Procedural and Post Procedural Risks pertaining to Root Canal Treatment
Summarised Version:
- The risks include the possibility of instruments separated within the root canals; perforations (extra openings) of the crown or root of the tooth; damage to bridges, existing fillings, crowns or porcelain veneers; loss of tooth structure in gaining access to canals; and cracked teeth. During treatment complications may be discovered which make treatment impossible, or which may require dental surgery. These complications may include: blocked canals due to fillings or prior treatment, natural calcifications, broken instruments, curved roots, periodontal disease (gum disease), splits or fractures of the teeth.
Detailed Version:
- The fine componentry can be accidentally swallowed during the procedure. If this occurs, there is a requirement to have appropriate x-rays and surgical treatment to have it removed.
- During root canal therapy there is a risk that the root or that the tooth may fracture, this can be attributed to previous cracks within the tooth or during the process of cleaning the infection. There is no accurate way to determine how extensive or how severe a crack is until the tooth has been checked or fillings removed. On some occasions, if the cracks or the damage to the tooth is too extensive, the tooth is not advantageous to keep and hence the tooth will need to be removed.
- During the process of root canal treatment, there lies the possibility of the fine instruments to perforate the side of the tooth. This tends to occur in more complex cases including calcified canals, thin canals, abnormal tooth root morphology, obstructions and/or previous root canal entry paths. Minor perforations often do not cause a problem and require a dressing to be placed to let the area heal before continuing.
- The ability to heal after treatment varies between individuals so do not be alarmed if the area is healing quickly or slower than expected. During the follow-up visits, the healing of the root canal will be assessed and managed appropriately if the healing process is not going as expected.
- After root canal therapy, the tooth is significantly weakened due to previous cracks, infections, decay and also shaping and cleaning out the infected pulpal tissues within the root canal. There lies a potential for the tooth to fracture overtime, especially if a final filling or crown has not been placed on a root treated tooth.
- Re-infection of the root canal can occur overtime especially if you do not have an adequate filling or crown to protect after root canal treatment. It can also occur due to decay, cracks, leaking root canal seal, resistant bacteria/infection in the tooth and lack of maintenance. If re-infection of the root canal occurs, it is often difficult to diagnose and the tooth is usually symptomless. It is important to attend follow up appointments in order to assess the healing of the root canal.
- Endodontically treated teeth are often weaker than a natural healthy tooth and most will require a crown to maintain it for long term. The same risk factors resulting in loss of teeth are the same factors that can cause loss of teeth that are treated with root canal. This can include periodontal issues, cracks, decay or trauma.
- In some blocked canal cases, the dentist is unable to effectively clean a root canal because it is blocked either by a separated file or filling left behind from prior root canal treatment or from naturalized calcification. This may warrant a referral to a specialist.
- Separation of instruments may occur when the root canal systems are extremely small and calcified. This may hinder cleaning and shaping procedures with potential impact on prognosis of treatment. However, when managed properly, the presence of a broken fragment per se may not adversely affect the outcome of root canal treatment.
- Risk of failure of treatment: While root canal treatment is a common and generally highly successful dental procedure, there can be potential risks and complications, including the possibility of treatment failure. In such cases where treatment is not successful, retreatment or other dental procedures may be necessary to address the issue. No guarantees can be provided in regards to the succcess of the root canal treatment.