A root canal, also known as endodontic treatment, is a common dental procedure aimed at saving a tooth that has become infected or severely damaged. A literal undoing of the procedure to restore the tooth to its original, living state is not possible. However, if complications arise, several effective dental procedures can address these issues and preserve the tooth.
Understanding a Root Canal
A root canal is performed to save a tooth when its inner soft tissue, the pulp, becomes infected or inflamed. The pulp contains nerves, blood vessels, and connective tissue within the tooth’s root canals. The procedure involves removing the damaged pulp, meticulously cleaning and shaping the canals, and then filling and sealing the space to prevent further infection. Common procedures include treatments for a single canal (CDT Code D3310), multiple canals (CDT Code D3320), or bicuspid teeth (CDT Code D3330).
After the pulp is removed, the tooth is considered non-vital because it no longer has its original blood supply or nerve sensation. This process eliminates the source of infection and pain, allowing the tooth to remain in the mouth rather than being extracted. While the tooth is no longer “alive” in the traditional sense, it continues to be nourished by the surrounding tissues and can function normally.
Why Literal Reversal Isn’t Possible
A root canal cannot be literally reversed because it involves the permanent removal of the tooth’s pulp tissue. Once this tissue, containing nerves and blood vessels, is extracted, the tooth becomes non-vital and cannot regenerate. The procedure’s goal is to eliminate infection and preserve the existing tooth structure, not to restore the pulp. Sealing the cleaned canals with a biocompatible material, such as gutta-percha, solidifies this permanent change.
Recognizing a Failed Root Canal
While a root canal treatment has a high success rate, sometimes a treated tooth may not heal as expected or can develop new problems months or even years later. Recognizing the signs of a failed root canal is important for seeking timely intervention. Common indicators include persistent pain or discomfort when chewing or biting, swelling and tenderness in the gums around the treated tooth, or sensitivity to temperature or pressure.
Other signs can include a recurring infection, sometimes manifesting as a “pimple” or boil on the gum, or even discoloration of the treated tooth. Failure can occur due to various reasons, such as incomplete cleaning of the canals during the initial procedure, a new cavity, a cracked tooth, or a new infection. Sometimes, a failed root canal might not present with obvious symptoms and is only detected through X-rays during a routine dental check-up.
Treatment Options for Complications
When a root canal fails, several dental procedures can address the complications and potentially save the tooth. One common approach is root canal re-treatment (CDT Code D3346 for anterior, D3347 for bicuspid, D3348 for molar), which is similar to the original procedure but involves reopening the tooth. During re-treatment, the dentist or endodontist removes the old filling material, thoroughly recleans and reshapes the canals, and then refills them to eliminate any persistent infection. This is often the first line of defense to try and preserve the tooth.
If re-treatment is not sufficient or possible, another option is an apicoectomy (CDT Code D3410 for anterior, D3426 for bicuspid, D3427 for molar). This is a surgical procedure where the tip of the tooth’s root and any surrounding infected tissue are removed. A small filling is then placed at the very end of the root to seal the canal system. An apicoectomy is considered when an infection persists at the root tip despite previous root canal treatment or re-treatment.
In cases where re-treatment or apicoectomy are not viable or successful, extraction of the tooth (CDT Code D7140 for simple, D7210 for surgical) may become necessary. Dental professionals consider tooth extraction a last resort, as preserving natural teeth is usually the preferred outcome. If a tooth is extracted, replacement options like dental implants or bridges can then be considered to restore function and appearance.