Endodontics is a specialized branch of dentistry that deals with the complex structures found inside the teeth. The Greek word “Endodontics” literally means “inside the tooth” and relates to the tooth pulp, tissues, nerves, and arterioles. Endodontists receive additional dental training after completing dental school to enable them to perform both complex and simple procedures, including root canal therapy.
Historically, a tooth with a diseased nerve would be removed immediately, but endodontists are now able to save the natural tooth in most cases. Generally, extracting the inner tooth structures, then sealing the resulting gap with a crown restores health and functionality to damaged teeth.
Signs and symptoms of endodontic problems:
- Inflammation and tenderness in the gums.
- Teeth that are sensitive to hot and cold foods.
- Tenderness when chewing and biting.
- Tooth discoloration.
- Unexplained pain in the nearby lymph nodes.
Reasons for endodontic treatment
Endodontic treatment (or root canal therapy) is performed to save the natural tooth. In spite of the many advanced restorations available, most dentists agree that there is no substitute for healthy, natural teeth.
Here are some of the main causes of inner tooth damage:
Bacterial infections – Oral bacteria is the most common cause of endodontic problems. Bacteria invade the tooth pulp through tiny fissures in the teeth caused by tooth decay or injury. The resulting inflammation and bacterial infection jeopardize the affected tooth and may cause an abscess to form.
Fractures and chips – When a large part of the surface or crown of the tooth has become completely detached, root canal therapy may be required. The removal of the crown portion leaves the pulp exposed, which can be debilitating painful and problematic.
Injuries – Injuries to the teeth can be caused by a direct or indirect blow to the mouth area. Some injuries cause a tooth to become luxated or dislodged from its socket. Root canal therapy is often needed after the endodontist has successfully stabilized the injured tooth.
Removals – If a tooth has been knocked clean out of the socket, it is important to rinse it and place it back into the socket as quickly as possible. If this is impossible, place the tooth in special dental solution (available at pharmacies) or in milk. These steps will keep the inner mechanisms of the tooth moist and alive while emergency dental treatment is sought. The tooth will be affixed in its socket using a special splint, and the endodontist will then perform root canal therapy to save the tooth.
What does an endodontic procedure invlove?
Root canal therapy usually takes between one and three visits to complete. Complete X-rays of the teeth will be taken and examined before the treatment begins.
Initially, a local anesthetic will be administered, and a dental dam (protective sheet) will be placed to ensure that the surgical area remains free of saliva during the treatment. An opening will be created in the surface of the tooth, and the pulp will be completely removed using small handheld instruments.
The space will then be shaped, cleaned, and filled with gutta-percha. Gutta-percha is a biocompatible material that is somewhat similar to rubber. Cement will be applied on top to ensure that the root canals are completely sealed off. Usually, a temporary filling will be placed to restore functionality to the tooth prior to the permanent restoration procedure. During the final visit, a permanent restoration or crown will be placed.
If you have questions or concerns about endodontic procedures, please contact our office.
Root Canal Retreatment
In rare cases, root canal therapy fails to work as expected. The treated tooth might not heal properly or a patient might experience post-surgical complications that jeopardize the tooth. Root canal retreatment involves the removal of the previous crown and packing material, the cleansing of the root canals, and the re-packing and re-crowning of the tooth. In short, root canal retreatment is almost identical to the original procedure, aside from the structural removal. The success rate for a root canal retreatment runs at around 75%.
Root canal treatments and retreatments are a better alternative than extraction for most individuals. If a tooth has good bone support, a solid surface and healthy gums beneath it, it stands a good chance of being saved. Opting for root canal retreatment can be far less expensive than the alternatives. Dental implants, extensive bridgework and the creation of aesthetically pleasing prosthetic teeth cost far more than working with the natural tooth. They also require maintenance and feel less natural than a “real” tooth.
Why is root canal retreatment required?
Though the prospect of more endodontic surgery might not be pleasant, root canal retreatment is fairly simple. In general, the whole treatment can be completed in 1-3 visits.
There are a number of reasons why root canal therapy unexpectedly fails, including:
- Cracked crown leaking filling material.
- Curved or narrow canals not treated during the original procedure.
- Delay in the placement of restorative devices following the procedure.
- New decay to the tooth.
- New fracture in the treated tooth.
- Saliva entering the restorative structure.
- Undetected complex canal structures.
What does root canal retreatment involve?
On the day of the retreatment procedure a local anesthetic will be administered, unless another type of anesthetic has been selected. The affected tooth is isolated with a rubber dam. The dam protects the tooth during treatment from bacteria and saliva. The amount the dentist can do within a single appointment will much depend on the amount of inflammation present, and the complexity of the treatment.
The first step in a root canal retreatment is to gain access to the inner tooth. If a crown and post have been placed, these will be removed.
Next, filling material and obstructions that block the root canals will be removed. This removal is conducted using an ultrasonic handpiece. The advantage of using this tool is that any unwanted material is vibrated loose. Tiny instruments will then be used to clean and reshape the root canals. X-rays may be taken to ensure that the roots are thoroughly clean. If this part of the treatment proves to be complex, medicated packing material will be applied, and the rest of the cleansing procedure will be done at the next visit.
When the dentist is confident that the root canals are completely clean, gutta-percha is used to pack the space. This rubbery material seals the canals to prevent bacterial invasion. Finally, a temporary crown or filling is applied to tooth. At a later date, the color-matched permanent crown will be placed.
If you have any questions or concerns about root canal retreatment, please ask your dentist.
Root Canal Therapy
Root canal therapy is needed when the nerve of a tooth is affected by decay or infection. In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.
Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed. Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.
Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.
Signs and symptoms for possible root canal therapy:
- An abscess (or pimple) on the gums.
- Sensitivity to hot and cold.
- Severe toothache pain.
- Sometimes no symptoms are present.
- Swelling and/or tenderness.
Reasons for root canal therapy:
- Decay has reached the tooth pulp (the living tissue inside the tooth).
- Infection or abscess have developed inside the tooth or at the root tip.
- Injury or trauma to the tooth.
What does root canal therapy involve?
A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).
While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria. If tooth decay is present, it will also be removed with special dental instruments.
Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.
At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials. A filling will be placed to cover the opening on top of the tooth. In addition, all teeth that have root canal treatment should have a crown (cap) placed. This will protect the tooth and prevent it from breaking, and restore it to its full function.
After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.
You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.
Meet Your Award-Winning Dentist
Dr. Harpreet Dhillon
Dr. Dhillon has been practicing dentistry in the state of Michigan since she graduated from University of Michigan School of Dentistry in 2011. She is board certified and licensed through the state of Michigan and an active member of American Dental Association, Michigan Dental association and is a part of the Macomb Dental Society.
Dr. Dhillon is very passionate passionate about dentistry and takes multiple Continuing Education courses every year to keep up and incorporate new technology and equipment into her practice. She is a member of the ADA, MDA and Macomb Dental Society.
Dr. Dhillon is a an avid animal lover and spends most of her free time with her Siberian Husky Saviour. They both enjoy hiking and long walks together. She also supports the Hairy Houdini Siberian Husky Rescue and believes in helping animals in need.
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