specialist endodontic assessment.
Where appropriate and with your consent, information can be communicated to your dentist so that your care can be coordinated.
You don’t need to work out whether you need retreatment, surgery or something else before contacting us.
That’s the purpose of the assessment.
Dr Alex Brett
Specialist Endodontist
GDC no. 244328
Consultation – £x
Self-referrals and dentist referrals welcome
Speak to the Evolve team about an assessment
You may also find these useful:
What is root canal retreatment?
Root canal treatment or extraction – how do I decide?
Your guide to root canal treatment
For independent patient information, visit the British Endodontic Society patient information resources.
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Book An Introduction Call Electric or manual toothbrush - which is better?
It`s one of those dental questions where almost everyone has an opinion.
But does buying an electric toothbrush automatically mean you`re doing a better job?
Richard tackles the question.
Whichever toothbrush you use, how you brush matters enormously - so don`t panic if there`s nothing rechargeable sitting beside your bathroom sink.
Now we`re curious...
Clear aligners or fixed braces - which is better?
Which is better - clear aligners or fixed braces?
Neither.
At least, not until we know more about you.
The right orthodontic treatment depends on your teeth, what you`d like to change, your lifestyle and a number of clinical considerations.
For some people, clear aligners can be a great option. For others, fixed braces may be more appropriate.
So rather than starting with:
“Which braces do you want?”
We`d much rather start with:
“What would you like to change about your smile?”
Swipe through to understand some of the differences.
💚 £338 raised for Macmillan Cancer Support! 💚
We had such a lovely time at our Macmillan Coffee Morning last week. ☕🍰
A huge thank you to everyone who popped into the practice, enjoyed a slice of cake, had a chat and made a donation. It was wonderful to see so many of our patients, friends and members of the local community getting involved, and we were genuinely touched by everyone’s generosity.
Together, you helped us raise an amazing £169.
And we’re delighted to share that Carol has very generously matched every pound raised, bringing our final total to…
🥁 £338 for Macmillan Cancer Support! 💚
Thank you to our brilliant team for baking, organising and keeping the cake table well stocked, and to every single person who helped make the day such an enjoyable one.
Days like this remind us just how lovely the community around Evolve really is. 💚
#MacmillanCoffeeMorning #MacmillanCancerSupport #Portishead #EvolveDentistry #PortisheadCommunity
Being shortlisted for Team of the Year means a lot to us, but not because of the trophy.
It’s because dentistry is never the work of one person.
It’s the nurse who notices you’re nervous before you’ve said a word. The reception team member who remembers the conversation you had last time. The clinician who takes time to explain something again. The person behind the scenes making sure your visit runs smoothly.
Those small things happen every day at Evolve, and they only happen because people care about the experience we create together.
So being a finalist gives us a lovely excuse to say something we probably don’t say often enough: we’re incredibly proud of this team.
#PrivateDentistryAwards #TeamOfTheYear #DentalTeam #EvolveDentistry
You might notice a familiar face missing from Evolve for a little while… 💚
Carol is heading to Zambia with SmileStar, a dental charity providing free dental care to communities with limited access to treatment.
In this video, Carol shares a little more about where she’s going, what she’ll be doing while she’s there and why she wanted to be part of the trip.
It’s going to be a very different couple of weeks away from the practice, and we’re incredibly proud to see Carol giving her time and skills to support SmileStar’s work.
We’ll be sharing a little more from her trip when we can, but for now, we’ll let Carol tell you all about it in her own words. 💚
Safe travels, Carol. We can’t wait to hear all about it when you’re home!
#EvolveDentistry #SmileStar #Zambia #Dentistry #Portishead
🍰 Come and join us today! 💚
Our Macmillan Coffee Morning is in full swing at Evolve Dentistry, and we’d love to see you!
We’ve got plenty of delicious homemade cakes waiting for you, so pop in, say hello, grab a slice (or two!) and help us raise money for Macmillan Cancer Support.
We’ll be serving cakes right through until 5pm today, so there’s still plenty of time to come down.
📍 Evolve Dentistry, Portishead
🍰 Cakes until 5pm
💚 Everyone is welcome
Come hungry! 😋
#MacmillanCoffeeMorning #MacmillanCancerSupport #Portishead #PortisheadCommunity #EvolveDentistry
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