Root Canal Treatment

A root canal is one of the most common dental procedures and well over 14 million are performed every year. This simple treatment can save your natural teeth and prevent the need for dental implants or bridges.

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Root Canal Retreatment

With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment 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.

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Apicoectomy 

Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal 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. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.

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Cracked Teeth

Cracked teeth demonstrate many types of symptoms, including pain when chewing, and temperature or pressure sensitivity. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.

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Traumatic Injuries

Injuries can happen to teeth and sometimes these can be severe.   Common accidents related to teeth are fractures, positional changes such as dislodgement,  or even avulsion or loss of the tooth.  

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Root Canal Retreatment

With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment 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.

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:

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  • Narrow or curved canals were not treated during the initial procedure.
  • Complicated canal anatomy went undetected in the first procedure.
  • The placement of the crown or other restoration was delayed following the endodontic treatment.
  • The restoration did not prevent salivary contamination to the inside of the tooth.

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

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  • 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.
  • A tooth sustains a fracture.

 

What will happen

during retreatment?

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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—crown, post and core material—must be disassembled and removed to permit access to the root canals.

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

 

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After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the other end of the root to be sealed.

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After your endodontist completes retreatment, 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 its full function.

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Apicoectomy

Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal the tooth and our Endodontists 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?

An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.

 

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What should I expect after an apicoectomy?

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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Your Guide to Cracked Teeth

With their more sophisticated procedures, dentists are helping people keep their teeth longer, because people are living longer and more stressful lives, they are exposing their teeth to many more years of crack-inducing habits, such as clenching, grinding, and chewing on hard objects. These habits make our teeth more susceptible to cracks.

 

Why have I been referred to an

endodontist?

All dentists are trained in the diagnosis and treatment of cracked teeth in dental school. Some cracked teeth, however, can be especially difficult to diagnose, and treatment may involve root canal treatment. That’s why you have been referred to an endodontist.

Endodontists are dentists with at least two additional years of education that include the diagnosis and treatment of unusual dental pain. Cracked tooth pain often comes from damage to the inner soft tissue of the tooth, the pulp. Endodontic treatment, also known as root canal treatment, can relieve that pain.

Early diagnosis is extremely important. Like cracks in a windshield, cracks in teeth often start small and progress slowly. The sooner the crack is detected and treated, the better the chance of saving your tooth. The endodontist’s special training and experience can be valuable when a cracked tooth is suspected

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, 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.

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.

Type of cracks

 

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

 Fractured Cusp

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

 Cracked Tooth

Cracked Tooth

This crack extends from the chewing surface of the tooth vertically towards the root. Sometimes the crack may extend below the gum line, and in severe instances, into the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a full crown to bind and protect the cracked tooth.

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

 Split tooth

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 fracture

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 fractured 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 recommendation. They will advise you on how to keep your natural teeth and achieve optimum dental health.

 Standard or Non-Surgical Root Canal Treatment Indications

Standard or Non-Surgical Root Canal Treatment Indications

 
 

What is a root canal? 

A root canal is one of the most common dental procedures and well over 14 million are performed every year. This simple treatment can save your natural teeth and prevent the need for dental implants or bridges.

At the center of your tooth is pulp. Pulp is a collection of blood vessels that helps to build the surrounding tooth. 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? 

If you experience any of these symptoms, your dentist will most likely recommend non-surgical treatment to eliminate the diseased pulp. This 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 or when a complication becomes evident. We use local anesthesia to eliminate discomfort. In addition, we will provide nitrous oxide analgesia if indicated. 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 restorative dentist. You should contact their office for a follow-up restoration within 30 days of completion at our office. Your restorative 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 always available. 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.

General Instructions Prior to Root Canal Treatment:

This procedure is performed using local anesthesia (numbing), therefore, there are usually no restrictions concerning driving. Time required for the procedure is usually one hour.

  1. Continue all medications for blood pressure, diabetes, thyroid problems and any other conditions as recommended by your physician. If there is any question, please call our office prior to appointment.
  2. Eat a full breakfast or lunch as applicable.
  3. If you have been advised by your physician or dentist to use antibiotic or premedication because of Mitral Valve Prolapse (MVP), heart murmer, hip, knee, cardiac or other prosthesis, or if you have rheumatic heart disease, please make sure you are on the appropriate antibiotic on the day of your appointment. If there is a question, please call the office prior to your appointment.

Post-Treatment Instructions:

Your tooth and surrounding gum tissue may be slightly tender for several days as a result of manipulation during treatment and previous condition of your tooth. This tenderness is normal and is no cause for alarm. Do not chew food on the affected side until your endodontic therapy is completed and your tooth is covered with a protective restoration provided by your restorative dentist. You may continue your regular dental hygiene regimen. Discomfort may be alleviated by taking ibuprofen (Advil), aspirin, or acetaminophen (Tylenol) as directed. NOTE: Alcohol intake is not advised while taking any of these medications. Should you experience discomfort that cannot be controlled with the above listed medications, or should swelling develop, please contact us immediately.

After Completion of Endodontic Treatment:

Endodontic treatment has now been completed. The root canal system has been permanently sealed. However, the outer surface is sealed with a temporary restoration. A follow-up restoration must be placed to protect your tooth against fracture and decay. Please telephone your restorative dentist for an appointment as soon as possible. A complete report of treatment will be sent to your restorative dentist.

