If your general dentist has referred you to an endodontist, or root canal specialist, it means that they are concerned with a complex condition that may have affected your root canal system requiring speciality care. Although all gereral dentist are trained in root canal therapy and they in fact perform most of the root canal treatments done, there are cases with increased complexity whether in diagnosis, treatment, or surgery that require the aid of a specailist. Endodontists are dentists that have not only received additional training in the science and treatment of root canal conditions but have limited their practice to solely treat those conditions. What this means is that as endodontists, we know how to treat complex root canal cases and we are great at doing it. It's the only thing we do. We have earned your referring doctors' trust and confidence to figure out the root canal issue in question and to be able to provide the best care possible in getting you back to optimal dental health.
All visits here at our office starts with a consultation. Although your dentist may have already seen you and recommended a root canal treatment to you prior to referring you to our office, we do our due diligence in going through everything with you thoroughly. We review your medical history, including medications taken and any drug allergies, your dental history, and current symptoms. We perform a thorough clinical examination, test the tooth in question, and take all necessary radiographs in order to properly evaluate your tooth to provide an appropriate diagnosis and treatment recommendation. We will also clearly explain the procedure recommended and answer any questions or concerns that you may have.
Root Canal Therapy
Root Canal Therapy, or RCT, is the treatment of the diseased or damaged nerve tissue requiring its removal in order to preserve the remaining roots and tooth to provide years of function which may otherwise be extracted. Complexities that arise in such treatment include but not limited to: difficulty accessing the tooth due to its location or limited jaw opening, hypersensitivity gag reflexes, curved roots, long roots, extensive calcification (constriction of the root canal space due to age, trauma, previous dental work, infection, orthodontic movement, wear and tear from clenching/grinding habits, etc.), infection, bone loss, root resorptions, crack tooth syndrome, fracture lines, etc. As you can see, there are many factors that will affect and increase the difficulty of the treatment procedure and they are the same reasons that your dentist has referred you to us. You can be assured that we will provide the best treatment possible in a comfortable manner.
Root Canal Retreatment
A tooth that has had a previous root canal therapy done can still have problems years after. The tooth can be reinfected by bacteria compromising the seal of a filling or crown leading to pain and swelling. Even if you have no symptoms, your dentist may notice areas of concern during your routine visits and refer you to us for evaluation and retreatment of a previously treated tooth. Retreatment is a complex procedure that may involve drilling through an existing crown, removing existing post/build-ups, removing obturations of various materials, bypassing existing ledges and extensive calcification, finding untreated canal systems, etc. The focus of the retreatment procedure is to clean and sterilize the root canal system once again to give your body the best chance of healing.
Apical Root Surgery
In cases where retreatment of a previously treated tooth has already been done but chronic infection persists or retreatment of a tooth is not considered due to various factors, apical root surgery may be a last option to save your roots instead of an extraction. Apical root surgery involve making incisions in your gums to allow separating of gingival tissues off the bone, drilling through the bone to gain direct access to the site of infection, direct removal of the infected tissue and any root structure involved, and placing a filling at the root end if appropriate. Bone graft is the placed in the boney defect before suturing the gingival tissues back in place. Although the procedure as described sounds quite invasive, it is done in our office with local anesthesia and patients are very comfortable with only minor pressure and vibration during the procedure.
In younger patients, root developement may not have fully matured when the need for root canal therapy arises. Treatment of these underdeveloped roots is not practical due to the immature root end, or wide root canal tip opening, which limits our ability to provide a proper seal of the canal system as filling materials will go right out into the bone structure. In such cases, apexogenesis or apexification is necessary to either stimulate the continue developement of the root end or create a calcific barrier at the root tip to provide a positive stop required in filling the canal system. The procedure involves the removal of dental caries and the damaged nerve tissue, creating a sterile environment, and placement of medicaments for periods of time while monitoring the progress of root end closure. Several visits may be necessary to replace and replenish the effectiveness of the medicament until adequate closure is formed to allow proper root canal obturation of all canals.
Incision and Drainage
Although not always the case, pain and swelling are common symptoms of dental infections. Unfortunately, acute abscesses can be so severe and debilitating to the patient that it can even decrease the effectiveness of local anesthesia preventing profound numbness to occur and make proper and comfortable treatment difficult. In such cases, an incision at the site of swelling to allow pus drainage and alleviate the pressure pain can be life saving. With the aid of antibiotics to help fight the infection and pain medication to manage its severity until the symptoms subsides, appropriate treatment can then be rendered comfortably to the patient.