endodontics
What is Endodontics?Root canal therapy can save your natural teeth and prevent the need of dental implants or bridges.
What is Endodontics?
Endodontics, also called root canal therapy, is the area of dentistry that focuses on the diagnosis and treatment of the diseased dental pulp. The pulp is the small amount of soft tissue containing minute nerves and blood vessels within the tooth. During initial tooth development the pulp is responsible for the formation and growth of the hard part of the tooth. After the crown and root(s) of the tooth have matured, the pulp tissue remains locked inside the tooth in a small root canal space.
During a lifetime, the pulp may become diseased due to a variety of reasons (decay, trauma, deep fillings, cracks). Bacteria that are introduced into the pulp can severely damage the pulp.The inflamed pulp can quickly cause pain and even infection of the surrounding bone and soft tissue. Symptoms of the infection can be identified as visible injury or swelling of the gums, sensitivity to temperature or pain in the tooth and gums. Left without treatment, pus builds up at the root tip, in the jawbone, forming a "pus-pocket" called an abscess. Elimination of the diseased pulp can be accomplished in two ways: saving the tooth by performing endodontic therapy and prevent further inflammation and infection, or extracting the tooth.
Root canal treatment can be very predictable and enjoys over a 95% success rate. Retaining the tooth prevents the loss of function (chewing ability), movement of adjacent teeth and unwanted cosmetic changes.
After successful endodontic treatment, the tooth continues to perform normally.
Specialists in saving teeth
If you choose endodontic treatment, our office will provide you with outstanding care and support. Prior to treatment, we routinely administer local anesthetics which will insure your absolute comfort while the diseased pulp tissue is being removed. We will then thoroughly clean and shape the root canal space and seal this space with a root canal filling. We can usually accomplish this procedure in one or maximum two visits. 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 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.
For over 10 years, dentists have referred patients to our practice with confidence that is based on our reputation for clinical skill and professionalism.
Before endodontic therapy
Root canal will be performed using local anesthesia. There are usually no restrictions after the procedure concerning driving or returning to work. Continue all medications for blood pressure, diabetes, thyroid problems and any other conditions as recommended by your physician. If there is a question, please call our office prior to your appointment.
Please eat a full breakfast or lunch as applicable.
If you have been advised by your physician or dentist to use antibiotic premedication because of mitral valve prolapse (MVP), heart murmur, 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 our office prior to your appointment.
If you can take ibuprofen (Advil, Nurofen), it does help reduce inflammation when taken pre-operatively. We recommend 2 tablets (400mg) 2-4 hours before endodontic therapy.
What happens after treatment?
When your root canal therapy has been completed, your tooth needs a short period of healing after treatment followed a permanent restoration within a few weeks. The restoration is necessary to protect your tooth against further reinfection.
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 fully covered with a protective restoration.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 this office immediately. The office telephone is answered day and night.
It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery.
What technologies are being used?
Endodontics Swiss Micromotor and Rotary ProTaper Files: we shape and clean your canals minimizing any further risk of reinfection
Apex Locator: we determine exactly the length of the canals and record data
Ultrasonics: Ultrasonic instruments can be valuable to remove or loosen obstructions that would otherwise prevent reliable endodontic therapy.
Hydrodinamic Disinfection: accurate cleaning of canals
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. Ten times less expensive!
Endodontic 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.
Improper healing may be caused by:
Curved or narrow canals were not treated during the initial treatment.
Complicated canals went 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 from contaminating the inside of the tooth.
In some cases, new problems can influence a tooth that 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 doctors 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 now 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.
At this point, you will need to make an appointment as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.
Apicoectomy (Root Canal Surgery)
Why would I need Endodontic Surgery?
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 with this procedure. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.
What is an Apicoectomy?
The diagram on the left and the video 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 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.
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.
Cracked TeethCracked teeth demonstrate many types of symptoms, including pain when chewing, temperature sensitivities, or even 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 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 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 commonplace. 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. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic retreatment and restoration 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.
Traumatic InjuriesDislodged Teeth
Injuries to the mouth can cause teeth to be pushed back into their sockets. Your 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, will be placed inside the tooth. Eventually, a permanent root canal filling will be implanted.
Sometimes a tooth may be pushed partially out of the socket. Again, your dentist may reposition and stabilize your tooth. If the pulp remains healthy, then no other treatment is necessary. Yet, if the pulp becomes damaged or infected, root canal treatment will be required.
Avulsed Teeth
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.
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. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close as the child gets older. In turn, the walls of the root canal 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 doctor place 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. At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures. So it is important to have the tooth properly and permanent restored.