Save or Extract

My root canal treatment has failed: what happens now?

Is saving the tooth still possible, or are you losing time?

If the same tooth is hurting again, swelling, or there is discharge from the gum, the treatment has not worked. On this page we explain the three options and which of them is realistic for your tooth. If you send us your X-ray, we will write to you within 24 hours to tell you which route you are on.

Short answer

You do not have to lose the tooth. There are three options: root canal retreatment, apicoectomy (root-end surgery), and extraction with an implant. Which one will work depends on two things: whether the root is cracked, and how much the bone around it has resorbed. If the root is sound, we try to save the tooth. If the root has cracked along its length, an attempt to save it only costs you time, and during that time the bone carries on resorbing.

What the decision needs: An examination and a 3D CBCT scan
Initial assessment: From your X-ray, within 24 hours
What decides it: A crack in the root, and the bone
Is it urgent?: Yes, if there is swelling and a fever

Medically reviewed by Bilge Ilgın, Dentist · ImplantologyLast reviewed 2026-08-27

Why root canal treatment fails

The aim of root canal treatment is to clean out the infected tissue inside the tooth and fill the space so that it is sealed. When it does not work, the reason is usually not a mistake by the dentist but the tooth's own anatomy: molars have fine side canals branching off the main canal, and neither the cleaning instruments nor the rinsing solution fully reach some of them. The bacteria left behind multiply again months or years later.

The second common reason is leakage. Even if the canal has been filled perfectly, bacteria get back into the canal space if the filling or crown on top opens up at its edge. That is why the permanent crown on a tooth whose root canal treatment has been completed should not be delayed; a tooth left with a temporary filling for months becomes infected again, even if the treatment itself was successful.

The third, and the one that matters most for the decision, is a fracture. A tooth that has had root canal treatment loses the living tissue inside it, and with it some of its flexibility. Over the years, under the force of chewing, a vertical crack can form in the root. This crack is often not visible on a standard X-ray; it can only be detected with a CBCT scan or by looking at it directly. There is nothing to save in a tooth whose root has cracked along its length, because the crack opens up a pathway for bacteria that cannot be sealed.

These three reasons do not lead to the same outcome. The first and second can be corrected; the third cannot. That is why the first thing we do is not choose a treatment but see which reason applies.

When the tooth can be saved

The breakdown below becomes clear after an examination and a CBCT scan. Seeing yourself in the second list does not mean the door has closed; it only means the option we will talk about changes.

The tooth can be saved

The root is sound and the problem is inside the canalIf the infection comes from the canal not having been fully cleaned, retreatment is a realistic option. In this case, saving your tooth is the first thing we try.
There is enough tooth left above the gumIf a sound wall is left for the crown to sit on, the tooth can be restored again and will carry on taking the load of chewing.
The supporting bone has been preservedIf the resorption around the root is limited, the tooth stays in place. This makes an attempt to save it both sensible and a step that can be reversed.
The problem is only at the root tipIf the infection is confined to the last few millimetres of the root, we deal with it by apicoectomy, without reopening the canal. Your crown stays in place too.

Saving it is unlikely to hold

A vertical crack in the rootThe crack opens up a pathway for bacteria that cannot be sealed; no retreatment will seal it. In this case, what we will talk about is not saving the tooth but when and how we replace it.
A fracture below the gum lineIf there is no sound wall left for the crown to hold on to, any restoration will not last long. You do not want to be back at the same point two years later, and with less bone.
Advanced bone lossIf most of the support around the root has resorbed, the tooth will carry on being loose. The real question here is not about the tooth but about how to preserve the remaining bone.
Repeated failureIf the same tooth has been treated several times and become infected again, the chances of another attempt succeeding are low. At this point, talking about a permanent solution costs less.

How we reach the decision

This sequence is for diagnosis, not treatment. At the end, you will know which option is realistic for your tooth and why.

1
Send us your X-ray
If you have a panoramic X-ray or a CBCT scan, send it through the form. Our dentist Bilge Ilgın assesses the image, and we write to you within 24 hours about which options are on the table. You do not need to come in for this step.
2
We talk through the history of the problem
When the pain started and in what situations, when the root canal treatment was done and how many times the problem has come back since then all directly affect the decision. Infection that keeps coming back is read differently from pain that has appeared for the first time.
3
Clinical examination
We assess how the tooth responds to tapping, how loose it is, how deep the gum pocket is and, if there is one, the opening of a fistula (a small gum boil). A deep pocket at a single point is often the first sign of a cracked root.
4
Three-dimensional imaging
A cone beam CT (CBCT) scan shows root cracks that are not visible on a standard X-ray, side canals that were missed and the true extent of the bone resorption. The decision usually becomes clear at this point. A dentist who does not ask for a CBCT scan is making the decision with incomplete information.
5
We talk through the options together
We explain openly what to expect from each option, how many visits it needs and what is left if it fails. How much time an attempt to save the tooth gains you, or loses you, is also part of this conversation.

The three options

None of them is better than the others in absolute terms. Which is better depends on the condition of the tooth, and the right order almost always starts with the least invasive.

Root canal retreatment

The existing filling is removed, and the canal is cleaned and filled again. It is the least invasive way to keep your own tooth and, if the root is sound, it is the first thing we try. If it fails, the implant option is still on the table; the reverse is not true. For teeth whose root is not cracked and that have enough tooth left above it.

Apicoectomy (root-end surgery)

Instead of reopening the canal, the infected tissue at the root tip is cleaned out through a small window in the gum, and the end of the root is sealed from that side. Your crown stays in place, and it is done in a single session. For teeth with a sound crown where the problem is confined to the root tip.

