Conventional retreatment versus surgery in failed root canal treatment--the importance of canal anatomy.

This case report highlights two important aspects of root canal treatment, knowledge of root canal anatomy and inappropriate use of surgery to correct failure of conventional treatment. Initially, two mandibular incisors were root treated conventionally but only one of the two canals present in both teeth was prepared and filled in each case. Symptoms persisted and a surgical approach was adopted but, again, only one of the root canals in each tooth was located and sealed with a root-end filling. Surgery was performed on a second occasion but again failed to resolve the patient's problems. On referral, the presence of the additional root canals was confirmed and further conventional non-surgical treatment resulted in the immediate cessation of symptoms. This case highlights the need for a thorough understanding of root canal morphology, and the need to expose an angled radiograph when performing root canal therapy on teeth with a high incidence of multiple canals. It emphasises that surgery should not be the first option when conventional treatment fails.