Endodontic Procedures

Root Canal Therapy

A root canal treatment is needed when the soft tissue inside the root of a tooth, known as the pulp, experiences inflammation or infection. Inflammation or infection can occur as a result of several things, including severe decay that burrows into the deeper reaches of a tooth, repeated dental procedures or the presence of a chip or crack. A trauma or injury to a tooth may result in pulpal damage that is not visible to the naked eye. However, if the tooth remains untreated, pain or sensitivity may occur and an abscess could develop.

Symptoms

Symptoms you may experience prior to needing root canal therapy include persistent sensitivity to heat or cold and tooth discoloration. The tooth may also be sensitive to chewing and touch. Other warning signs include inflammation, drainage and sensitivity in the lymph nodes, nearby bone and gum tissues. However, sometimes you may not experience any symptoms but still be in need of endodontics treatment.

Treatment

Under a microscope, we will extract the inflamed or infected pulp, and then thoroughly cleanse and carefully reshape the canal. Afterwards the channel is filled and sealed with a temporary filling material. Within two to five weeks, you will need to see your general dentist for a permanent restoration (filling or crown) of the tooth. This will protect the tooth and restore it to its proper function.

Procedure

We will use local anesthesia in your tooth area.

A dental rubber dam will be placed to isolate your tooth.

Your tooth will be opened to allow access for the removal of infected or necrotic dental pulp.

Under the microscope the canals are thoroughly cleaned.

With specialized instruments your doctor will shape your canals.

The roots are filled again will biocompatible filling material.

A temporary filling will be placed over the access opening to protect your roots from being exposed or contaminated until you return to your general dentist for your final restoration.

We advise you return to your general dentist between two to five weeks after your root canal therapy is completed to have your final restoration. A common misconception is that a root canal is an uncomfortable procedure. Actually, root canals are similar to having a cavity filled, producing minimal discomfort.

Root Canal Retreatment

With proper care, most teeth that have had endodontics (root canal) treatment can last as long as other natural teeth. In some cases, however, a tooth that has received endodontics treatment fails to heal. Occasionally, the tooth becomes painful and diseased months or even years after successful treatment.

As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons.

Narrow or curved canals were not treated during the initial procedure.
Complicated canal anatomy went undetected in the first procedure.
The restoration did not prevent salivary contamination to the inside of the tooth.

Sometimes a new problem can develop in a tooth that was successfully treated during the initial procedure. These include:

A fracture occurs.
New decay develops, exposing the canal to bacteria and a new infection.
Infection can occur if the crown or filling becomes loose or cracked

If retreatment is necessary, using a microscope, we will reopen the tooth. After extracting the filling material, the canals will be thoroughly cleaned and carefully examined to see if additional canals are present that require treatment.

Once the canals are comprehensively cleaned, we will place a temporary filling. If the canals are unusually narrow or blocked, we may recommend endodontics surgery. After retreatment is completed, within two to five weeks, you will need to see your dentist for the final restoration. If possible, preserving your natural tooth is always the best option. Teeth that have been restored with a filling or crown can last for years, even a lifetime.

Cracked Teeth

Since people are living longer and more demanding lives today our teeth sometimes can suffer the consequences, being subjected to additional years of crack-inducing habits. Some of these habits include, clenching, grinding and chewing hard objects, which ultimately make our teeth more vulnerable to cracking.

There are numerous symptoms for cracked teeth, including increased sensitivity and pain while chewing or being exposed to extreme temperature changes. Occasionally, the pain will not be consistent, which can make it difficult for our endodontists to determine which tooth is causing the discomfort.

We want to help you understand why cracked teeth may cause pain and discomfort. It is important to first understand the anatomy of the tooth. Beneath the white enamel of the tooth (the hard layer called dentin), there is inner soft tissue called pulp. The loose pulp is connective tissue that is comprised of cells, blood vessels and nerves. When a tooth is cracked, chewing can cause the movement of the hard pieces of the tooth to irritate the pulp, which can cause severe sharp pain at times, and even numerous times, while chewing. If treatment is not sought quickly, the irritation to the pulp could eventually damage the pulp enough where it can no longer heal itself. When this occurs, pain may also occur when subject to extreme temperatures. It is also possible for larger cracks that are left untreated to cause an infection inside the pulp tissue, which can spread to surrounding bone and gum tissue.

Early diagnosis is extremely important with cracked teeth. The sooner a crack is detected and treated, the better the chance of saving your tooth. Endodontists are dentists with two to three additional years of education that includes diagnosing and treating unusual dental pain. Your endodontists specialized training and expertise can be valuable when a cracked tooth is suspected. Cracked tooth pain often comes from damage to the pulp tissue and having root canal therapy can relieve this pain.

Cracked Tooth Syndrome

Although the tooth is not completely separated, the crack will extend from the chewing surface of the tooth vertically down towards the root of the tooth. Damage to the pulp tissue is very common when the position of the crack is vertical, and root canal therapy will be necessary to treat the damaged pulp. Following treatment, your general dentist will place a crown over the tooth to hold the pieces together and protect it from further damage. In some cases, where the crack extends below the gingival tissue, an extraction may be necessary.

It is sometimes very difficult to determine the extent of the crack, even when using state-of-the-art magnification equipment and specialized lighting. If a cracked tooth is left untreated it will only worsen and will eventually require the tooth to be extracted. We highly recommend early diagnosis and treatment to make every effort to save a cracked tooth.

Vertical Rot Fracture

A vertical root fracture begins in the root of the tooth and extends upward towards the chewing surface. This type of crack often has few symptoms and therefore goes undetected. Sometimes they are not noticed until the surrounding bone and gum tissue become infected. Although extraction is normally recommended for these types of cracks, your endodontist may be able to offer endodontic surgery as an alternative in effort to save the tooth.

A fractured tooth is unlike a broken bone; it cannot heal. Although treatment may sometimes help prevent further cracking, it is possible that it may progress and completely separate, ultimately requiring an extraction of the tooth. A crown can offer maximum protection for a cracked tooth, but does not guarantee that the crack tooth will not continue to deteriorate in the future.

In most instances, treated cracked teeth can continue to function properly and provide years of comfortable use.

Traumatic Dental Injuries

Chipped teeth account for the majority of all dental injuries. Dislodged or knocked-out teeth are examples of less frequent, but more severe injuries. Treatment depends on the type, location and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam.

Endodontic Surgery

Occasionally, as a result of repeated procedures and/or micro crack some inflammation or infection persists in the bony area around the end of the tooth after endodontic treatment. In such a case, surgery may be indicated.

Surgery can help save your tooth in a variety of situations:

Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on you x-ray, you tooth may have a tiny fracture or canal that could not be detected during non surgical treatment. In such a case, surgery allows us to examine the root of your tooth, find the problem and provide treatment.
Sometimes calcium deposits make a canal too narrow for the cleaning and shaping instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this "calcification," we may perform endodontic surgery to clean and seal the remainder of the canal.
Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may fail to heal. The tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save the tooth.
Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Local anesthetics make the procedure comfortable. You may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. We will recommend appropriate pain medication to alleviate your discomfort. Most patient return to work or other routine activities the next day.

Often the only other alternative to surgery is the extraction of the tooth. The extracted tooth must be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting.

No matter how effective modern tooth replacements are, nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning, natural tooth for the rest of your life.