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Endodontic Treatment




For Patients
These points cover the main issues surrounding Root Canal Treatment.
Many people have a deep-seated fear of root canal (endodontic) treatment. They will say gnot as bad as a root canalh - as if it is one of the worst human experiences. Such fears are unfounded. In professional hands, root canal treatment is the best way to keep your natural teeth and preserve good dental health. By having better information about this treatment, you will understand why it is often called ethe tooth saverf.


Why do teeth need root treatment?
The nerve and blood vessels in the tooth (known as edental pulpe) are there to help the tooth grow to maturity. They protect against bacteria within the body. Bacteria play a defensive role in the general mouth area, but can become destructive when they attack the body via the dental pulp or through gum disease. Bacteria cause decay in teeth. When the decay is deep, it can allow bacteria to invade the dental pulp - the living tissue inside your teeth. Your dentist removes the decay in the tooth to protect the pulp and to restore the function and appearance of the tooth. However repeated bacterial attacks can weaken the pulp to such an extent that the nerve can no longer recover, and so the pulp dies.


Is there an alternative to endodontic treatment?
If you choose not to have root treatment, your affected tooth will be extracted. Should you fill the space? That depends on functional and aesthetic grounds. People today are aware of their mouth and smile, so someone displaying unaesthetic black gaps between their teeth may feel self-conscious about speaking or smiling. Back teeth may not be immediately noticed in a smile, but they are very important in terms of chewing function. Every tooth stabilizes the teeth adjacent to it and those immediately above or below. If it is removed and not replaced, other teeth may well shift from their natural positions. This will stimulate problems with gum disease, food packing (leading to further decay) and bite problems.


How long does treatment take?
This will depend on the complexity of the root canals and any problems that are encountered. To achieve success it is important that the procedure is not rushed. A one, to one and a half hour appointment is usually required on the first visit; further time required can be gauged at the end of this appointment. Often it is possible to complete treatment in one visit. Re-treatment cases usually take a little longer than first time treatments. It may be necessary to follow up on the treatment on a regular basis to monitor healing.


If a tooth needs extracting, what next?
Teeth can be replaced with bridges, implants or removable dentures and the possibilities should be discussed with your own dentist. Implants have revolutionized restorative dentistry and can be an excellent substitute for the natural tooth. The dental root has often been described as nature's implant, so wherever possible existing teeth should be kept in place. However there are situations when it is neither feasible nor cost- effective to keep the tooth. The options have to be considered carefully either by your general dental practitioner, or by an endodontics specialist.


How successful is endodontic treatment?
Nobody can guarantee success. However when the endodontic treatment and the restorative treatment that follows it are both carried out to a high standard, long-term success is very likely. Failure would be caused by the leakage of bacteria into the root canal system or by mechanical failure i.e. fracture of the remaining tooth.
Should endodontic treatment fail, it may be possible to re-treat the tooth. If further treatment is impossible, the tooth may require extraction. Endodontic re-treatment may be carried by your own dentist or by an endodontist, depending on the particular problems and reasons for the failure.
General dentist or root canal specialist?
General dentist are trained to carry out root canal treatment and many of them do this to a very high standard. Whether root canal treatment is carried out by your regular dentist or an endodontics specialist will depend on many factors. Is your dentist skilled, experienced and confident in performing these kinds of procedures? Is it a straightforward treatment or are there complications? The molar teeth have a more complicated root canal system than the front teeth (incisors and canines), are harder to access and may require more specialized equipment.


Is there an alternative to a dental implant ?
Your dentist may have told you that your tooth has to be extracted and can be replaced with an implant. Is there an alternative? Although a dental implant is recognised today as an excellent long-term solution, keeping original teeth is always better.


What is Endodontist?
The Endodontist is a root canal specialist
With the lengthy education that an endodontist receives, they are able to perform all aspects of root canal therapy including routine as well as complex root canals, retreatments and endodontic surgery.


What is endodontic treatment?
gEndoh is the Greek word for ginsideh and godonth is Greek for gtooth.h Endodontic treatment treats the inside of the tooth. Root canal treatment is one type of endodontic treatment.
To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development.
The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a toothfs growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.


Endodontic Retreatment
Why do I need another endodontic procedure?
Initial Treatment may be completed in one or more visit depending on the treatment required .Success for this type of treatment occurs in about 90% of cases , however it sometimes fails when treatment falls short of acceptable standards . The reason many teeth do not respond to root canal treatment is because of procedural errors that prevent the control and prevention of intracanal endodontic infection . Undoubtedly, the major factors associated with endodontic failure are the persistence of microbial infection in the root canal system and/or the periradiculararea . In addition , that procedural errors, such as broken instruments, perforations, overfilling, underfilling, ledges and so on are the direct cause of endodontic failure.
A procedural accident often impedes or makes it impossible to accomplish appropriate intracanal procedures. Thus, there is potential for failureof root canal treatment when a procedural accident occurs during the treatment of infected teeth. So root canal retreatment make it difficult in our clinical practice . Scientific evidence indicates that some factors may be associated with the unsatisfactory outcome of well-treated cases. They include microbial factors, comprising extraradicular and/or intraradicular infections, and intrinsic or extrinsic nonmicrobialfactors .


What will happen during retreatment?
First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials-crown, post and core material-must be disassembled and removed to permit access to the root canals.

After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.

After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the other end of the root to be sealed.

After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.


Is retreatment the best choice for me?
Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime.
Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with retreatment.
As with any dental or medical procedure, there are no guarantees. Your endodontist will discuss your options and the chances of success before beginning retreatment.


What are the alternatives to retreatment?
If nonsurgical retreatment is not an option, then endodontic surgery should be considered. This surgery involves making an incision to allow access to the tip of the root. Endodontic surgery may also be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.


What are the alternatives to endodontic retreatment and/or endodontic surgery?
The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.

No matter how effective tooth replacements are-nothing is as good as your own natural tooth. Youfve already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.


Endodontic Surgery
Why would I need endodontic surgery?
Surgery can help save your tooth in a variety of situations. Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this gcalcification,h your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
Surgery may also be performed to treat damaged root surfaces or surrounding bone.
Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy.




What is an apicoectomy?
In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly.Over a period of months, the bone heals around the end of the root.







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