Root Canal Therapy
A root canal is a treatment of the pulp of the tooth that is inflamed, infected, or dead. The dental pulp is a soft substance in the center of the tooth that consists of the nerve, blood vessels, and connective tissue. The pulp chamber is the hollow part in the center of the tooth that contains the pulp, and it continues down canals that extend through the roots of teeth and into the surrounding bone. Some roots have more than one root canal, but all have at least one canal.
Root canal treatment (RCT) and endodontic treatment are the more correct terms for a procedure that treats the nerve of the tooth. Endodontics is a specialty of dentistry that deals specifically with the tooth pulp and tissues surrounding the root of the tooth. A root canal problem may be treated by a general dentist or by an endodontist.
What Is Root Canal Therapy?
Commonly called a root canal, root canal therapy (RCT) is a type of endodontic therapy that is often recommended if the tooth pulp and nerves become infected or damaged. This may occur if injury or decay reaches deep into the tooth, past the outer enamel layer. When left untreated, this type of infection and disease may cause the tooth to die and necessitate tooth extraction. To restore the health of the tooth and avoid the need for extraction, dentist will remove the infected and injured tissues from within the tooth, clean the tooth, and fill it with a medicated material. We will then cap the tooth with a restoration, such as a dental crown, to return the tooth to its original shape and structure. In most cases, a root canal can be completed in only one or two comfortable visits to our office.
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 and the gum may feel sensitive and/or sore, especially if there was pain or infection before the procedure. You may even have pain, but in most of cases it will subside within a week. This discomfort or pain can be relieved with over-the-counter or prescription medications.
Root Canal Retreatment
With proper care, even teeth that have had root canal treatment can last a lifetime. But sometimes, a tooth that has been treated doesn't heal properly and can become painful or diseased months or even years after treatment. If your tooth failed to heal or develops new problems, you have a second chance. An additional procedure may be able to support healing and save your tooth.
As with any dental or medical procedure, it’s possible your tooth won’t heal as expected after initial treatment for a variety of reasons, including:
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.
A new problem can also jeopardize a tooth that was successfully treated, such as:
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. During retreatment, dentist will reopen your tooth and remove the filling materials that were placed in the root canals during the first procedure. The tooth will be carefully examined for additional canals or new infection. Infection will be removed. All these canals will be cleaned and reshaped. New filling materials will be placed. Sometimes, the opening is then sealed with a filling. or a new crown will be placed.
An apicoectomy, also known as root end surgery or surgical root canal, might be necessary if an infection develops or continues after a root canal. Most of time, retreating the root canal is an option to save the tooth. However, when it is not a good option to go in from the crown side, apicoectomy is preferred. Often, apicoectomy is the final option to save the tooth.
What happens in an apicoectomy?
During the treatment, an incision is made in the gum near the tooth to expose and get rid of any inflamed or infected tissue. The tip of the tooth’s root will also be removed to make sure everything is clean. The end of the root canal is sealed with a small filling. A few stitches are used to close the gum tissue and the bone heals around the end of the root over the next few months.
What is recovery like?
Many patients are able to continue to normal activities the next day. You may experience discomfort and swelling as you heal. Make sure to follow postoperative instructions – including diet and brushing advice - given by your endodontist. Call him or her immediately if your pain doesn’t respond to medication or recovery instructions.
Picture on the left shows infected tissue at the end of a tooth root.
Picture on the right shows the end of the root gets cut and removed.