Root Canal

 

What is endodontic treatment?

 

"Endo" is the Greek word for "inside" and "odont" is Greek for "tooth". Endodontic treatment treats the inside of the tooth.

To understand endodontic treatment, it helps to know something about the anatomy of a 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 tissue 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 tissue 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, a blow 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, and swelling and tenderness in the nearby gums. Sometimes, there are no
symptoms.

 

Who performs endodontic treatment?

All dentists, including your general dentist, received training in endodontic treatment in dental school. General dentists can perform endodontic procedures along with other dental procedures, but often they refer patients needing endodontic treatment to endodontists.


Endodontists are dentists with special training in endodontic procedures. They do only endodontics in their practices because they are specialists. To become specialists, they complete dental school and an additional three or more years of advanced training in endodontics. They perform routine as well as difficult and very complex endodontic procedures, including endodontic surgery. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.

 

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. Afterwards, 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.

 

Will I feel pain during or after the procedure?

Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure For the first few days after treatment your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with overthe-
counter or prescription medications. Follow your endodontist's instructions carefully. Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that last more than a few days, call your endodontist.

 

A second chance to save your tooth.

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.

 

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 some 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.

 

What will happen during retreatment?

 

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

 

 

After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth, carefully searching for any additional canals or unusual anatomy that requires treatment.

After cleaning the canal(s), the endodontist will fill and seal the canal(s), and place a temporary filling in the tooth*. Post space may also be prepared at this time.

 
After the final visit with your endodontist, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to full function.
* If the canals are unusly narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed.
 

Is retreatment the best choice for me?

Retreated teeth can function well for years, even for a lifetime. It's always best to save the tooth if your endodontist believes retreatment is the best option for you.

Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may even be able to use a new technique that was not available when you had your first procedure. If your tooth has unusual anatomy that was not cleaned and sealed during the first procedure, your endodontist may be able to resolve this problem with a second treatment.

Of course, there are no guarantees with any dental or medical procedure. Your endodontist will discuss your options and the chances of success before beginning retreatment.

 

What are the alternatives to retreatment?

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 the chewing function and to prevent adjacent teeth from shifting. Because these options require extensive 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 your natural tooth. You've already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.

 

Why would I need endodontic surgery?

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 your x-ray, your tooth may have a tiny fracture or canal that could not be detected during non-surgical treatment. In such a case, surgery allows your endodontist 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 non-surgical root canal treatment to reach the end of the root. If your tooth has this "calcification," your endodontist may perform surgery to clean and seal the reimagesder 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 your tooth.
  • Surgery may also be performed to treat damaged root surfaces or surrounding bone.
 

What is an apicoectomy?

Although there are many surgical procedures that can be performed to save a tooth, the most common is called 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.

 


In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.A small filling may also be placed to seal the end of the oral canal, and a few stitches or sutures are placed in the gum to
help the tissue heal properly.
 

 


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

Are there any other types of endodontic surgery?

Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.

In very complex cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.

The procedures are designed to help you save your tooth.

 

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. Your endodontist will recommend appropriate pain medication to alleviate your discomfort.


Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.

 

Can I drive myself home?

Often you can, but you should ask your endodontist before your appointment so that you can make transportation arrangements if necessary.

 

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.

 

How do I know the surgery will be successful?

Your dentist or endodontist is suggesting endodontic surgery because he or she believes it is the best option for you. Of course, there are no guarantees with any surgical procedure. Your endodontist will discuss your chances for success so that you can make an informed decision.

 

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 imagestaining 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 the 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.

 

Why does a cracked tooth hurt?

To understand why a cracked tooth hurts, 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 the inner soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue.

When the outer hard tissues of the tooth are cracked, the chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

Types of Cracks

 

There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and severity of the crack.

Craze Lines
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.

 
Fractured Cusp
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. The tooth will usually be restored by your dentist with a full crown.
 
Cracked Tooth
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. The tooth will usually be restored by your dentist with a full crown.
 

Cracked Tooth
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. The tooth will usually be restored by your dentist with a full crown.

Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.

 

Split Tooth
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth can never be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.

 

Vertical Root Fracture
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment usually involves extraction of the tooth.

However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractures root.

 

Will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will never heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your dentist and/ or endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.