Extraction and an implant

If the tooth cannot be saved, we replace it with an implant. We carry out the extraction and the implant in the same session; this largely prevents the bone in the extraction socket from resorbing and reduces the need for a graft later. For teeth with a cracked root, advanced bone loss or a history of repeated treatment.

What you need to know when deciding

We write these down not to frighten you but so that you can ask the right questions whichever dentist you see. If a dentist does not tell you these things of their own accord, ask.

Waiting costs you bone

As long as the infection around the root continues, the bone keeps resorbing. A tooth that could be extracted today, with an implant placed in the same session, may six months later need a graft first, then a wait, then an implant. Putting off the decision usually makes the treatment bigger.

A crack does not show on a standard X-ray

A vertical root fracture often goes unnoticed on a two-dimensional X-ray. A decision to save the tooth made without asking for a CBCT scan is based on incomplete information.

Retreatment can fail too

An area that could not be reached in the first treatment may also be out of reach at the second attempt. It is worth trying, but you need to go in knowing from the start what will happen if it fails.

The order cannot be reversed

If an attempt to save the tooth fails, extraction is still possible. But a tooth that has been extracted cannot be put back. That is why we almost always try to save it first, as long as the root is not cracked.

The real cost of a cheap solution

An attempt to save the tooth made with inadequate planning brings the extraction, a graft and an implant all together two years later. The total cost ends up higher than making the right decision at the start.

What to expect afterwards

The course below applies when extraction and an implant are chosen. Healing after retreatment is much shorter and is usually complete within a few days.

The first 48 hours
Some swelling and tenderness are normal. A cold compress and the painkiller we give you are enough. You do not usually need to take time off work during this period.
The first week
The swelling goes down. We ask you to avoid hard and hot food and to brush the area gently. If you have stitches, they are removed according to the clinic's follow-up plan.
The first three months
During this period the implant's fusion with the bone progresses, and you still need to be careful when chewing.
Once it has healed
Care is no different from a natural tooth: brushing, interdental cleaning and regular check-ups.

Message us right away if

Swelling increases after the third day. Swelling is expected to go down as you heal; if it increases, it needs to be assessed.
You have a fever. A fever can be a sign of infection. Call without waiting.
Numbness does not wear off. Always tell us about numbness that persists in your lip or chin.

What determines the cost

We do not give a single figure on this page, because the right figure can only be given once the CBCT scan has been seen, and the difference between saving the tooth and an implant is very large. Send us your X-ray and we will share the scope and the figure in writing. These are the items that determine the price:

The route chosen: Retreatment, apicoectomy and an implant are different procedures, and their duration, materials and number of sessions differ too. The difference between them can be several-fold.
Whether additional surgery is needed: If a bone graft or a sinus lift (sinus floor elevation) is needed, the scope widens. For patients who decide early, this item often does not come into it at all.
The crown on top: The material of the crown made on the implant and the laboratory work have a direct effect on the total. We tell you in writing at the outset which brand of material we use.
The number of teeth: If more than one tooth is affected in the same area, the plan is not built around a single tooth; dealing with them together often means both fewer visits and a lower total cost.

Frequently asked questions

Another dentist said 'it can't be saved, let's take it out'. Should I get a second opinion?

Getting a second opinion when an extraction has been recommended is a reasonable step. But when you ask for one, take your CBCT scan with you: if the discussion is not based on the same image, the two dentists will in fact have assessed different things. If you send us your X-ray, we give you a second opinion in writing, free of charge.

I have no pain. Do I still need to do anything?

Yes. Infection at the root of a tooth that has had root canal treatment can progress for a long time without pain, because the nerve tissue that would give the warning has already been removed. A lesion at the root tip seen on a check-up X-ray should be monitored even if there is no pain; in the meantime, the bone is quietly resorbing.

Should I try retreatment, or go straight for an implant?

If the root is sound and there is enough tooth left, we try retreatment first; if it fails, the implant option is still there. The reverse is not true. But if the root is cracked or the bone has resorbed to an advanced degree, the chances of success are low and the time that passes costs you bone. This distinction cannot be made without a CBCT scan.

Can I have the extraction and the implant on the same day?

Yes, and that is the route we prefer. If the bone walls of the extraction socket are sound and the infection is under control, we place the implant in the same session. This largely prevents the bone from resorbing and reduces the need for a graft later. It is not possible for every patient; the decision is made on the basis of the CBCT scan and what is found during the extraction.

What happens if an implant does not take?

Losing an implant is a possible outcome, and we say so from the start. If it happens early on, a new implant can often be placed once the area has healed. If the loss is down to us, we take on redoing the treatment; we set out the scope of this in writing in the treatment plan rather than leaving it as a verbal promise.

Why don't you put the price on the page?

Because the costs of the three options on this page are very different from one another, and we cannot tell which one applies to you without seeing a CBCT scan. Any figure we wrote would either frighten you unnecessarily or change at the clinic. Send us your X-ray and we will share the scope in writing, item by item.

Who carries out the treatment?

Implant planning and surgery are carried out by our dentist Bilge Ilgın. Bilge Ilgın also reads the X-ray you send for the initial assessment, so the first reply is written not by an assistant but by the dentist who will carry out the treatment.

Sources

Send your X-ray and we will tell you which option is realistic for your tooth.

Get an assessment

Next step

Send your X-ray and we will talk through the options.

Share your CBCT or panoramic X-ray. We will write back within 24 hours on which option is realistic for your tooth.

Get an assessment