Case 22 Why root canals fail/ 5 canals, tooth #19

Pre-operative x-ray

Previous root canal treatment.  It appears that there are spaces in the root canal system that have not been negotiated or cleaned, especially the distal root.

Post-operative x-ray

Note: 3 files in distal root

Photo: 5 canal orifices
Post-operative x-ray

All canals were cleaned and filled to the radiographic apex.

Though teeth may have multiple canal systems and some of the canals may meet apically, a dirty canal will inevitably cause periapical symptoms as contamination may occur from the unclean canal.  A canal obturated with gutta percha will not stop contamination from a neighboring canal that joins it.