Endodontic Therapy (Root Canal Therapy)
Endodontics is a dental specialty which deals with the tooth pulp and the internal dental tissue. Endodontists perform a variety of procedures including root canal therapy (endodontic therapy), endodontic retreatment, root end surgery (apicoectomy), treatment of cracked teeth and traumatic injury.
"Root canal" is the term used to describe the natural cavity within the center of the tooth. Endodontic therapy is a treatment used to repair and save a tooth that is badly inflamed or infected from trauma, caries, a large restoration, or a crack in the tooth. During endodontic therapy, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatement, the tissue surrounding the tooth will become infected and an abscess may form.
Root canals within teeth come in a variety of shapes and sizes, and some have extreme curvatures. Because the canals within a tooth are so small and dark, special lighting and microscopes are required for optimal visibility. Once a root canal is performed, a general dentist should restore the tooth with a permanent filling and crown, if necessary.
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
• Complicated canal anatomy
• 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. Human saliva is full of bacteria, with can cause disease if it finds its way into iiiiiithe root canal system.
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 endodontic 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-- may 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 and illumination, searching for any additional canals or unusual anatomy that require 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 family 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.
In a small number of cases, root canal treatment or retreatment alone don't permit healing. For these teeth, endodontic surgery may be necessary, either to diagnose or fix a persisting problem. The most common surgical procedure is called an apicoectomy.
During an apicoectomy a small incision is made in the gum and it is elevated to provide access to the underlying bone and root. The root tip is resected and any inflamed or infected tissues are removed. A small filling is then placed at the end of the root to seal the canal space and sutures are placed to facilitate healing.
Tooth discoloration may result from either external or internal staining. Internal discoloration arises from within the tooth and typically involve the dentin. The most common cause of internal staining is trauma leading to necrosis, or death of the nerve. In some cases, the trauma responsible for tooth injury with might have occurred many years ago, perhaps during childhood. In these cases, the tooth may appear yellow to brown to gray due to the breakdown of the diseased pulp. Regardless of when the traumatic event occured, tooth discoloration is often associated with a non-vital pulp. Therefore, root canal treatment is necessary.
Once root canal treatment is completed, internal bleaching can render the tooth closer to its original color. The "walking bleach" method of internal bleaching involves placing a mild "bleaching" agent in the pulp chamber to break down the organic pigments. The chamber is sealed with a temporary filling and the bleaching agent is a few days to work into the dentin. If one round of bleaching is sufficient, the agent is removed and the tooth is permanetly restored. If the patient desires further whitening, the agent is replaced and the bleaching is repeated. In extreme cases several rounds of bleaching may be needed.