Root canal treatment

Treatment is usually performed in two visits and involves the following steps:

1. We examine and x-ray the tooth, and then administer a local anaesthetic. After the tooth is numb, Naomi places a small protective sheet called a “rubber dam” over the area to isolate the tooth. This is an essential but simple tool which also enables us to use stronger cleaning agents and keep it clean and free of saliva during the procedure. It also makes treatment more comfortable for patients.

           
2. We then make an opening in the crown of the tooth. Very small instruments are used to clean the pulp tissue from the pulp chamber and root canals and to shape the space for filling.

3. After the space is cleaned and shaped, we fill the root canals with a rubber like material called gutta-percha which is biocompatible. The gutta-percha is placed with a cement to ensure complete sealing of the root canals. A temporary filling is placed to seal the opening until you can attend your dentist for the final permanent restoration.
                         
4. After the final visit with Naomi, you must return to your dentist to have a permanent restoration placed on the tooth to protect and restore it to full function. In molar teeth ideally a crown is placed.

          

If the tooth lacks sufficient structure to hold the restoration in place, your dentist may place a post inside the tooth.

           

5. Review appointments are included in the treatment fee and we encourage all our patients to return to the practice for a review after a minimum of 4 months (but usually after six months to a year) to assess for healing. This is conducted at no cost and is an important part of the treatment. Naomi will advise you when you will be due for a review.

Root canal retreatment

Why do I need another root canal treatment?

The source of the initial infection was bacteria and as occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

• 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.

There are cases when for a variety of reasons, everything was not treated optimally the first time around and we are happy to retreat these teeth with the aim of enhancing the cleaning of the canals and upgrading the root filling. As with any medical procedure, occasionally cases can still fail even though everything may have been previously treated to an optimum. We would be reluctant to retreat a case previously treated by another endodontist or ourselves if there were no problems during the initial treatment. In these cases we would usually recommend surgery as the next option.
In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:

• 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.

Often, when this happens, revision of the previous treatment may be performed to save the tooth.

The tooth is first reopened 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.

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

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

Once completed, 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.

Surgery

Why would I need endodontic surgery?

• Surgery can help save your tooth in a variety of situations.
• Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows Naomi to examine the entire root of your tooth, find the problem, and provide treatment, if feasible.
• Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this “calcification,” Naomi may perform endodontic surgery to clean and seal the remainder of the canal.
• Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is the case, surgery may help save your tooth.
• Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Although there are many surgical procedures that can be done to save a tooth, the most common is called apicectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, Naomi may have to do an apicectomy.

                   

What is an apicectomy?

In this procedure, Naomi lifts the gum back to expose the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.

                     
We clean up into the end of the root using ultrasonics and then a seal is placed into the root end. Then the gum is placed into its original position and stitches or sutures are placed in the gum to help the tissue heal properly. We normally see you one week later to remove the stitches and assess for healing.

                      
Over a period of months, the bone heals around the end of the root.

Will the procedure hurt?

Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort as this is a more invasive procedure but usually patients are surprised at how quickly things feel normal. You may experience pain, swelling or bruising for a few days after the procedure while the incision heals. This is normal for any surgical procedure. Naomi will recommend appropriate pain medication to alleviate your discomfort and go through post-operative instructions. You will also have Naomi’s mobile number in case you need to contact her.

Can I drive myself Home?

Usually you can, but sometimes we recommend having someone with you to bring you Home as you might be tired after the procedure.

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. Naomi will be happy to discuss your expected recovery time with you.

How do I know the surgery will be successful?

If everything goes well at the time of the surgery and no cracks are detected in the root the chances of success are very high. Healing can only be properly assessed with a radiograph a few months after the procedure. At the review appointment we look for evidence of bony healing at the root tip. Occasionally a treatment can fail although the patient experiences no symptoms so it is important to have your review appointment.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery is extraction of the tooth. Occasionally nothing is placed into the gap but the restorative options to replace the gap include an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from moving. Because these alternatives require dental procedures on sometimes adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.

No matter how effective modern artificial tooth replacements are nothing is as good as a natural tooth. You’ve already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.

Post removal

Prior to some dental treatments, old posts sometimes need removing or replacing. We provide this service and your dentist will advise if this is required.

Images reproduced with permission from the American Association of Endodontists.