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1st Root Canal - Factors Contributing To Root Canal Failures |
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Factors Contributing To Root Canal
Treatment Failures
By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS
There are a variety of factors that cause
root
canal treatment to fail:
- Many teeth have been treated
endodontically using techniques that were considered state-of-the-art at the
time of treatment but are outdated by today's standards.
The good news is
that root canal treatment rarely fails when there is proper diagnosis and
treatment utilizing modern concepts, the best materials, and improved
technologies and techniques.
Additionally, better trained general dentists
and endodontists can now successfully retreat many of the previously treated
teeth that are failing.
A
root canal generally fails because of
leakage and bacterial infection. Bacteria may enter a tooth via three
mechanisms:
"Coronal leakage" results when decay
and bacteria invade a tooth under a loose filling or ill-fitting crown.
Bacteria may persist within the
complex anatomy of the root canal system following prior root canal
treatment.
"Anachoresis" is a process in which
bacteria from the systemic circulation are attracted to areas of chronic
inflammation, such can occur when a tooth is failing endodontically.
Root canal treatment may fail because
of chronic "wear and tear" on the teeth.
The mouth is a very harsh
environment and teeth are subject to tremendous stresses. These stresses can
compromise even the best dental treatment by causing teeth and fillings to
crack and leak.
If this occurs, saliva, which contains bacteria, can be
introduced into the tooth and cause a well-performed root canal to fail.
Endodontic treatment may also fail if a tooth fractures as the result of
biting on something hard (ice, popcorn, a piece of bone, etc.) or from a
traumatic accident.
Root canal treatment may fail due to an
unforeseen procedural mishap. During any treatment procedure, an event may
occur that has a potentially negative effect on the prognosis of the tooth.
For example, if an instrument breaks inside the root canal space and the
fragment cannot be removed, then treatment may be compromised.
As another
example, the root canal space may calcify and make canal identification and
treatment difficult.
In trying to find these small or restricted canals, an instrument may
perforate the side of the tooth. These procedural mishaps can oftentimes be
repaired using current techniques and materials.
Infrequently, however, a procedural mishap cannot be adequately managed and
root canal treatment fails. Every treatment has risks and mishaps may occur
even when the best techniques are being utilized by the most skilled and
experienced practitioners.
Endodontically treated teeth can fail
due to periodontal disease. This disease can undermine and destroy the
supporting structures of the tooth.
Even though root canal treatments sometimes
fail, it is not a frequent occurrence when modern concepts, improved
technologies and current techniques are utilized for clinical treatment
procedures.
If a
root canal treatment has not been successful, endodontic
retreatment may be considered. Retreatment procedures have become increasingly
predictable in successfully saving teeth.
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