Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, a blow to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abcess.

Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, swelling and tenderness in the nearby gums. Sometimes, there are no symptoms. 

At Endodontic Specialists we take every reasonable step to remain at the forefront of our profession.

Among other advanced techniques and instruments utilized by our group, surgical loupes with fibre optic illumination, and the surgical operating microscope have opened up entirely new vistas for the treatment of both non-surgical and surgical endodontics. Due to the enhanced illumination and high magnification optics, calcified canals can be optimally located. Additionally, retreatment of endodontic cases that have failed due to separated instruments, separated posts, and repair of perforations can now be managed with greater efficiency and success. These cases, in the past, could be managed only by surgical approaches that had a lower success rate.

In those cases in which surgical endodontics is the treatment of choice, the increased magnification and illumination provided allows for enhanced visualization of the surgical field. This, in turn, allows for more efficient surgical technique and greater ability to achieve success in surgical endodontics.

To understand endodontic surgery, it helps first to know something about the nonsurgical endodontic procedure, or “root canal.” A root canal is necessary when the soft inner tissue, or “pulp” of the tooth becomes inflamed or infected. This may happen as a result of deep decay, repeated dental procedures on the tooth, or a blow to the tooth. Endodontic treatment removes the damaged pulp. Then the tooth’s canals are cleaned and filled to help preserve the tooth.

In a few cases, however, nonsurgical endodontic treatment alone cannot save the tooth. In such a case, your dentist or endodontist may recommend surgery.

The most common endodontic surgical procedure is called an apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after endodontic treatment, your endodontist may perform an apicoectomy. In this procedure, the endodontist opens the gum tissue near the tooth to expose the underlying bone, and the infected tissue is removed. The very end of the root is also removed, and a small filling may be placed to seal the root canal. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day.

Endodontic Retreatment: A second chance to save your tooth

With proper care, most teeth that have had endodontic (root canal) treatment can last as along as other natural teeth.

In some cases, however, a tooth that has received endodontic treatment fails to heal or the pain continues. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment.

If your tooth has failed to heal or has developed new problems, you have a second chance. Another endodontic procedure may be able to save your tooth.

Most chipped teeth can be repaired with a simple filling. Sometimes a chip will expose the pulp of the tooth. Some exposures can be treated by placing a filling over the injured area. Other exposures, however, may require root canal treatment.

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split teeth. Cracks may or may not extend into the root. If the crack does not extend into the root, the tooth can usually be restored by your dentist with a full crown. If the crack does extend into the root and affects the pulp, root canal treatment is usually necessary in an attempt to save all or a portion of your tooth.

During an injury, a tooth may be pushed into its socket. This can be one of the more serious injuries. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury, and a medication, such as calcium hydroxide, may be put inside the tooth. A permanent root canal filling will be placed at a later date. You should continue to have the tooth monitored periodically by your dentist to assure proper healing.     Dislodged Tooth

Sometimes a tooth is pushed partially out of the socket. Repositioning and stabilization of the tooth are usually necessary. If the pulp remains healthy, no additional treatment may be needed. If the pulp is injured, your dentist or endodontist may need to start root canal treatment. Medication, such as calcium hydroxide, may be placed inside the tooth and should be followed by a permanent root canal filling at a later date.

If a tooth is completely knocked out of your mouth, time is of the essence. If this type of injury happens to you, pick up your tooth by the crown, or chewing portion. Try not to touch the root. If the tooth is dirty, gently rinse it in water. Do not use soap or any other cleaning agent. If possible, place the tooth back into its socket. Go to the dentist immediately.

If you cannot put the tooth back in its socket, be sure to keep it moist. The less time the tooth spends drying out, the better the chance of saving the tooth. Solutions to keep your tooth moist are available at local drug stores. You can also put the tooth in milk or a glass of water with only a pinch of salt, or you can simply put it in your mouth between your gum and cheek. Bring your tooth to the dentist immediately.

If the tooth has been put back in its socket, your dentist may stabilize the tooth with a splint and check for any other facial injuries. If the tooth has not been put back into its socket, your dentist will examine the tooth to determine if it is still intact and check for other facial injuries. Your dentist will clean the the tooth carefully and place it gently back into the socket. Your tooth may need to be stabilized with a splint for a period of time. Depending on the stage of root development, your dentist or endodontist may start root canal treatment. A medication may be placed in the tooth followed by a permanent root canal filling at a later date. The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist may influence the type of treatment you receive. You should contact your physician to see if a tetanus booster is necessary.

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are better. If the fracture does not result in the two pieces of the root being separated, there is also a better chance for success. However, the nearer the fracture is to the chewing surface of the tooth, the poorer the long-term success rate, regardless of whether the pieces are separated.

Sometimes stabilization with a splint is required for a period of time. If the tissue inside the tooth is damaged, root canal treatment may be needed. A medication may be placed in the canal to prepare the fracture site for the eventual root canal filling.