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In general, whenever a root canal procedure seems to have
failed, the first reaction is to try to redo the root canal
in standard fashion. In other words, try to remove the old
root filling materials (usually gutta percha and endodontic
cement) and re-instrument the tooth before replacing them.
This is not always possible to do since it can be quite difficult
to remove the original root filling. It is often impossible
to do if a post has been placed in the canal to stabilize
the subsequent filling for placement of a crown. In cases
like this, if the failure can be demonstrated (generally using
x-rays) to be associated with one root, it is possible to
do a surgical procedure to remove the offending root tip along
with any abscess associated with it. This is called an Apicoectomy
procedure.
An apicoectomy is done by cutting a soft tissue flap just
above the tip of the root canal treated tooth, puncturing
through the bone and amputating the root tip. This generally
removes any offending dead (or living) tissue and often cures
the problem. In some instances, the dentist will prepare a
tiny cavity preparation at the tip of the root and seal off
the rest of the canal with a tiny amalgam filling. If this
is not possible, it is still often possible to melt some gutta
percha at the tip of the root to seal it off. This is called
a retrofill (retro="from behind"). Apicoectomies
and retrofills are generally thought of as a last resort in
an ongoing effort to save an otherwise hopeless endodontically
treated tooth. They are especially useful in treating a failed
root canal in a tooth with a post and core.
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