How would an endo retreat this?

[Kennethk]

On my bottom two it looks like infection is spreading, the dentist said it was far from needing to be extracted however I'm curious is it a simple case of just redoing the root canal? Since these are nearly 15 year old root canal treatments.

 

[Dr M]

The root canals are not filled to length. They can be re-done, but the re-treatment will be done through the crowns, which can compromise the crowns. The patient should be informed that the crowns might need to be replaced at a later stage. It is a risk.
Also take into consideration the length of the infection. There is a chance that the peri-apical areas will not clear up with re-treatment alone and then you might need an apicoectomy to be done in conjuction with the re-treatment. Chronic infection often leads to granulation tissue formation, that will need to be scraped out of the bone, to allow healing to take place.
I would recommend doing a CBCT to evaluate the extent of the infection/area.

 

[Kennethk]

The root canals are not filled to length. They can be re-done, but the re-treatment will be done through the crowns, which can compromise the crowns. The patient should be informed that the crowns might need to be replaced at a later stage. It is a risk.
Also take into consideration the length of the infection. There is a chance that the peri-apical areas will not clear up with re-treatment alone and then you might need an apicoectomy to be done in conjuction with the re-treatment. Chronic infection often leads to granulation tissue formation, that will need to be scraped out of the bone, to allow healing to take place.
I would recommend doing a CBCT to evaluate the extent of the infection/area.

These are my teeth I was assuming the gum line might have to be cut and further drained I plan to replace the crowns as they're 15+ years old. I noticed that also it almost looks like the gutta percha is dissolving I'm not sure if that can be common being so old. If you look at the bottom it almost looks like a piece of mate has fallen through bone.

 

[Dr M]

Most likely the GP was extruded on the one incisor, when the initial RCT was done, or part of a K-file broke off at the tip

 

[MattKW]

1. It'll be high-risk dentistry and your endodontist will prepare you for the worst, i.e. possible extractions.
2. Placing crowns on lower incisors is difficult and often leaves not much remaining natural tooth - we can't see what is left from these Xrays because the metal of the crown obscures what's underneath.
3. Having said that, normally an endo will try to retreat the root canals as this is the least risky and drastic thing to do. He may want to remove the crowns to more easily find the canals, or maybe drill through the crowns (difficult) to get to the canals. If he can do the retreatment, then it is likely you'll heal up without surgery.
4. If retreatment is technically redone but the damage at the tip of the roots doesn't heal, then he may consider minor surgery to lifting the gum and curetting out the bad tissue.

 

[Kennethk]

1. It'll be high-risk dentistry and your endodontist will prepare you for the worst, i.e. possible extractions.
2. Placing crowns on lower incisors is difficult and often leaves not much remaining natural tooth - we can't see what is left from these Xrays because the metal of the crown obscures what's underneath.
3. Having said that, normally an endo will try to retreat the root canals as this is the least risky and drastic thing to do. He may want to remove the crowns to more easily find the canals, or maybe drill through the crowns (difficult) to get to the canals. If he can do the retreatment, then it is likely you'll heal up without surgery.
4. If retreatment is technically redone but the damage at the tip of the roots doesn't heal, then he may consider minor surgery to lifting the gum and curetting out the bad tissue.

From the generals I've seen they think it's far from extraction so hopefully that. From what I know they drill from the front and treat that way. Sucks I won't be able to get crowns on thrm for a while. Original plan was to have a bridge redone but since infection can spread I'd rather get this done first. From my understanding abcess infection hardly ever goes away root canals just stop it from spreading to the bone.

 

[MattKW]

The infection is already in the bone. The unfilled space in the canals is supplying it with a source of bacteria. If the root canal therapy can be successfully retreated, then your body will clean up the abscess.

 

[Kennethk]

The infection is already in the bone. The unfilled space in the canals is supplying it with a source of bacteria. If the root canal therapy can be successfully retreated, then your body will clean up the abscess.

Further update just had my endo exam and luckily the endo does think only 24/25 needs a retreat and the infection should subside. Since 26 responded to a cold test which was weird and painful it was vibrations of cold. New dental tools are crazy.