Endodontic treatment part 3: endodontic retreatment

At the end of the second article in this series, we had completed root canal therapy on the patient in this case study. The pre-treatment radiograph demonstrated a significant radiolucency, which needed a period of healing, and a review appointment was scheduled for approximately 6 months' time. At this appointment the patient was asked if the tooth was comfortable and that, on examination, any sinus/fistula present had healed. A radiograph was taken, and the pre- and post-operative pictures compared. If the radiolucency had completely resolved, then we can call the treatment ‘successful’ or ‘healed’.

Very commonly, the radiolucency would only be partially resolved, in which case we might describe it as ‘incomplete healing’ and an appointment scheduled for a further review in six months. At this stage, typically the patient may well lose interest, because in their opinion the treatment is successful because the tooth is asymptomatic/comfortable. If, at the first review visit the tooth is not comfortable and the symptoms have not resolved, it is highly likely that the periradicular radiolucency will still be present. This might be deemed as ‘part-healing’, but in reality, it is probably a ‘failed treatment’. Assuming the tooth was only mildly symptomatic, it might be reviewed for a further 6 months. If the case originally showed a sinus or fistula—and this was still present—then the omens do not look good and the dentist and, indeed, the patient might consider this as a failure.