Endodontics Procedures
As an endodontic patient, what should I expect?
- A comprehensive examination to diagnose oralfacial pain and pulpal injury and determine if the tooth is a good candidate for endodontic therapy.
- Non-surgical treatment to eliminate the diseased pulp. The pulp is removed and the root canal system is thoroughly cleaned and sealed.
- Under certain circumstances, microsurgery may be indicated. We are experts in performing this procedure, and utilize sophisticated equipment to ensure the best result.
Non Surgical Root Canal
What is a root canal? A root canal is one of the most common dental procedures performed. Well over 14 million root canal procedures are performed each year. This simple treatment can save your natural teeth and prevent the need of dental implants or bridges.
At the center of your tooth is pulp tissue. Pulp tissue is a collection of blood vessels and nerves that helps to form tooth during development. Infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums.
How is a root canal performed? The injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or more visits depending on the treatment required. Success for this type of treatment occurs in about 90% of cases. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation. Sometimes complications become evident only during or after treatment. You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine.
What happens after treatment? When your root canal therapy has been completed, a record of your treatment will be sent to your general dentist. You should contact his/her office for a follow-up restoration within a few weeks of completion at our office. Your general dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond. To prevent further decay, continue to practice good dental hygiene.
How much will it cost? The cost associated with this procedure can vary depending on factors such as the severity of damage to the affected tooth and which tooth is affected. In general, endodontic treatment is much less expensive than tooth removal and replacement with an artificial tooth.
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Endodontic Retreatment
With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. However, a tooth that has had root canal therapy may fail to heal or pain may continue to exist. Sometimes, the pain may occur months or years after treatment. If so, Endodontic Retreatment may be needed.
Improper healing may be caused by:
Curved or narrow canals which were not treated during the initial treatment.- Complicated canals which were undetected during the initial treatment.
- The crown or restoration was not placed within the appropriate amount of time following the procedure.
- The crown or restoration did not prevent saliva and bacteria from contaminating the inside of the tooth.
In some cases, new problems can influence a tooth which was successfully treated:
New decay can expose a root canal filling material, causing infection.- A cracked or loose filling or crown can expose the tooth to new infection.
Once retreatment has been selected as a solution to your problem, the doctor will reopen your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctors will clean your canals and carefully examine the inside of the problematic tooth. Once cleaned, the doctors will fill and seal the canals and place a temporary filling in the tooth.
After endodontic retreatment, you will need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.
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Apicoectomy: An overview of endodontic surgery
Why would I need Endodontic Surgery?
Generally, a root canal is all that is needed to save teeth with an injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to save the tooth and your endodontist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.
What is an Apicoectomy?
The above diagram illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the tip of the root. A root-end filling is placed to seal root and the gums are sutured. The bone naturally heals around the root over a period of months restoring full function.
Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended. If you have pain that does not respond to medication, please call our office.
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Cracked Teeth
Cracked teeth demonstrate many types of symptoms, including pain when chewing, temperature sensitivity, or even pain upon the release of biting pressure. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.
Chewing can cause movement of the cracked pieces of your tooth, and as a result, the pulp within the tooth becomes irritated. At the same time, when biting pressure is released, the crack can close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and the tooth will consistently hurt, even when you are not chewing. It is possible that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.
Types of Cracks
Craze lines
These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. These types of cracks are superficial and are usually of no concern.
Fractured Cusp
When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp rarely damages the pulp, so root canal is not necessary. Your dentist will usually restore the tooth with a full crown.
Cracked Tooth
This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is common. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential.
Split Tooth
A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. However, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic retreatment by an endodontist and restoration by your dentist can be used to save a portion of the tooth.
Vertical Root Fracture
A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms and may go unnoticed. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise the tooth will have to be extracted.
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Traumatic Injuries
Dislodged Teeth (picture 1 & 2)
Injuries to the mouth can cause teeth to be pushed back into their sockets. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury and a medication will be placed inside the tooth. Eventually, a permanent root canal filling will be placed.
Sometimes a tooth may be pushed partially out of the socket. Again, your endodontist or general dentist may reposition and stabilize your tooth. If the pulp remains healthy, then no other treatment is necessary. However, if the pulp becomes damaged or infected, root canal treatment will be required.
Avulsed Teeth (picture 3)
If an injury causes a tooth to be completely knocked out of your mouth, it is important that you are treated immediately! If this happens to you, keep the tooth moist. If possible, put it back into the socket. A tooth can be saved if it remains moist. You can even put the tooth in milk or a glass of water (add a pinch of salt.) Your Endodontist may start root canal treatment based upon the stage of root development. The length of time the tooth was out of your mouth and the way the tooth was stored, may influence the type of treatment you receive.
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Injuries in children
An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:
Apexogenesis
This procedure encourages the root to continue development as the pulp is healed. The remaining healthy pulp tissue is covered with a medication to encourage continued root development. The tip of the root (apex) will continue to close as the patient gets older. In turn, the walls of the tooth will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.
Apexification
In this case, the unhealthy pulp is removed. The endodontist places medication into the root to help a hard tissue form near the root tip. This hardened tissue provides a barrier for the root canal filling. The walls of the tooth will not continue to develop because the pulp is dead. This situation leaves the tooth susceptible to fractures. It is important to have the tooth properly restored by your dentist.
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