All dentists, including your restorative dentist, received training in endodontic treatment in dental school. Restorative dentists can perform root canal procedures along with other dental procedures, but often they refer patients needing endodontic treatment to an endodontist, who is a valuable partner on your restorative dentist’s team of trusted caregivers.
An endodontist is a dentist who specializes in saving teeth. Endodontists become specialists by completing dental school, followed by an additional two or more years of advanced training that includes the diagnosis and treatment of dental pain. They perform routine, as well as difficult and very complex root canal procedures, including endodontic surgery and treatment of traumatic dental injuries.
Endodontists often utilize state-of-the-art technology such as digital imaging, enhanced magnification, ultrasonic instrumentation and fiber optics while performing root canal treatment. Advanced technologies, together with specialized techniques, give endodontists a very accurate view of the tooth, and allow them to treat the tooth quickly and comfortably,
What is endodontic treatment?
“Endo” is the Greek word for “inside” and “odont” is Greek for “tooth”. Endodontic treatment treats the inside of the tooth.
To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue, and creates the surrounding hard tissues of the tooth during development.
The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.
Why would I need an endodontic procedure?
Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, a blow to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.
How does the endodontic treatment save the tooth?
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.
Will I feel pain during or after the procedure?
Many root canal procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.
For the first few days after treatment, your tooth may feel tender, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications: follow the doctor’s instructions carefully.
Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment is completed. However, if you have severe pain or pressure, or pain that lasts more than a few days, call Dr. Allen
The endodontic procedure sequence
Endodontic treatment can often be performed in one visit. Occasionally a second visit will be necessary. The treatment involves the following steps:
1. The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2. The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.
3. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber material called “gutta- percha.” The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling will be placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.
4. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.
If the tooth lacks sufficient structure to hold the restoration in place, your dentist may place a post inside the tooth. Ask your dentist for more details about the specific restoration planned for your tooth.
How much will the procedure cost?
The cost varies depending on how severe the problem is and which tooth is affected. Molars are more difficult to treat and usually cost more. Most dental insurance policies provide coverage for endodontic treatment.
Generally, root canal treatment and restoration of the natural tooth are less expensive than the alternative of the having the tooth extracted. An extracted tooth must be replaced with a bridge or implant to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration.
Will the tooth need any special care or additional treatment?
You should not chew or bite on the treated tooth until you have it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.
Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone root canal treatment fails to heal or pain continues. Occasionally the tooth may become painful or diseased months or even years after successful treatment. Often when this happens, another endodontic procedure can save the tooth.
What causes an endodontically treated tooth to need additional treatment?
New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover very narrow or curved canals that could not be treated during the initial treatment.
Can all teeth be treated endodontically?
Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. And, when endodontic treatment is not effective, endodontic surgery may be able to save the tooth.
What are the alternatives to endodontic treatment?
Though root canal procedures are intended to help save your tooth, this is not always possible. Often, the only alternative is extraction of the tooth. Missing teeth can make you self-conscious, affect your ability to bite and chew, cause other healthy teeth to shift and have a negative impact on your overall health. For these reasons, the extracted tooth should be replaced with an artificial one. Though nothing looks, feels or functions exactly like your natural tooth, dental implants are a viable alternative to help you maintain a beautiful smile.
Endodontists are dentists with at least two additional years of advanced specialty education in diagnosis and root canal treatment. Because they limit their practices to endodontics, they treat these types of problems every day. Endodontists are experts in performing nonsurgical and surgical retreatment. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals or unusual anatomy. Endodontists may use advanced technology, such as microscopes, ultrasonics and digital imaging, to perform these special services.
Why do I need another endodontic procedure?
-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.
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.
What will happen during retreatment?
First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth 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 canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification, searching for any additional canals or unusual anatomy that requires treatment
After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the tip of the root to be sealed.
After your endodontist completes retreatment, 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 full function.
Is retreatment the best choice for me?
Generally it is best to save your natural tooth. Retreated teeth can function well for years, even a lifetime.
Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with retreatment.
As with any dental or medical procedure, there are no guarantees. Your endodontist will discuss options and the chances of success before beginning retreatment.
How much will the procedure cost?
The cost varies depending on how complicated the procedure will be. The procedure will probably be more complex than your first root canal treatment, because your restoration and filling material may need to be removed to accomplish the new procedure. In addition, your endodontist may need to spend extra time searching for unusual canal anatomy. Therefore, you can generally expect retreatment to cost more than the initial endodontic treatment.
While dental insurance may cover part or all of the cost for retreatment, some policies limit coverage to a single procedure on a tooth in a given period of time. Check with your employer or insurance company prior to retreatment to be sure of your coverage.
What are the alternatives to retreatment?
If nonsurgical retreatment is not an option, then endodontic surgery should be considered. This surgery involves making an incision to allow access to the tip of the root. Endodontic surgery may also be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.
The only other alternative is extraction of the tooth. The extracted tooth must be replaced with a bridge, removable partial denture or implant to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.
No matter how effective tooth replacements are, nothing is as good as your natural tooth. You’ve already made an investment in saving your natural tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.
What is endodontic surgery?
The most common endodontic surgical procedure is called an apicoectomy or root-end resection. When inflammation or infections persists in the bony area around the end of your tooth after endodontic treatment, your endodontist may perform an apicoectomy. In this procedure, the endodontist opens the gum tissue near the tooth to expose the underlying bone, and the infected tissue is removed. The very end of the root is also removed, and a small filling may be placed to seal the root canal. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day.