Endodontic dental treatments or ‘root canal treatments’ involve the treatment of disease or injury to the dental pulp or ‘nerve in the tooth’. The dental pulp exists in the root canal of the tooth – the area inside the centre of each tooth that contains nerves and blood vessels that help nourish the tooth. If the ‘pulp’ is injured or diseased then it can die and this often leads to sensitivity, toothache or a dental abscess. It can also lead to the tooth discolouring – going grey or virtually black in extreme cases.
The most frequent causes of disease or injury to the dental pulp are through tooth decay, subsequent deep fillings or heavy restorations, leaking restorations such as defective fillings, crowns, bridges or veneers, trauma (such as a blow to the tooth), cracks in teeth or fillings, and gum disease. Essentially the dental pulp can be infected by bacteria in tooth decay, under leaking fillings or through cracks that leads to de-vitalisation of the pulp, i.e. the ‘nerve in the tooth dies’ and the root canal fills with pus. If left untreated, this infection can build up at the tip of the root, forming an abscess. In an acute case, this causes acute pain and swelling and can lead to the destruction of the bone supporting the tooth. However, the process can also occur slowly over time and patients can be unaware of a problem until it is spotted on an X-ray, i.e. a chronic abscess which silently destroys the bone at the tip of the root and can also resorb or ‘eat’ the root of the tooth and create a cyst in the bone.
Root canal treatment saves teeth that would otherwise need to be extracted. It involves removing the damaged or dead pulp tissues and pus in the root canals of teeth that have become infected. The infected or dead tissue in the dental pulp is cleaned away, the inside of the roots are also cleaned and disinfected, and the root canal is prepared so that it can be sealed with a root filling. The tooth can then be restored and can remain in function for many years provided there is sufficient sound tooth structure to support a new filling or crown.
If you need an endodontic re-treatment, it means that the previous root canal treatment failed or that symptoms persist. This may happen shortly after the original treatment or even years later. Endodontic re-treatment involves the removal of existing root filling material, re-cleaning and disinfecting the root canals and placing a new root filling.
In some cases a surgical procedure called an ‘apicectomy’ is also necessary. This is when the problem is not solved by a conventional root treatment alone. A small surgical procedure is performed to remove the infected root tip, clean and remove any infection or cyst in the bone.
In most cases a root treatment or re-treatment can be performed in one visit, but more visits may be necessary in trickier cases or where there is a more severe infection.
Finally, if endodontic treatment or re-treatment cannot be successfully carried out on a particular tooth, or if the tooth is too structurally compromised to be successfully or predictably restored, then it may be better to remove the tooth and restore it with a dental implant and crown.
The right equipment to do the job well is essential and today the state-of-the-art is to use operating microscopes to help us carry out root treatments to the highest standards. The Windsor Centre for Advanced Dentistry is equipped with the most up-to-date technology including digital X-ray technology and operating microscopes.