Teeth are one of the strongest parts of the body with an undeniable role in nutrition, appearance, and confidence. However, your teeth are prone to deterioration and disease and cannot repair themselves.
In efforts to preserve our natural teeth, dentists have explored the interior structure of the tooth, including the complex root system, leading to the rise of endodontic services.
According to the American Association of Endodontists, the natural tooth beats any artificial replacement that can be used when the tooth is injured or damaged. Endodontists perform advanced procedures to preserve your natural tooth.
In the following sections, Northridge Dentist will explain all the important aspects of endodontic services. We offer endodontic services such as root canals, endodontic retreatment, and periradicular surgery.
Overview of Endodontic Services
The dental pulp is the living part of the tooth consisting of nerves, fibrous tissue, blood vessels, and lymphatic tissue. Diseases in the dental pulp can lead to conditions such as tooth sensitivity and, eventually, destruction of the tooth.
Dental problems, such as those of the pulp, require a specialized diagnosis to identify alternatives that could be applied to save your teeth. Endodontic services target the dental pulp seeking ways to preserve it.
General dentists do not handle complicated tasks such as those of an endodontist.
Endodontists are specialized dentists who use superior tools and technologies to save your natural teeth and, in other cases, provide the best dental treatment.
Endodontic treatments could involve partial or full removal of the pulp, depending on the reversibility of the problem.
Your natural teeth are worth saving, which is why you should visit an endodontist if you are experiencing dental problems such as:
- A cracked tooth
- Tooth pain
- Persistent pain with swollen gums
- Uncomfortable aches in your upper jaw or teeth
- Tooth sensitivity
- Facial trauma (especially if you have been in an accident)
Endodontists are skilled in advanced diagnostic procedures to pinpoint the root cause of your dental problems. They utilize advanced tools such as microscopes and dental loupes to increase the visibility of oral tissue.
Your dentist could refer you to an endodontist if he or she feels you need specialized diagnosis and treatment. Upon diagnosis, the endodontist can recommend one of the following endodontic services:
- Root canal
- Dental implants
- Endodontic retreatment
- Endodontic surgery
- Dental trauma
1. Root Canal
The root canal consists of the pulp and the nerve of the tooth. When the tooth is infected, the tooth nerve becomes sensitive, which could result in pain.
Root canal treatment is the most common endodontic procedure used in the repair of heavily decayed teeth. Extensive decay occurs when a crack or cavity develops on the tooth and extends to the dental pulp.
When left unattended, the decay can lead to additional complications such as:
- Infection and abscess in the tissue surrounding the tooth
- Bone loss at the tip of the root
- Swelling that extends to other parts of the face, head, and neck
Root canal treatment is necessary where the pulp and tooth nerve have been exposed to irritation, inflammation, or infection due to decay, cracks in the teeth, facial, and repeated dental procedures.
In addition to fixing the issues mentioned above, root canal therapy serves additional purposes such as:
- Preserving the surrounding tissues from developing adverse symptoms
- Repairing and facilitating the healing of the surrounding tissues and the affected tooth
- Preserving the functions of a tooth that is re-implanted after facial trauma
General dentists can comfortably handle simple root canal procedures. However, complicated root canals require the diagnosis and treatment of an endodontist.
It might take several visits to perform a root canal. In the first visit, the dentist will examine the shape of the root canals to examine the presence and extent of the infection.
He or she will then apply anesthesia to numb the surrounding area. The anesthesia applied is usually to make the patient comfortable during the procedure.
The dentist will also have to keep the area around your tooth dry using a rubber dam. Saliva flowing to the tooth can lead to visibility problems, an unclean working surface, and the ingestion of the chemicals used by the patient.
Your endodontist will drill an access hole into your tooth, through which he or she will remove the pulp and decayed tissue of the tooth. The matter removed from the tooth also includes bacteria and decayed nerve tissue.
Once removed, the cleaning process commences using root canal files. These files are of different sizes and scrape the interior of the root to remove debris. Your dentist will periodically flush the area out with sodium hypochlorite or water.
Your dentist could perform the final step on the same day or another appointment, depending on the circumstances. For example, if your tooth has an infection, the dentist will place medication into it until the infection clears.
Meanwhile, you will have a temporary filling that keeps the cavity-free of contaminants. Sealing of the tooth involves filling the interior part of the tooth with a sealer paste and a gutta-percha. The dentist will then use a filling on the exterior tooth.
Most root canal procedures treat teeth with large cavities; therefore, additional restoration must be made to the tooth after sealing. The restorative options typically used in dentistry include crowns and bridges.
A few days after the procedure, you might experience sensitivity, usually due to tissue inflammation. However, you can still resume your daily routine soon after the procedure. However, you will need to chew carefully, particularly if the procedure is not complete.
