Contraindications of Root Canal Treatment

Contraindications of Root canal Treatment or When should Root Canal Treatment not be performed:

  1. In case of Acute infection which is not yet treated, for RCT to be performed all the infected tissue has to be removed to make it successful but in case of acute infections, proper disinfection is difficult to obtain. Antibiotic treatment has to be done to control the Acute infection and in case of any cyst or granuloma and in severe cases a Sinus opening is seen we have to perform incision and drainage to relieve pressure and pain.
  2. Click here for  – “Step by Step Procedure of Root Canal Treatment”
  3. When there is extensive destruction of the Peri apical tissues involving more than one third of the length of the root. The greater amount of bone destroyed, the less will be likelihood of repair. It was first mentioned by Strinberg.
  4. The Rate of Root Canal treatment Success was lower in cases with areas of rarefaction than those of Vital Pulp extirpation.  Prognosis of Vital Tooth RCT < Prognosis of RCT of infected Tooth.Contraindications of Root canal treatment
  5. The incidence of success decreases with an increase in the size of the area of rarefaction. The larger the initial periapical lesion, the less likely are the chances of repair.
  6. When the root canal of a pulpless tooth with a radiolucent area is obstructed by a curved tooth, a tortuous canal, secondary dentin, a pulp stone that cannot be removed or bypassed, a calcified or partially calcified canal, a malformed tooth or a broken instrument. Instrumentation, disinfection and obturation of the coronal and middle third of the canals are less important, provided the apical third of the root is properly cleaned, disinfected and obturated.
  7. Persistent excessive periapical exudates that cannot be controlled prior to filling the root canal or when negative cultures cannot be obtained. If seepage cannot be controlled in severely infected upper anterior teeth of young people by the usual irrigating solutions or by sealing in an iodine solution or calcium hydroxide paste. Then Periapical Surgery is indicated in such cases.
  8. In case of Accidental or Pathologic perforation of the root surface either due to a misdirected Bur while any step in root canal procedure be it access opening or BMP with and engine driven File or Reamer. The condition of the perforation should be accessed based on the severity if it can be sealed with any cement and continue the RCT procedure it will show good prognosis but if the perforation is either too large or is too deep in the canal RCT is contra-indicated.
  9. In case of Internal or External Resorption RCT procedure may lead to Perforation, based on the resorption stage we should access whether to use Calcium hydroxide and help in inducing repair or to use any restoration to reinforce the walls of the tooth. This has to be done to prevent hemorrhage from entering the root canal and it will not be possible to disinfect the canal properly.
  10. In case of any foreign body embedded in the periapical tissue like a guttapercha cone or any Root canal filling material, these foreign bodies make it difficult to completely disinfect the canal and cause obstruction in intracanal treatment.in such cases Periapical curettage is performed to determine whether to go for  RCT or not.
  11. In case of Root Fracture and Non-Vital Pulp. But in case of Fracture in  the Apical third and non Vital pulp Endodontic treatment can be carried out.
  12. In Perio-Endo Lesions where an Acute infected Pulpless tooth forms a Communication with Gingival Sulcus int he form of a Sinus Tract that cannot be eliminated.
  13. In case of Alveolar Resorption which is extensive involving at least half the root surface. When the periodontal involvement is severe and the tooth is mobile or when the crown root ratio is unfavorable, an effort should be made to improve the periodontal status. And in Case Grade III mobility Endodontic procedure is strictly contra indicated.
  14. In case of Extensive crown destruction where Endodontic treatment is not possible should be accessed properly to go ahead with the treatment.
  15. A minimum of 6-12 months time is required for Osteogenesis to take place after a successful RCT. If after 6 months we can see infection it shows failure of RCT.
  16. Under Systemic conditions: Uncontrolled Diabetes and a recent Myocardial infarction within 6 months of the procedure is strictly contraindicated
Latest Comments
  1. Saba

    Hello, I was going through your website and came across contraindications for RCT. Here you have missed out on the systemic contraindications for RCT- Uncontrolled Diabetes and recent myocardial infarction (6 months).

  2. Varun

    @Saba: thanx for letting me know, will surely add this to the list. Thanks

  3. Tshidi

    Thank you so much for the list. i’l be doing a presentation on RCT soon. plz add on uncompliance of patients as one of the contraindications

  4. Linda

    Please also add inability of many people to pay as the majority of Americans have no or inadequate insurance and lack the funds to pay for this expensive procedure.

  5. davis

    hello , am a dental student, want to find out if root canal in contraindicated in children of any age group and kindly give reasons why. ill appreciate greatly

  6. Fatima

    Can you please explain why wait for 20-30 minutes before pouring of condensation silicone impression, for stress relaxation to occur? I mean when there is stress relaxation, wouldn’t there be change in the actual dimensions of the impression after that and when we invest the wax pattern, we do it immediately to avoid stress relaxation?

  7. dr,mayuri rai

    i want full acess of this article plz send me on my mail id .

  8. Varun

    Hello Dr. Mayuri, can I know the reason you want the article ?

  9. Hiba

    May I please know the reason of contraindication of such patients with these systemic conditions?

  10. Varun

    In both the above mentioned Systemic conditions, the healing process is impaired in uncontrolled diabetes and in case of Mycardial infarction the LA injection is not advisable and the prolonged duration of the RCT procedure is contra-indicated in these patients.

  11. ayaan

    sir 10 years back when i was in 8th std, i got a fight n in that fractured my maxillary central incisor at CEJ portion… doctors suggested me fr implant that time but i refused,…. my tooth has got no problem but only a little(1 mm approx) tipped down n with 3rd grade mobility,,, i want to save it,, can u suggest me the treatment if any??

  12. Varun

    Hi ayaan,

    There are two major factors which suggest at a failure if you try to save your tooth in your case 1) Fracture at CEJ and 2) Grade 3 mobility both of which point at extraction and going for an immediate implant placement the best option as it is anterior tooth.

  13. Preetinder

    Hi doc any syndromes that are contraindicated for treatment like down’s syndrome ,cerebral palsy?

  14. Varun

    Most of the syndromes do not pose any hindrance to Root Canal therapy in particular and can be performend in patients suffering from them, the only thing which should be kept in mind is the amoung of cooperation from the patient which affects the outcome of the treatment.
    Even in uncooporative pateints suffering from Downs Syndrome etc, Consious sedation or General Anesthesia is known to be used to perform Root Canal Treatment.

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