Endodontics or root canal therapy continues to be maligned even though advancements in endodontics have made root canal therapy a more predictable and comfortable procedure that ever before. Root canal therapy is an attempt to save a tooth that has a compromised blood supply and “dying” or dead nerve. By accessing the pulp chamber and removing organic debris, the “fuel for the fire” is removed. Proper cleaning and shaping of the canal allows us to fill the space once occupied by the nerve with a material and stop the leakage of fluid and bacteria through the tooth. It is important to understand that the root canaled tooth must be properly restored in order to avoid reinfection. Many root canaled teeth are lost because restorative treatment was not completed in a timely manner. With proper restorative therapy, an endontically treated tooth can last for many, many years.
Endodontics is the dental specialty that deals with the nerves within the teeth. Root canals are probably the most notorious procedure in dentistry and the most common procedure relating to endodontics. When a tooth becomes infected it is usually related to the blood supply and nerves in the root of the tooth. The infected nerves need to be removed. If left untreated, an infection can turn into an abscess, which is a much more serious problem that includes bone loss in the jaw.
The area around the tooth and the tooth itself are anesthetized with a local anesthetic to start the procedure. The dentist will then isolates the tooth with a rubber dam to protect the patient’s airway and throat. Once isolated, access to the pulp chamber is accomplished by drilling down into the tooth to create an opening into the pulp chamber. They will then be able to remove infected tissue and clean the canal. After the infection has been removed, the space is filled with a material called gutta percha. It is highly recommended that a tooth that has undergone a root canal is fitted with a crown. This will improve the appearance of the tooth, and will also make it much more likely that the root canal is successful.
An apicoectomy is performed if a root canal fails and can’t be retreated. When an infection will not go away or returns after a root canal has been performed this procedure is usually necessary. During an apicoectomy, the tip of the root of the tooth is removed and sealed with a filling.
In most cases a second root canal is considered before an apicoectomy, since it is a simpler, less invasive procedure. Before the apicoectomy begins you will be given a local anesthetic to anesthetize the area. Access to the infected root tip will begin by making an incision in your gum to expose the root tip. Any inflamed tissue will be removed to clean out the area. The surgery takes place in a very small area, and only a few millimeters are removed from the root. For this reason, the doctor will use magnification and small precision instruments to perform the surgery. The precise nature of the surgery gives it a high rate of success. After the root tip is removed, a filling is placed in the root tip and the tissues are sutured. Depending on the type of sutures you may have to return in a week or more to have them removed, or dissolving sutures may be used instead. Over the course of the next few months the bone will heal around the root.
With proper care and restoration, most teeth that have had endodontic (root canal) treatment can last as long as other natural teeth. Root canals can have as high as a 95% success rate. In some cases, however, a tooth that has received endodontic treatment fails to heal. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment.
Why do I need retreatment? Occasionally, as with any other dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
Narrow or curved canals that were not treated during the initial procedure. Complicated canal anatomy went undetected during the initial 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.
In other cases, a new problem can jeopardize a tooth that was successfully treated.
When preparing for the replacement of teeth with a prosthesis, it is often necessary to smooth and sculpt the bone and tissues in addition to extracting teeth. In some instances, long term denture wearers will experience that as the boney support changes, it is necessary to smooth and reshape the bone and soft tissues for maximum support and comfort. This will allow us to provide you with a more natural and comfortable prosthesis. With alveloplasty, the sharp bone left after extraction is smoothed or removed. Excess soft tissue that would otherwise make a denture or partial unstable, can be removed to provide for a firm stable foundation.
It is important that the denture/partial denture wearer have routine visits with us to insure of a continued proper fit of the prosthesis. Improper fitting dentures can accelerate bone loss and tissue changes that make wearing the prosthesis difficult. If you are experiencing difficulty with your removable denture or partial, contact our office and schedule a consultation to see what options are available for you.