Root Canal Treatment

Root canal treatment is a common dental procedure performed by dentists and endodontists. Depending on your general dentist’s preference and comfort level, a patient may be referred to an endodontist for completion of the procedure. Regardless, the goal of this procedure is to retain a natural tooth which would otherwise require extraction.

The root canal of a tooth is the hollow space in the center of the tooth and root(s) which contains the soft dental pulp (root canal tissue). This tissue was primarily involved in the formation of the tooth during childhood. The dental pulp is basically composed of blood vessels, nerve, and connective tissue.

A tooth can develop the need for root canal therapy from a variety of reasons. Commonly, a history of deep decay, deep decay and subsequent restoration- fillings, crowns etc., can ultimately lead to an inflammation and/or infection of the soft root canal tissue over time. Depending on the severity, the presence of a crack or history of dental trauma may also create the need for root canal therapy.

Root canal treatment involves the removal of the inflamed or infected tissue in the central portion of a tooth. A biocompatible filling material is then placed within the disinfected root canal system. Eventually, a permanent crown or permanent filling material will need to be placed to protect the tooth.

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Root Canal Retreatment

Generally, teeth which have undergone endodontic treatment will provide you with years of service. Most often, these teeth will last as long as other natural teeth. However, an endodontically treated tooth may fail to heal and cause pain months or years after successful treatment. Retreatment of a tooth with past root canal therapy initially involves the removal of the existing canal filling material. Then, the entire root canal system is cleaned and disinfected. Your endodontist will be simultaneously searching for additional canals or unusual root canal anatomy which likely necessitated the retreatment.

There are a number of reasons for improper healing after root canal therapy. Occasionally, a tooth possesses a complicated root canal anatomy and these variations were undetected during the initial root canal treatment. Excessively curved or narrow canals can also pose an extreme clinical challenge for complete disinfection during the initial root canal treatment. Contamination by saliva and decay (bacteria) of the treated root canal system can also occur months or years after successful endodontic therapy.

Lastly, the species of bacteria contributing to a dental infection and the patient’s inherent ability to heal properly after root canal therapy have a large impact on the success rate of root canal treatment.

Every patient’s tooth and dental condition are unique. Prior to initiating root canal retreatment, your endodontist will discuss the probability of success for the procedure. Considerations of other treatments will also be discussed including root canal surgery (apicoectomy) as well as extraction.

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Endodontic Surgery

Most often, standard root canal treatment (and possibly retreatment) is sufficient to address dental problems associated with the root canal tissue and supporting periodontal (gum and bone) structures. Occasionally, an endodontic surgical procedure may be necessary to save a tooth from extraction.

The name of the most common endodontic surgical procedure is Apicoectomy:

(apico = apex or tip of the root, ectomy = to remove)

The success of standard root canal treatment and retreatment can be affected by variations in canal anatomy. These variations may include extra canals, excessively narrow (calcified) canals, and extreme curvatures of the canals. These variations can be impossible to manage with standard non-surgical treatment. Consequently, the source of the infection may persist and necessitate surgical intervention. Additionally, the size of the localized endodontic infection, the species of bacteria comprising this dental infection, and the patient’s inherent ability to heal properly after non-surgical root canal therapy have a large impact on the necessity of endodontic surgery.

Lastly, surgical exposure can aid in the diagnosis of a cracked root or in the locating of an accessory canal which may not appear on the radiograph and yet may be contributing to a patient’s symptoms.

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