A root canal that fails — persistent infection, recurring pain, or new problems at a previously treated tooth — presents a difficult decision: retreatment (redo the root canal) or extraction (remove the tooth and replace it with an implant or bridge). Both options are valid, and the right choice depends on the specific cause of failure, the tooth's structural condition, and the long-term prognosis.
Why Root Canals Fail
Root canal failure occurs in approximately 5–15% of cases. Common reasons include missed canals (the tooth has anatomy the original treatment didn't address — a common issue in molars with complex canal systems), incomplete cleaning (bacteria remaining in the canal system), coronal leakage (the crown or filling over the root canal fails, allowing bacteria to re-enter), and root fracture (a crack in the root that can't be sealed).
Retreatment vs. Extraction
| Factor | Retreatment | Extraction + Implant |
|---|---|---|
| Preserves natural tooth? | Yes | No |
| Success rate | 75–90% | 95%+ (implant success) |
| Treatment time | 1–2 visits | 3–6 months (extraction → healing → implant → crown) |
| Cost (Colombia) | $300–$600 | $800–$1,400 (extraction + implant + crown) |
| Best when | Cause of failure is correctable; tooth structure is sound | Root is fractured; tooth is structurally compromised; poor long-term prognosis |
Success Rates
Retreatment success depends on why the first root canal failed. Missed canals (good prognosis — the untreated canal is found and treated), incomplete cleaning (moderate prognosis — re-treatment cleans more thoroughly), and root fracture (poor prognosis — retreatment can't fix a cracked root; extraction is usually necessary).
Cost in Colombia
| Procedure | Colombia (typical 2026) | United States |
|---|---|---|
| Root canal retreatment (molar) | $300–$600 | $1,000–$1,800 |
| Apicoectomy (surgical retreatment) | $300–$500 | $800–$1,500 |
| Extraction + implant + crown | $800–$1,400 | $3,000–$6,000 |
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