2. Endodontic Retreatment
Root canals are usually successful procedures, with longevity as long as that of your natural tooth. However, some complications, such as the following, may arise:
- One root canal was not cleaned
- The dentist failed to notice a crack on the root of your tooth
- Improper dental restoration or filling that allows bacteria to seep into the tooth
- Delayed installation of the restorative material such as crowns
- Contamination of the inner tooth due to a breakdown of the sealing material
- Improper healing leading to pain and discomfort
In some cases, the problem develops after the first root canal procedure. Some of these problems include:
- New decay which causes infection in the tooth
- Cracks or fractures on the teeth or crown, which expose the teeth to additional problems
Endodontic retreatment gives your tooth a second chance at redemption. Such treatment can reduce pain and encourage healing.
The procedure involves the removal of the crown and filling to reach the root canal filling. The dentist will remove this material and clean the tooth, as in a root canal procedure.
He or she will also use advanced lighting and magnification to identify infections, unusual anatomy of your teeth, and additional canals that he or she might have missed before.
After the tooth is clean and free from infection, your endodontist will reshape the tooth and place filling materials to restore your tooth.
Speak to your endodontist before the procedure to address concerns you might have, such as the healing period required, the discomfort you may feel, and the recovery time. You could also discuss other options to treat your tooth, such as an endodontic surgery or extraction of the tooth.
You can enhance the longevity of your tooth after retreatment through the following steps:
- Do not chew on hard foods with the retreated tooth.
- Maintain good oral hygiene which includes a brushing your teeth at least twice each day and flossing at least once
- Schedule regular dental checkups to check for potential problems that could lead to root canal failure
As an alternative to endodontic retreatment, your dentist might recommend endodontic surgery.
3. Endodontic Surgery
Endodontic surgery is an alternative to root retreatment, in case the initial root canal procedure fails or cannot be performed. For example, if your tooth has narrow or inaccessible canals, then the endodontist has to perform surgery to access the entire root of the tooth.
Apart from correcting problems of a failed root canal, endodontic surgery can be used in other situations such as:
- To diagnose persistent symptoms that do not show on imaging tests.
- Calcified root canals that make it impossible to clean the tooth
- When you endodontist needs to treat the root surface or the nearby bone tissue
An apicoectomy is one of the endodontic surgery procedures, which involves the removal of the tip (apex) of the root. It is often a recommended procedure where the infection develops at the end of the root, making it hard to use root canal treatment.
The procedure is done under local anesthesia. After the anesthesia, the endodontist makes an incision in the gum close to the affected tooth to expose the infected tissues. He or she then removes the affected tissues, and in some cases, the tip of the root.
A small filling might be required at the root apex to seal the tooth. Your endodontist will then stitch the incision to allow healing. The bone will heal over the root in a few months, thus holding the root and the filling in place.
You might experience some discomfort and swelling during the healing procedure, but you can resume your normal activities by the following day.
However, you must adhere to the regulations of your dentist. These regulations focus on developing good oral hygiene practices, and proper diet to avoid complications from the procedure.
Visit your endodontist immediately if your tooth experiences persistent pain regardless of adhering to the post-surgery regulations.
Some of the common complications associated with an apicoectomy include:
- Pain and swelling
- Bruising around the surgical site
- Injuries to blood vessels
- Infection at the site of the surgery
- Poor healing, particularly in patients with poor oral hygiene or a smoking habit
Your endodontist could also perform an intentional replantation procedure whereby he or she extracts your tooth for treatment then re-implants it into its socket.
An initial root canal procedure has a three percent failure rate, especially when the root cause of the problem is not addressed fully.
Your endodontist might recommend an apicoectomy or other surgical procedures to treat the problem. Intentional replantation is ideal, where access to the tooth apex is difficult.
The procedure involves a gentle extraction of the affected tooth. The endodontist then performs the necessary procedures, including an apicoectomy and retrofilling outside the mouth.
The success rate of intentional replantation depends on the shortness of the procedure and the gentleness of the extraction.
Treatment of the tooth outside the mouth should take less than ten minutes to enhance the success of replantation.
If root canal failure occurs in the molars of the lower jaw, your endodontist might recommend a hemisection (also called root sectioning or root amputation).
A hemisection involves the removal of the diseased root, and the connected crown. The procedure leaves the rest of the whole tooth intact, thus preserving your tooth. Hemisection procedures are ideal for teeth in which:
- Only one root in a multirooted tooth is affected.
- The affected root is too close to the roots of the adjacent teeth, which affects good oral hygiene.
- Vertical fracture of the tooth restricted to one root.
- Only one root of the tooth is affected, in a multi-unit dental bridge (where the cost and ethics of a hemisection are more favorable than the replacement of the entire bridge)
Conducting a hemisection can be affected by:
- Roots that have a difficult anatomy, for example, curved roots, which make it impossible to section one root without damaging the adjacent ones
- Roots that have calcified or inaccessible canals
A hemisection always comes after a failed root canal and retreatment. The steps involve radiographic analysis to determine the location or the root to be sectioned, with consideration of the position of the roots to be retained.
In some cases, you could choose to have your tooth extracted and replaced with a prosthesis, such as a dental implant or a bridge.
4. Treatment of Dental Trauma
Endodontists also specialize in treating patients who have suffered dental trauma. Dental trauma includes injuries to the enamel, dentine, roots, and gums and in the supporting bones.
