ROOT CANAL THERAPY
Root canal therapy is performed on over 15 million teeth each year. Endodontic treatment (commonly referred to as root canal therapy) involves removing the infected of inflamed dental pump (commonly called the nerve). This inflammation or infection can have a variety of causes such as deep cavities, fractures of the tooth, or trauma to the tooth. These events cause irreparable damage to the nerve tissue. our office performs a thorough examination to ensure root canal therapy is truly needed. Digital radiographs (x-rays) are taken of the tooth and displayed on our treatment room computer monitors. Next, a detailed dental interview is completed including any symptoms present currently and in the past, the onset of symptoms, medications taken, etc. Certain conditions will require further testing consisting of chewing tests, examination for swelling, testing for the pulp tissue's response to cold, and examination of the surrounding gums for gum disease. The first step to root canal therapy is achieving profound anesthesia. Both topical anesthetics (numbing gels) and local anesthetics (often called Novocaine) are used to get out patients numb and comfortable. The pain associated with root canal therapy is legendary, but unnecessary. Patients are very pleasantly surprised that root canal therapy can be completed so painlessly and so quickly at an endodontist's office. We pride ourselves on delivering the best care available anywhere. Next, a small rubber rain coat called a rubber dam is placed over the individual tooth to keep it clean and free of saliva during the procedure. This ensures the tooth is isolated, tongue and cheeks are protected, and bacteria from the rest of the mouth do not re-infect the tooth during the procedure.
Our doctors will make a small window into the crown of the tooth. Very small stainless steel and nickel titanium instruments are used to clean and shape the inside of the
tooth and roots. Several irrigants are applied to disinfect the inside of the tooth. It is then dried and then sealed with a biocompatible material. 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. These temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored. These temporary fillings seal the tooth well, but we do not encourage patients to chew on their tooth. This greatly reduces the chance of the tooth fracturing. After the root canal is completed by our office, you must return to your dentist to have a crown or other restoration to protect the tooth and restore it to full function. For additional information please visit AAE (American Association of Endodontists)
Retreatment
With proper care and when performed optimally, a tooth that has received root canal therapy can last a lifetime. However, an occasionally happens with any dental or
medical procedure, a tooth may not heal as expected for a variety of reasons:
Narrow or curved canals were not treated during the initial procedure (missed canals)
Complicated canal anatomy went undetected in the first procedure
The placement of the final restoration or crown as delayed following endodontic treatment
The filling and/or crown did not prevent saliva from re-contaminating the inside of the tooth
New problems can arise that can cause a successfully root canal treated tooth to fail. Examples are
New decay can expose the root canal filling material to bacteria, causing another entirely new infection in the tooth
A loose, cracked, or broken down filling can expose the tooth to bacterial contamination
The tooth sustains a fracture
If the tooth in questions needs retreatment, our doctors will meet with you to discuss all treatment options.
Root canal therapy retreatment requires making a small hole into the tooth to remove all of the previous filling material.
Root canal surgery (Apicoectomy)
An apicoectomy is a surgical root canal procedure whereby the tip (apex) of a tooth is trimmed and removed. Additionally, any abnormal
tissue present around the apex is removed. This tissue may be a cyst that has grown around a tooth root, or abnormal tissue related to persistent infection. First, an evaluation and consultation is performed to ensure root canal surgery is necessary. The procedure will be explained in detail. Any questions you may have are answered. The surgical appointment will then be made.
The first key to success with surgery (and conventional root canal therapy for that matter), is profound anesthesia. Both topical anesthetics (numbing gels) and local anesthetics (often call Novocaine) are used to get our patients numb and comfortable. The pain associated with root canal therapy is legendary, but unnecessary. Patients are very pleasantly surprised that a surgical root canal is virtually painless. In fact, most patients have less discomfort after surgery than conventional root canal therapy. We pride ourselves on delivering the best care available anywhere.
Our office uses Zeiss operating microscopes during the procedure. With modern technology and advanced training, a very small incision is made. The tip of the root is visualized and any abnormal tissue is curetted (removed). If enough tissue is present, a biopsy may be submitted. The tip of the root is removed and the canal is then cleaned in a reverse manner (relative to traditional root canal therapy) using a sophisticated instrument called an ultrasonic hand piece. Our ultrasonic hand pieces use vibrational energy to prepare and clean the canal (they do not cut or rotate like a drill). A surgical filling material called MTA is placed to seal the end of the tooth. This material is very bio-compatible and seals remarkably better than older materials. Finally, a few stitches are placed. Remarkably most patients are amazed at how uneventful the apicoectomy truly is. Most remark, "That was not a big deal at all." They also commonly state that it did not hurt one bit, and they are impressed with the level of expertise and sophistication of the procedure.
Traumatic injuries
-Dislodged teeth/teeth pushed back or up
Injuries to the mouth can cause teeth to be pushed back into their sockets or knocked out of position. Our doctors will examine the extent and severity of the injury. The teeth may then be repositioned in the mouth and stabilized using orthodontic wire. Occasionally the tooth will not require root canal therapy, if the injury was not severe or if the root tip (apex) is not fully mature. However, root canal treatment is usually started within several weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth. Eventually, a permanent root canal filling will be placed.
Avulsed teeth/teeth knocked out of the socket
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. Avoid touching the delicate root as much as possible. If possible gently rinse any debris off of the root (do NOT scrub or handle the root roughly), and place 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. Immediate care is necessary. The tooth will need to be splinted (held in place) by an orthodontic wire. 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.
Children with dental injuries/trauma
An injured immature tooth may need to undergo an initial stage of treatment designed to allow the tooth root to continue to mature. Children's roots are often not fully developed and simply undergoing root canal therapy will leave them unnecessarily weak and susceptible to fracture. The process of Apexogenesis/ Apexification will allow for the root to form more completely and increase its strength. A small window is made in the tooth and pulp tissue (nerve) is covered with medication to encourage growth. The tip of the root (apex) will continue to mature over several months or even years. In turn, the walls of the root canal will thicken. The more mature the root becomes, the better the chance to save the tooth.
Cracked teeth
Cracked teeth demonstrate many types of symptoms including pain when chewing, temperature sensitivities (usually to cold first), or even the release of biting pressure. The painful sensation generally is very brief (sometimes like a quick burst) and may not occur every time you chew. The episodic nature of the discomfort may cause its diagnosis to be challenging. Chewing can cause movement of the cracked pieces of your tooth, and the pulp (nerve) within the tooth becomes irritated. When the biting pressure is released, the crack can close quickly, resulting in sharp pain. Without proper treatment, the pulp tissue will become irreparably damaged and begin hurting without provocation. This spontaneous pain indicates root canal therapy is necessary. 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. Again, root canal therapy is necessary to save the tooth. For additional information please visit AAE (American Association of Endodontists).