Complex Endodontics and Root Canal Treatment

Healthy Tooth 

What is root canal treatment?

Retaining your natural tooth should always be your first choice.

From the outside, a tooth looks like a hard, solid substance, but this diagram shows that a tooth is really a complex system of various tissues.

Why you might have needed root canal treatment?

Root canal treatment may be needed due to deep decay, large fillings, infection, trauma, cracked teeth, periodontal (gum) disease, resorption (root damage), forceful movement of the teeth (orthodontics), as well as unexplained causes

It becomes necessary when the soft 'pulp' of the tooth becomes infected by bacteria. The toxins from the bacteria then seep out though the ends of the roots and affect the tissues around the tip of the roots. This can sometimes occur without pain in which case your own dentist may have noticed a change in the appearance on an x-ray.

Benefits of Root Canal Treatment

The aim of root canal treatment is to treat/prevent an infection, relieve pain, prevent further decay that has occurred in the tooth. The purpose of root canal treatment is to hopefully retain your tooth that would otherwise require extraction; that is to attempt to keep your tooth functioning comfortably in your mouth.

The general procedure:

Once we have the necessary information from your own dentist, we can then book you an initial consultation appointment.

At this appointment we will discuss your chief complaint and complete a history of the tooth pain before taking digital x-rays of your teeth. Your symptoms will be evaluated prior to testing the tooth in question along with adjacent teeth. After the tests are complete, a diagnosis will be given to determine the best treatment care and prognosis. Possible post-treatment decisions, such as a crown on the treated tooth, will be addressed.

We will make you aware of the benefits, options and risks involved in order for you to understand how endodontic treatment is a way of saving your tooth.

If you decide to receive treatment, we will get you booked in as soon as possible.

On completion of treatment, a report will be sent back to your own dentist with details of treatment carried out including copies of x-rays, the prognosis for the tooth, restorative recommendations and the need for a review - usually after one year. Be sure to contact us if you have any questions or concerns regarding your treatment.

Root canal treatment (procedure)

This is a technically complex procedure usually split over two appointments; on occasions three appointments maybe required. This will all be dependent on the stage of infection/inflammation and degree of treatment difficulty. To us, it's more important to do it to the best of our ability rather than to meet a specific time criteria.

At all appointments, local anaesthetic is used, and a rubber dam is placed to isolate the tooth from the rest of the oral cavity and to prevent the swallowing of instruments and materials.

The first appointment is to assess the restorability of the tooth (this is to check if the tooth can be restored at the end of treatment); subject to the tooth being restorable access is made to the pulp and disinfection and shaping of the canal system is undertaken. An antibacterial paste will be sealed inside your tooth between appointments.

You will be provided with post-operation instructions and what to expect over the next few days.

The second appointment will usually take place two/three weeks later, allowing time for signs and symptoms of infection to subside. If there are no symptoms at this appointment, the canal system will be sealed with a bio-compatible material usually a rubber-like material called gutta percha and a restoration placed. If there is persisting infection, we may occasionally need extra sessions and redressing of the tooth.

After the final visit, you will be returned to your dentist for continued care and to have a full or partial crown or other restoration placed on the tooth to protect it from fracture and restore it to full function. If the tooth lacks sufficient structure to hold the restoration in place, your dentist may need to place a post inside the tooth. All this will have been discussed with you at the initial consultation but do ask for the endodontist if you are unsure about the specific restoration planned for your tooth.

Will I need to return to your practice for additional visits?

Once endodontic therapy is completed, your tooth may need to be examined periodically, usually after 12 months. This allows us to make sure the tissue around the tip of the roots has healed or is healing properly. You will be sent a reminder when we feel it is appropriate to re-evaluate the treated area. Occasionally complete healing of a large abscess can take longer and the practice will re-evaluate the tooth, if necessary, for several years.

Retreatment - Why do I need another endodontic procedure?

Occasionally a tooth that has undergone endodontic treatment fails to heal or pain continues despite therapy and may require re-treatment; this can occur with any dental or medical procedure. A tooth may not heal as expected after initial treatment for a variety of reasons, but a simple way of explaining this is to say that problems persist either due to certain pathogenic bacteria surviving in the tooth or managing to get back in later. These causes are detailed below:

  • 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 jeopardise 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

Diagnosis and Treatment of Pain

Oral pain can often be difficult to pinpoint due of the vast network of nerves in the mouth and the pain of a damaged or diseased tooth often is felt in another tooth and/or in the head, neck, or ear. An endodontist is a specialist in diagnosing and treating this type of pain.

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