Endodontics

Endodontic treatment, also known as root canal, is one of the most common dental procedures performed.  This simple treatment can save your natural teeth and prevent the need of dental implants or bridges.  At the center of your tooth is the 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.

A comprehensive examination to diagnose pulpal injury is necessary to determine if the tooth is a good candidate for endodontic therapy. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. Under certain circumstances, microsurgery may be indicated.

The injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy involves local anesthesia and may be completed in one or more visits depending on the pulpal infection. 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 during or after treatment.  You will be able to drive home after your treatment.  Set up an appointment for a follow-up restoration within a few weeks of completion at our office. Together we will decide on what type of restoration is necessary to protect your tooth. With the appropriate care, teeth that have had endodontic treatment will last as long as other natural teeth.

In some cases, new problems can influence a tooth that was successfully treated.  New decay, a cracked or loose filling, a fracture of tooth or crown can expose a root canal filling material, causing infection. Once retreatment has been selected as a solution to your problem, the doctor 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. Once cleaned, the canals will be filled and sealed and a filling or buildup restoration will be placed in the tooth.  At this point, you will need to return as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality. 

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 we will recommend surgery of the tooth. 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.  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 may be placed to prevent re-infection of the root and the gum is sutured. Following the procedure, there may be some discomfort or slight swelling while the incision heals.  This is normal for any surgical procedure.

Cracked 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 the 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.

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. The tooth has about one hour under these conditions before risk of complete damage to the tooth occurs.  A tooth may be saved if it remains moist. You can put the tooth in milk or a glass of water (add a pinch of salt.) We 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 will influence the prognosis of your tooth.

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 doctors 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 restored by our dentists.