If a Tooth That Has Had Root Canal Treatment Hurts Again, Does It Need to Be Extracted? | Sangil-dong Dentist

Hello!

I am the director of Seoul Bardi Dental Clinic.

| This post was written directly by Seoul Bardi Dental Clinic for the purpose of providing medical information, in compliance with Article 56, Paragraph 1 of the Medical Service Act regarding medical advertising. We recommend using the information provided for reference only. Please visit a medical institution and receive guidance from a medical professional regarding symptom assessment and accurate management methods. All procedures and surgeries performed at a dental clinic may involve individual risks, such as inflammation, bleeding, and swelling. Please make your decision after having a thorough consultation with a medical professional in advance. All images were created using AI to aid understanding. |

If something resembling a pimple appears on your gums

and repeatedly subsides,

you should have a tooth that underwent root canal treatment in the past

examined.

Some people visit us after being advised elsewhere to have the tooth extracted,

while still looking for a way to save it.

To give you the conclusion first,

an inflamed tooth that has undergone root canal treatment

does not necessarily need to be extracted immediately.

There is a way to treat it again

and continue using it.

Today, I will explain why inflammation develops

and what the likelihood of success with retreatment is,

along with the supporting evidence.

| Chapter 1. Why does inflammation develop again? |

"I had root canal treatment,

so why has inflammation developed again?"

This is a question I receive very often.

You may feel that the treatment was not done properly

and feel wronged as well.

Root canal treatment removes the infected nerve,

disinfects the inside thoroughly,

and then fills and seals the empty space.

There are two main points

where treatment can fail.

One is a missed canal.

The nerves inside a tooth are not a single strand.

They branch out like ginseng roots,

and their number and shape vary from person to person.

According to a study that used CBCT for examination,

untreated canals were found in 55.2% of first molars

and 50.8% of second molars in the upper jaw

that had already undergone root canal treatment.

The canal missed most frequently

is called the MB2 canal.

It accounted for 72.4% of cases in first molars

and 81.7% in second molars.

Teeth with a missed canal

were 2.57 times more likely to have inflammation

at the root tip.

This means that in more than half of the teeth,

there was a passage that had not been treated.

If bacteria remain inside,

inflammation can develop again over time.

The other factor is sealing.

Even if the inside is disinfected thoroughly,

bacteria can enter again if there is leakage from above.

It has been reported that the quality

of the restoration placed on top

may be more important to the outcome

than the quality of the material filling the root canal.

This is why you should not postpone

having a crown placed after root canal treatment.

To summarize:

The inside of a tooth

is much more complex

than we imagine.

| Chapter 2. What does a gum blister mean? |

If a pimple or blister develops on the gum

near a tooth that has undergone root canal treatment,

you should not simply ignore it.

It means that a passage has formed

for pus collected at the root tip to drain out.

Dentists call this a sinus tract.

There is a point here that can be confusing.

When a path for the pus to drain develops,

pressure decreases,

so there may be no pain.

The blister may grow

and then subside on its own.

That is why some people think they have improved

and go on for months or years.

Meanwhile, the inflammation at the root tip

remains,

and the surrounding bone continues to deteriorate.

The absence of pain

does not mean that the condition has healed.

| Chapter 3. What is the likelihood of success with retreatment? |

The success rate of nonsurgical root canal retreatment

has been reported as 70.9% with 2–4 years of observation

and 83.0% with 4–6 years of observation.

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A surgical method that removes the root tip

has a better initial success rate of 77.8%,

but this falls to 62.9% after more than six years.

(Torabinejad et al.)

The conclusion is as follows.

Surgery has better initial results,

while retreatment of the root canal

has better long-term results.

Therefore, in most cases,

we first try removing the existing restoration

and disinfecting the tooth again.

This is commonly called endodontic retreatment.

And this process

does not end in a single visit.

The existing prosthesis is removed,

the material packed inside is taken out,

any missed canals are located,

and the tooth is disinfected repeatedly

until the inflammation subsides.

You should be aware in advance

that retreatment takes more time

than the initial treatment.

Today, I explained how to approach the situation

when inflammation develops again

in a tooth that has undergone root canal treatment.

Inflammation can develop again

because the inside of the tooth is that complex.

More than half of the teeth

are found to have missed canals.

With retreatment,

approximately 83% remain maintained

after 4–6 years of observation.

A tooth that has been extracted

cannot be brought back.

Even if you have been advised to have it extracted,

I hope you will be sure to check

whether there are other options.

Before we make a decision,

I hope you will not give up

on the tooth first.

Thank you for reading this lengthy post today.

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