About Endodontic Treatment
You're probably on this website because your dentist or endodontist has said you need endodontic (root canal) treatment. If so, you're not alone. More than 14 million teeth receive endodontic treatment each year. By choosing endodontic treatment, you are choosing to keep your natural tooth as a healthy foundation for chewing and biting for years to come. If you've never had endodontic treatment, you may have many questions about the procedure. If you have had previous endodontic treatment, but it's been many years since your last procedure, you may be interested in how modern technology has greatly improved the process.
This website attempts to answer your questions and explains how today's endodontic treatment saves teeth. If after reviewing this information,you would like to know more, you are welcome to call our office and speak to one of the doctors.
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 a hard layer called the dentin, is a soft tissue called the pulp. The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. It contains blood vessels, nerves and connective tissue, as well as the DNA which guides the development of the hard tooth structure during maturation. Once a tooth is fully mature, however, it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.
What is Microscopic Endodontic Treatment?
In many teeth, the pulp tissues have receded to the point where they are so small that they are not visible to the naked eye. Most dentists performing root canal therapy would use some form of magnification to help find all of the canals present in a tooth. Many endodontists, our office included, have gone a step further, and utilize a very powerful surgical operating microscope, in order to ensure that even the smallest canals will not go un-noticed. Our office was one of the earliest to utilize these microscopes, currently with over 25 years of experience. It is one of the ways we can help to make sure that your treatment is thorough and uneventful.
When is Endodontic treatment necessary?
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, trauma, cracks or periodontal involvement of the tooth. If pulp inflammation or infection is left untreated, it can cause pain, bone loss or abscess.
Who performs endodontic treatment?
All dentists, including your general dentist, received training in endodontic treatment in dental school. General dentists can perform many dental procedures including endodontic treatment, but often they refer patients needing root canal therapy treatment to endodontists.
Endodontists are dentists with special training in root canal procedures. As specialists, they provide only endodontic services in their practices, and will perform no other procedures. To become specialists, after completing dental school, they receive an additional two or more years of advanced training in endodontics. They perform routine as well as very complex endodontic procedures, including endodontic surgery. Endodontists are also experienced at finding the cause of oral and facial pain which is not localized to a specific tooth, and is therefore difficult to diagnose.
How does endodontic treatment save the tooth?
Root canal therapy removes the diseased pulpal tissue, and replaces it with a special root canal filling. After treatment is completed, a permanent filling or crown will be placed by your general dentist, to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.
A brief description of the procedure:
Endodontic treatment can often be performed in one or two visits and involves the following steps:
After an examination of the tooth and the x-rays, the endodontist administers a local anesthetic. After the tooth is sufficiently numb the endodontist places a small protective sheet called a "rubber dam" over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
The endodontist makes an opening into the crown of the tooth, generally through the biting surface. Very small instruments are then used to completely clean the pulp tissues from the pulp chamber and all of the root canals. A single tooth may have as many as four or more canals, and they all need to be thoroughly cleaned and shaped, in preparation to receive a root canal filing.
After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like 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 is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.
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 or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth
Will I feel pain during or after the procedure?
Many endodontic 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 sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist's instructions carefully.
Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure, or pain that lasts more than a few days, call your endodontist.
Why is retreatment sometimes necessary? Why was the initial treatment unsuccessful?
With proper care, most teeth that have had endodontic (root canal) treatment can last as long as other natural teeth. In some cases, however, a tooth that has received endodontic treatment may become re-infected, and this may not occur until months or years after initial treatment. This re-infection may manifest itself as pain or swelling, but quite often there may be no symptoms whatsoever. In such cases, the only evidence of this may be seen on x-rays.
If your tooth has failed to heal or has developed new problems, you have a second chance. Another endodontic procedure may be able to save your tooth.
Who performs endodontic retreatment?
All dentists have been trained to perform endodontic treatment in dental school. However, because retreatment can be more challenging than providing initial treatment, many dentists refer patients needing retreatment to endodontists.
Endodontists are dentists with at least two additional years of advanced education in root canal techniques and procedures. Because they limit their practices to endodontic cases, they have concentrated experience in endodontic treatment. In addition to treating routine cases, they are experts in performing complicated procedures, such as surgery, and in treating difficult cases, such as teeth with narrow, blocked, or unusually positioned canals. This special training and experience can be valuable if retreatment is necessary.
Why do I need another endodontic procedure?
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
- Complicated canal anatomy went undetected in the first procedure.
- Narrow or curved canals were not treated during the initial procedure
- The crown or other restoration was not placed soon enough after the procedure.
- The restoration did not prevent saliva from contaminating 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
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, searching for any additional canals or unusual anatomy that requires treatment.
After cleaning the canal(s) the endodontist will fill and seal the canal(s) and place a temporary filling in the tooth.* Post space may also be prepared at this time.
After the final visit with your endodontist, 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.
*If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed.
Is retreatment the best choice for me?
Retreated teeth can function well for years, even for a lifetime. It's always best to save the tooth if your endodontist believes retreatment is the best option for you.
Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may even be able to use a new technique that was not available when you had your first procedure. If your tooth has unusual anatomy that was not cleaned and sealed during the first procedure, your endodontist may be able to resolve this problem with a second treatment.
Of course, there are no guarantees with any dental or medical procedure. Your endodontist will discuss your 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 treatment to be sure of your coverage.
What are the alternatives to retreatment?
For some patients considering retreatment, endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed. Endodontic surgery may 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 then be replaced with an implant, bridge, or removable partial denture 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 modern tooth replacements are—and they can be very effective—nothing is as good as your natural tooth. You've already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.