When a tooth (#14) with RCT is symptomatic with a PARL on one canal, what is the recommended treatment?

When dealing with a symptomatic tooth that has undergone root canal treatment (RCT) and presents with a periapical radiolucency (PARL) visible on one canal, the recommended treatment is to retreat all canals instead of just the affected one. The rationale behind retreating all canals is based on several important considerations.

Firstly, the presence of symptoms and a PARL indicates that there may be persistent infection or inflammation even beyond the affected canal. Retreatment of all canals ensures that any non-healing or unresolved issues that may exist in the other canals are addressed. There could be factors such as missed canals, inadequate sealing, or reinfection that contribute to the ongoing symptoms.

Additionally, root canal treatments often involve complex anatomical variations; therefore, treating only the affected canal could lead to suboptimal outcomes, missed pathology, or the potential for reinfection in the other canals. This strategy increases the chances of complete eradication of the infection and reduces the risk of further complications.

In summary, retreating all canals provides a thorough approach to manage the symptomatic condition effectively, ensuring that any issues in all parts of the tooth's root system are adequately treated.