 
 

TRAUMATIC INJURIES

Most traumatic dental injuries occur in children, but people of all ages can be affected. Whether the injury is a result of an automobile accident, a sports mishap, an altercation or a bad fall, the severity and type of injury will determine the treatment necessary. There are a number of common injuries that occur to teeth. Many of them affect the inner soft tissues of the tooth, known as the dental pulp. When the pulp becomes injured or inflamed, root canal treatment may be needed.

Type of injuries

Most chipped teeth can be repaired with a simple filling. Sometimes a chip will expose the pulp of the tooth. Some exposures can be treated by placing a filling over the injured area. Other exposures however may require root canal treatment.

 

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split teeth. Cracks may or may not extend into the root. If the crack does not extend into the root, the tooth can usually be restored by your dentist with a full crown. If the crack does extend into the root and affects the pulp, root canal treatment is usually necessary in an attempt to save all or a portion of your tooth.

Chipped or fractured teeth

During an injury, a tooth may be pushed into its socket. This can be one of the more serious injuries.

 

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, such as calcium hydroxide, may be put inside the tooth. A permanent root canal filling will be placed at a later date. You should continue to have the tooth monitored periodically by your dentist to assure proper healing.

 

Sometimes a tooth is pushed partially out of the socket. Repositioning and stabilization of the tooth are usually necessary. If the pulp remains healthy, no additional treatment may be needed. If the pulp is injured, your dentist or endodontist may need to start root canal treatment. Medication, such as calcium hydroxide, may be placed inside the tooth and should be followed by a permanent root canal filling at a later date.

Dislodged teeth

If a tooth is completely knocked out of your mouth, time is of the essence. If this type of injury happens to you, pick-up your tooth by the crown, or chewing portion. Try not to touch the root. If the tooth is dirty, gently rinse it in water. Do not use soap or any other cleaning agent. If possible, place the tooth back into its socket. Go to the dentist immediately.

 

If you cannot put the tooth back in the socket, be sure to keep it moist. The less time the tooth spends drying out, the better the chance for saving the tooth. Solutions to keep your tooth moist are available at local drug stores. You can also put the tooth in milk or a glass of water with only a pinch of salt, or you can simply put it in your mouth between your gum and cheek. Bring your tooth to the dentist immediately.

 

If the tooth has been put back in its socket, your dentist may stabilize the tooth with a splint and check for any other facial injuries. If the tooth has not been put back into its socket, your dentist will examine the tooth to determine if it is still intact and check for other facial injuries. Your dentist will clean the tooth carefully and place it gently back into the socket. Your tooth may need to be stabilized with a splint for a period of time. Depending on the stage of root development, your dentist or endodontist may start root canal treatment. A medication may be placed in the tooth followed by a permanent root canal filling at a later date. The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist may influence the type of treatment you receive. You should contact your physician to see if a tetanus booster is necessary.

 

Avulsed teeth

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth.  If the fracture is close to the root tip, the chances for success are better. If the fracture does not result in the two pieces of the root being separated, there is also a better chance for success. However, the nearer the fracture is to the chewing surface of the tooth, the poorer the long-term success rate, regardless of whether the pieces are separated.

 

Sometimes stabilization with a splint is required for a period of time. If the tissue inside the tooth is damaged, root canal treatment may be needed. A medication may be placed in the canal to prepare the fracture site for the eventual root canal filling.

Root fractures

Children’s permanent or adult teeth that are not fully developed at the time of the Injury may need special attention. In an immature adult tooth, the tip of the root, called the apex, is open, and the root canal walls are thin. As the tooth develops, the apex closes and the canal walls thicken. An injured immature tooth may need one of the following two procedures to improve the chances of saving the tooth:

 

TRAUMATIC DENTAL INJURIES IN CHILDREN?

 

APEXOGENESIS

During apexification, the unhealthy pulp tissue is removed. The endodontist places a medication into the root to help a hard tissue form near the apex, or root tip. This hard tissue provides a barrier for the permanent root canal filling. In spite of appropriate treatment, the root canal walls of a tooth treated by apexification will not continue to develop and thicken, making the tooth susceptible to crown or root fractures. Proper restoration will minimize this possibility and maximize protection of your tooth.

APEXIFICATION

An immature permanent tooth that has been dislodged may require minimal or no treatment other than follow-up until it has matured. If the tooth is severely dislodged, orthodontic or surgical repositioning and stabilization may be necessary.

 

If an immature permanent tooth has been out of the mouth for less than one hour, the tooth should be placed back in its socket, stabilized and watched closely by your dentist or endodontist for three to four weeks. During this time, your dentist will look for changes in tooth color, pain, swelling or loosening of the tooth. If any of these problems arise, an apexification procedure followed by a permanent root canal filling may be needed. If the immature permanent tooth has been out of the mouth and dry for more than one hour, the tooth may be put back in the socket, filled with medication and re-evaluated in six to eight weeks. The long-term health of this tooth is generally poor, so your dentist or endodontist  may discuss other treatment options with you.

Other injuries

The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response all affect the long-term health of the tooth. Timely treatment is particularly important with the dislodged or avulsed tooth to prevent resorption. Resorption occurs when your body, through its own defense mechanisms, begins to reject your own hard tooth structure in response to the traumatic injury. You should return to your dentist or endodontist to have the tooth examined at regular intervals following the injury to ensure that resorption is not occurring and that surrounding tissues continue to heal.