Endodontic Treatment



To understand Endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue and creates the surrounding hard tissues of the tooth during development.

The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature, it can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.

Why would I need an Endodontic procedure?
Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess. Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.

How does Endodontic treatment save the tooth?
The Endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterward, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.  
What is the process of an Endodontic treatment?

Endodontic treatment can often be performed in one or two visits and involves the following steps: 


1


Once it is determined that the tooth requires root canal treatment through a thorough exam, the Endodontist administers local anesthetic. After the tooth is numb, the Endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.    





2


The Endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.




3


After the space is cleaned and shaped, the Endodontist fills the root canals with a biocompatible material, usually a rubber-like material called “gutta-percha.” The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.




4


After the final visit with your Endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.




5


If the tooth lacks sufficient structure to hold the restoration in place, your dentist or Endodontist may place a post inside the tooth. Ask your Endodontist for more details about the specific restoration planned for your tooth.


Endodontic Re-Treatment


With proper care, most teeth that have had Endodontic (root canal) treatment can last as long as other natural teeth. In some cases, however, a tooth that has received Endodontic treatment fails to heal or the pain continues. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment. If your tooth has failed to heal or has developed new problems, you have a second chance. Another Endodontic procedure may be able to save your tooth.

Why do I need another Endodontic procedure?

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 crown or other restoration was not placed soon enough after the procedure
  • The restoration did not prevent saliva from contaminating the inside of the tooth



In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:


  • New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth
  • A loose, cracked or broken crown or filling can expose the tooth to new infection

Is retreatment the best choice for me?
For some patients considering retreatment, Endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed. 
Endodontic surgery may be recommended in conjunction with retreatment or as an alternative. Your Endodontist will discuss your options and recommend appropriate treatment.

The only other alternative is an extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time-consuming than retreatment and restoration of the natural tooth.

No matter how effective modern tooth replacements are -- and they can be very effective -- nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The payoff for choosing Endodontic surgery could be a healthy, functioning natural tooth for many years to come.
What are the alternatives to treatment?
For some patients considering retreatment, Endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed. Endodontic surgery may be recommended in conjunction with retreatment or as an alternative. Your Endodontist will discuss your options and recommend appropriate treatment. The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth. No matter how effective modern tooth replacements are -- and they can be very effective -- 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 many years to come.
What will happen during retreatment?
Endodontic Re-treatment can often be performed in two visits and involves the following steps:

1

First, the Endodontist will discuss your treatment options. If you and your family dentist choose retreatment, the Endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials -- crown, post, and core material -- must be disassembled and removed to permit access to the root canals.   




2

After removing the canal filling, the Endodontist can clean the canals and carefully examine the inside of your tooth, searching for any additional canals or unusual anatomy that requires treatment. A medicated paste is placed within the canals to help treat the infection and a temporary filling is placed within the tooth.




3

After the medicine has been within the canals for 2-4 weeks, you will return to our office and the Endodontist will fill and seal the canals with new root canal filling material. We will place another temporary filling within your tooth and ask you to return to your general dentist for a permanent restoration.


Endodontic Surgery

 

 

To understand Endodontic surgery, it helps first to know something about the nonsurgical Endodontic procedure, or “root canal”. A root canal is necessary when the soft inner tissue, or “pulp” of the tooth becomes inflamed or infected. This may happen as a result of deep decay, repeated dental procedures on the tooth, or a blow to the tooth. Endodontic treatment removes the damaged pulp. Then the tooth’s canals are cleaned and filled to help preserve the tooth.  

In a few cases, however, nonsurgical Endodontic treatment alone cannot save the tooth. In such a case, your dentist or Endodontist may recommend surgery.


Why would I need Endodontic surgery?

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 your tooth.   Although there are many surgical procedures that can be performed to save a tooth, the most common is called an “apicoectomy” or “root-end resection”. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy.

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

  • Treating infection that is not responding to traditional root canal therapy
  • Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical 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 your root. If your tooth has this “calcification”, Endodontic surgery may be able to clean and seal the remainder of the canal.

    What is an Apicoectomy?
    1

    In this procedure, the gum tissue near the tooth is opened to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.    





    2

    A small filling may be placed to seal the end of the root canal, and a few stitches or sutures are placed in the gum to help the tissue heal properly.




    3

    Over a period of months, the bone heals around the end of the root.


     


    Will the procedure hurt?
    Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Appropriate pain medication will be prescribed to alleviate your discomfort.
    Who will perform your surgery?

    Our Endodontists are specifically trained to treat recurring Endodontic infections, both surgically and nonsurgically. We offer the most up to date and technologically advanced surgical treatment in our office. 

    How will I know that the surgery will be successful?

    We recommend evaluating the tooth in 6-12 months following the procedure to ensure proper healing at no additional cost to you.

    What are the alternatives to Endodontic surgery?
    Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most cost-effective option for maintaining your oral health. No matter how effective modern tooth replacements are -- and they can be very effective -- 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.