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Root Canal Treatment Risks and Complications


While root canal treatment (aka endodontic therapy) is often successful in the hands of a specialist endodontist, it is not without potential complications, which may adversely affect the outcome. These complications may include:

A thorough understanding of these complications is crucial for the prevention, timely diagnosis, and management to ensure the best possible prognosis.

Root Canal Instrument Fractures.

Specialists endodontists occasionally face endodontic therapy instrument fractures wherein a segment of the metal file used during the procedure may break and remain inside the tooth. This complication is one reason why seeking the care of a specialist is useful as specialist dentists are trained to retrieve the fractured instrument. They will therefore attempt to do it straightaway. This occurrence is influenced by factors such as the narrowness, curvature, length, calcification, and the number of roots of the tooth being treated.

  • Ensure straight-line introduction of files
  • Create a glide path before using larger taper NiTi files
  • Use rotary instruments at recommended speed and torque settings
  • Adopt a single-use file policy

These practices can enhance success rates and outcomes of the procedure.

Even with a broken file segment, provided the canal has been sufficiently cleaned, the tooth's longevity and function can be preserved in the hands of a specialist.

Instrument breakage during treatment can lead to serious complications and carries the risk of treatment failure.

Root Canal Sodium Hypochlorite Leak

Essentially, the sodium hypochlorite can, very occasionally, leak outside the tooth and come in contact with bone (entry into the periapical space) despite meticulous precautions taken during endodontic therapy treatment. This event is characterized by severe pain, swelling, haematoma, and ecchymosis.

Aspect Description
Cause Often due to excessive pressure or an unusually large apical foramen
Resolution Usually self-resolves within 2-5 weeks
Impact on Treatment Outcome Can affect the success rates of the primary root canal treatment

In a prospective cohort study, such incidents were shown to impact the outcome of endodontic therapy. Therefore, careful handling and appropriate technique are essential to prevent such accidents. This is incredibly rare in the hands of a specialist endodontist.

Tooth Discolouration.

Tooth discolouration is a common complication of primary endodontic therapy.  This condition can impact the aesthetic result of restorative dentistry and may lead to further procedures such as tooth extraction.

It is suggested that the discoloration is due to internal staining from: Residual pulp tissue becoming necrotic and staining the tooth from the inside - endodontic therapy materials, such as gutta-percha and sealer cements. The lack of pulp pressure in dentinal tubules leads to the increased incorporation of dietary stains in dentin causes staining. In addition, inadequate removal of decayed discoloured tooth structure during the original treatment could be a reason for discolouration.

Poor-quality Root Canal Filling

A poor-quality root filling seriously jeopardizes the outcome of a primary endodontic therapy. When the canal system is not completely cleaned or filled, or the filling material is extruded from the apex, the success rates drastically plummet. Infections may develop in the surrounding bone, as indicated by dark circles at the bottom of the tooth roots in X-ray images.

Such factors can lead to treatment failure, requiring either an endodontic retreatment or tooth extraction and implant placement. The quality of root filling is a critical factor in the treatment's success hence our recommendation to see a specialist dentist.

Inferior Alveolar Nerve Damage.

Nerve damage, which usually happens in the lower jaw due to the anatomy, is typically characterised by symptoms such as: - Tingling or burning sensation in the mouth - Loss of feeling or numbness affecting chewing and speaking - Temporarily or permanently altered sensation. This happens for the same reasons as the hypochlorite leak above i.e. the root canal files OR gutta percha damage the nerves around the teeth. This complication is most likely to happen in the lower jaw (premolar and molar regions) and is best prevented by seeking the care of root canal specialists (who are trained to minimise this risk as much as is humanly possible.


Root Canal Treatment Risks and Complications FAQ

What are the possible complications of root canal treatment?


Complications that can arise from endodontic therapy include instrument fracture, untreated canal, and reinfection of the tooth. These can lead to the need for additional treatment or tooth extraction.

What are the risks and complications associated with root canal therapy?


Risks and complications of root canal therapy may include damage to surrounding tissues, overfilling of the root canal, and post-treatment discomfort or pain. It's important to discuss these risks with your dentist or endodontist before the procedure.

What is a root canal?


A root canal is a dental procedure to treat infection in the pulp of a tooth. It involves removing the infected or damaged pulp, cleaning and disinfecting the root canal system, and then filling and sealing the space.

Can a root canal treatment fail?


Yes, endodontic therapy may fail if the tooth doesn't heal properly or if new infection occurs. In such cases, additional treatment or extraction of the tooth may be necessary.


What are the side effects of root canal treatment?


Possible side effects of endodontic therapy may include temporary numbness or discomfort, which usually subside within a few days. It's important to follow post-operative care instructions provided by the dentist.

What are the effects of root canal treatment on the affected tooth?


Endodontic therapy aims to save the affected tooth by removing the infected pulp and preserving its structure. The tooth may become more brittle over time, and a dental crown may be recommended to protect it from further damage.

How does a root canal procedure affect the dental pulp?


During a root canal procedure, the infected or damaged dental pulp is removed, and the root canal system is cleaned and filled. This helps to eliminate infection and preserve the tooth.

What is the truth about root canal treatment complications?


The truth about endodontic therapy complications is that while they can occur, advancements in dental technology and techniques have significantly reduced the occurrence of complications. It is essential to discuss any concerns with your dentist or endodontist.

Can an infected tooth lead to complications that may require a root canal?


Yes, an infected tooth may lead to complications that can necessitate a root canal procedure. If the infection reaches the dental pulp, root canal therapy may be recommended to save the tooth.

Who can perform a root canal procedure, and what should I expect from the treatment?


A dentist or endodontist can perform a root canal procedure. During the treatment, the affected tooth is numbed, and the infected pulp is removed to alleviate pain and save the tooth from extraction.



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