Root canal therapy is one of the most common dental procedures performed by an Endodontist. Root canal therapy also known as a "Root Canal", can save your natural teeth and prevent the need of dental implants or bridges.
In the center of your tooth is the pulp which is a collection of blood vessels that helps to build the surrounding tooth. The pulp can become infected by trauma to the tooth, deep decay, cracks, chips, and by having 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.
If any of these symptoms are experienced, the endodontist will likely recommend non-surgical treatment to eliminate the infected pulp. The pulp is removed and the root canal system is thoroughly cleaned and sealed. Typically local anesthesia will be used 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 the tooth is not amenable to endodontic treatment or the chance of success is unfavorable, the patient will be informed at the time of consultation or when a complication arises during or after treatment.
Endodontic re-treatment will usually last as long as other natural teeth. There may be cases where a tooth has received treatment and may fail to heal or pain may continue to exist. The pain may occur right away or may occur months or years after treatment. If so, endodontic re-treatment may be needed. Improper healing of the tooth can be caused by:
* Curved or narrow canals that were not treated during the initial treatment.
* Complicated canals 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.
Problems can also effect a tooth that was successfully treated. The common problems are, new decay that can expose a root canal filing material, which then may cause an infection and a cracked or loose filling or crown that can expose the tooth to infection.
When endodontic re-treatment has been selected as a solution to the problem, the Endodontist will reopen the tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctor will then clean the canals and carefully examine the inside of the problem tooth. Once the canal has been cleaned they will then fill and seal the canals and place a temporary filling in the tooth. A new crown or restoration will be placed on the tooth to restore full functionally.
Additional information regarding endodontic re-treatment may be found on the American Association of Endodontists website.
Generally, root canal therapy treatment is all that is needed to save a tooth with injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal the tooth, and the 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 in a apicoectomy or also known as a root-end resection.
An apicoectomy is when an incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is then removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root, and then the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.
Cracked teeth display many types of symptoms. These symptoms may include pain when chewing, temperature sensitivities, and even the release of biting pressure. For many patients the pain may come and go, making it difficult to diagnose the cause of discomfort.
Chewing can cause movement of the cracked pieces of the tooth, and the pulp within the tooth becomes irritated. When biting pressure is released, this may cause the crack to close quickly resulting in sharp pain. Over a length time, the pulp will become damaged and the tooth will consistently hurt, even when not chewing. There is a good chance that cracks can also lead to infection of the pulp tissue, then spreading to the bone and gum surrounding the problematic tooth.
Listed below are some examples of Cracked Teeth:
These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common with adults than children. The craze line cracks are superficial and usually do not concern us.
A cusp may become weakened , thus resulting in a fracture. The cusp may break off or be removed by a dentist. When a cusp is fractured it is very rare that it would damage the pulp, so no root canal would be necessary. With no root canal needed, your Endodontist will restore the tooth with a full crown.
This crack in the tooth extends from the chewing surface and vertically travels towards the root of the tooth. Within some dental patients, the crack in the tooth can extend below the gum line, also with possibility of extending as even as far as the root. If the crack reaches the root, then damage to the pulp is common. When this occurs, your Endodontist will recommend root canal treatment. If a cracked tooth is not treated and worsens, this may result in the loss of the tooth. Early detection of a cracked tooth is very important.
A split tooth is usually the result of an untreated cracked tooth. A split tooth is a crack with distinct segments, and unfortunately can not be saved intact. Depending on the position and the severity of the split, it can then be determined if any part of the tooth can be saved. Endodontic re-treatment and restoration can be used to save a portion of the split tooth.
Vertical Root Fracture
A vertical root fracture begins at the root and extends towards the surface of the tooth. Vertical root fractures usually show minimal symptoms and may go without notice. Treatment for a vertical root fracture involves endodontic surgery, this will determine if a portion of the tooth can be saved by removing the fractured root.
A tooth may be dislodged or pushed back onto their sockets due to an injury/trauma. Your Endodontist may try to stabilize the tooth and reposition it. A root canal treatment will be performed within a few weeks of the injury and medication will also be used within the tooth. A permanent root canal filling, will be the final result.
An injury can cause a tooth to be completely knocked out. Should this happen a patient needs to see an Endodontist immediately. The tooth must be kept moist to save it. Root canal treatment will be administered based upon the stage of the development of the root and the length of time the tooth has been out of the mouth.
CHILDREN WITH TOOTH INJURIES
An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:
Apexogenesis helps the root to continue development as the pulp is healed. Soft tissue is covered with medication to promote growth. The tip of the root, which is known as the Apex, will continue to close as the child gets older, allowing the walls of the root canal to thicken. If the pulp heals, then no other treatment will be needed.
Apexification is the removal of unhealthy pulp. The Endodontist will place medication into the root to help a hard tissue form near the root tip, thus hardening the tissue providing a barrier for the root canal filling. The root canal walls will not continue to develop, making the tooth susceptible to fracture. The patient must make sure the tooth is restored correctly.
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