What should be done if a patient is symptomatic and has radiolucency at one of the canals post-RCT?

When a patient exhibits symptoms and shows radiolucency in one of the canals after a root canal treatment (RCT), it indicates that there may be residual infection or an issue with the root canal filling or sealing. In such circumstances, retreating all canals is a prudent approach because it allows for a thorough re-evaluation and cleaning of the canal system. This ensures that any remaining bacteria or infected tissue is addressed, thus improving the chances of treatment success.

Retreating is particularly essential when there are symptoms present, as symptoms often suggest that the situation has not resolved satisfactorily. The presence of radiolucency, which often indicates an inflammatory process or persistent infection, further supports the need to revisit the treatment. By retreating all canals, the clinician can ensure that the entire root canal system is adequately treated, which is essential for achieving proper healing and resolution of the symptoms.

In contrast, merely placing a crown or observing without addressing the root cause of the problem would likely lead to continued issues or failure of the treatment. Referral for surgery might be considered in certain cases, but it is generally premature without first attempting a retreatment, which addresses the initial concern directly.