My root canal hasn’t worked – can my tooth still be treated?

Why a problem after root canal treatment doesn’t automatically mean losing the tooth

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?”

How do I know whether my root canal has failed?

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:

• pain or tenderness
• discomfort when biting
• swelling
• a gum swelling near the tooth
• a change seen on an X-ray
• new decay or damage
• concerns about the restoration
• another clinical finding

These don’t all mean the same thing.

Assessment is needed to establish the cause.

Why can a problem happen after root canal treatment?

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.

Does the tooth have to come out?

No – not automatically.

Extraction is one possible outcome, but it isn’t the only possible pathway.

Depending on the findings, options may include:

Monitoring

In some circumstances, observation and review may be appropriate.

Root canal retreatment

The existing root canal treatment may be removed and the root canal system treated again.

Apical microsurgery

In selected cases, a surgical approach involving the end of the root may be considered.

Other restorative treatment

Sometimes the problem involves another aspect of the tooth that needs to be considered.

Extraction

If further treatment isn’t appropriate, extraction may be recommended.

The existence of these options doesn’t mean they all apply to you.

How will Alex decide whether the tooth can be treated again?

Alex will look at the entire tooth rather than the root filling in isolation.

He may consider:

• your symptoms
• the original treatment
• existing X-rays
• the current restoration
• the amount of tooth structure remaining
• the root canal anatomy
• the tissues around the roots
• whether there appears to be a crack or fracture
• whether the tooth is restorable
• what further treatment would involve

Additional investigations may be recommended where appropriate.

Will I need a CBCT scan?

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.

What is root canal retreatment?

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?

What if there is a post in the tooth?

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.

What is apical microsurgery?

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.

Could Alex tell me the tooth isn’t treatable?

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.

Does seeing a specialist mean the tooth is more likely to be saved?

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.

What if I don’t want to lose the tooth?

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.

Do I need my dentist to refer me?

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.

How much will an assessment cost?

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.

Myth versus reality

Myth: If a root canal develops a problem, the tooth has to be extracted

Reality: Further treatment may sometimes be possible. Assessment is needed before the options can be determined.

Myth: A problem means the first dentist did the root canal badly

Reality: Problems can arise for different reasons. You cannot establish the cause simply from the fact that further treatment is now being considered.

Myth: Retreatment always fixes the problem

Reality: No endodontic procedure can guarantee a particular outcome.

Myth: A specialist can save any tooth

Reality: Specialist assessment may sometimes conclude that further endodontic treatment isn’t appropriate.

Questions patients often ask

Can a root canal be done twice?

A previously treated root canal system may sometimes be treated again. Whether retreatment is appropriate depends on the tooth and previous treatment.

Is retreatment my only option?

No. Depending on the findings, other possibilities may include monitoring, apical microsurgery, another restorative approach or extraction.

Why has the tooth started hurting years later?

There are several possible reasons, including changes affecting the tooth or restoration. An examination is needed to determine the cause.

Can I see Alex for a second opinion?

Yes. You can self-refer for specialist endodontic assessment.

Will Alex tell my own dentist what he finds?

Where appropriate and with your consent, information can be communicated to your dentist so that your care can be coordinated.

Key takeaways

• A problem after root canal treatment doesn’t automatically mean extraction.
• The reason for the problem needs to be diagnosed.
• Root canal retreatment may sometimes be an option.
• Apical microsurgery may be considered in selected cases.
• Existing restorations, posts and tooth structure affect the decision.
• Specialist assessment cannot guarantee that a tooth can be retained.
• You can self-refer to Evolve without changing dentist.

Not sure what to do next?

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.

Specialist endodontic 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

What if your root canal treatment hasn’t worked?

If a previously root-treated tooth is causing problems, it doesn’t automatically mean it needs to be removed.

At Evolve Dentistry in Portishead, Dr Alex Brett, Specialist Endodontist, can assess previously treated teeth and explain whether further treatment may be appropriate.

Depending on your circumstances, options might include root canal retreatment, apical microsurgery or extraction.

You don’t need a referral from your dentist to arrange a specialist endodontic assessment.

⁠Explore specialist root canal treatment at Evolve Dentistry

For independent patient information, visit the ⁠British Endodontic Society patient information resources.