Dental trauma can be complicated or uncomplicated, depending on the location and extent of the injury. For example, fracture of the crown, which exposes the pulp, is a complicated condition.
Crown fracture affects the enamel, dentin, and, sometimes, the pulp. Another type of dental fracture is the crown-root fracture, which results in fracture of the enamel, dentin, and cementum. This type of trauma goes beneath the gingival margin, often leading to loss of the tooth structure. The pulp might be exposed to such trauma.
Fracture of the root affects different parts of the root structure, including the apex, middle, or cervical third.
An alveolar fracture affects the bone segment that holds the affected teeth. Alveolar fractures are accompanied by:
- Changes to occlusion
- Movement of multiple teeth of the same alveolar socket
- Bruising of the gum
In addition to the trauma of the tooth structures, dental trauma often causes soft tissue injuries on the lips, the frenum, and the tongue.
The treatment of dental trauma requires radiological tests to determine the nature of the injury and the most appropriate treatment method. Some of the treatment options an endodontist can explore include:
- Resin etching and sealing of the enamel
- Bonding of the tooth
- Composite resins
- Pulp capping
- Root canal
- Tooth repositioning and stabilization
5. Internal Bleaching
You must be familiar with teeth whitening for the exterior of the teeth. Such bleaching aims to remove external stains that develop on the teeth due to foods and drinks, poor oral hygiene, or smoking. Few people are, however, unaware of internal bleaching, which can restore your teeth to match the color of adjacent ones.
Internal bleaching is a different and more specialized procedure offered in endodontic service. It involves removing teeth stains that are within the tooth. Such stains develop in dead teeth, due to blood or bodily fluids accumulating in the tooth after a root canal, or due to structural defects in your teeth.
Internal bleaching is a safe procedure whose results indicate that it can last a long time without staining.
The process an endodontist uses to perform internal bleaching will depend on the situation.
For example, if your tooth is stained due to a previous root canal, the dentist will require drilling the tooth to access the root canal. Once inside, he or she will place the bleaching solution and leave it in for several days.
However, if your tooth requires a root canal, the endodontist will have to remove the decayed matter and clean the cavity. He or she will then place the bleaching agent and a temporary filling. The bleaching agent will remain inside the tooth for a maximum of two weeks.
The dentist will examine you before replacing the temporary filling.
Endodontic services also target baby teeth, which might require extraction due to decay or dental trauma. A Pulpotomy involves the removal of the pulp in the crown. In this procedure, the endodontist will leave the pulp in the root canal in place.
Pulpitis is a condition that affects baby teeth. Your child might complain of sensitivity to sweet, hot, or cold things, which is one of the signs of pulpitis. The condition develops due to untreated tooth decay.
The first step when you take your child to the dentist for a sensitive tooth is a dental examination. Your dentist will examine the tooth for decay through physical and imaging tests.
He or she will determine the extent of the decay to recommend the most appropriate treatment.
Tooth decay is not the only cause of Pulpotomy if your child has suffered dental trauma. In this case, the procedure seeks to preserve the root.
Children have temporary teeth, which eventually fall out. However, these teeth are essential in holding the position for permanent teeth. Therefore, Endodontists also seek as many restorative procedures as possible before they can extract a child's tooth.
A Pulpotomy is a relatively safe procedure but can only be done if the pulp in the root is still healthy. The dentist will anesthetize the area that requires treatment before removing the decayed material.
He or she will then open the pulp chamber by drilling and remove the decayed coronal pulp. He or she will then cover the affected pulp with a medication solution before sealing and restoring the tooth.
In some cases, the decay in the pulp is too extensive to treat through a Pulpotomy, in such a case, the child will go through a pulpectomy.
A pulpectomy is essential when the entire pulp of the tooth is damaged. Pulpal damage can occur due to either decay or facial trauma, especially during sporting activities. The signs that the child’s pulp is damaged can be viewed when the dentist opens the pulp chamber. They include:
- Bleeding that lasts more than five minutes
- Pus or inflammation in the pulp chamber
The procedure is similar to a root canal but is performed on children. The dentist fills the root canal with material that the body can reabsorb (which is the major difference between a root canal and a pulpectomy).
The process involves cleaning the cavity, preparing it, and filling it with the filling material. The filling material will be reabsorbed into the body when the permanent teeth begin erupting.
Protecting tooth loss in children is crucial in their speech development and proper alignment of permanent teeth.
In cases where the extraction of baby teeth is unavoidable, the dentist will use a space maintainer to hold the place of the permanent tooth until it erupts.
Find Endodontic Services Near Me
Proper oral hygiene can help your teeth maintain their integrity for a long time. In some cases, damage to these teeth, especially through decay, overuse, and trauma, is inevitable and could lead to tooth loss.
Endodontic services target teeth that would face extraction and apply techniques that preserve your natural teeth. These procedures include root canals and endodontic surgeries.
The procedures involved are complex and require expertise and specialized skill to handle. At the Northridge Dentist, we provide endodontic services to residents of the Northridge area. Schedule an appointment today by calling 818-875-0216.