YOUR GUIDE TO ENDODONTIC TREATMENT
Who performs Endodontic Treatment? How does Endodontic treatment save the tooth? Can all teeth be treated Endodontically? Types of cracked teeth.
What is Endodontic treatment? Will I feel pain during or after the procedure?  What is Endodontic Surgery? Will my tooth completely heal?
What is the Endodontic procedure? Will the tooth need any special care or additional treatment? What are the alternatives to Endodontic treatment? Who performs Endodontic retreatment?
Why would I need an Endodontic procedure? What causes an Endodontically treated tooth to need additional treatment?  Why does a cracked tooth hurt?  Why do I need another endodontic procedure?
 What will happen during retreatment? What are APEXIFICATION and APEXOGENESIS?
   

YOUR GUIDE TO ENDODONTIC TREATMENT

WHO PERFORMS ENDODONTIC TREATMENT?
All dentists, including your general dentist, received training in endodontic treatment in dental school. General dentists can perform endodontic procedures along with other dental procedures, but often they refer patients needing endodontic treatment to endodontists.

Endodontists are dentists with special training in endodontic procedures. They provide only endodontic services in their practices because they are specialists. To become specialists, they
complete dental school and an additional two or more years of advanced training in endodontics. They perform routine as well as difficult and very complex endodontic procedures, including endodontic surgery. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.
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WHAT IS ENDODONTIC TREATMENT?
"Endo" is the Greek word for "inside" and "odont" is Greek for "tooth". Endodontic treatment treats the inside of the tooth.

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 treatment.

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 tooth's 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. (BACK TO TOP)

ENDODONTIC PROCEDURE
Endodontic treatment can often be performed in one ore two visits and involves the following steps:
1. The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth in numb the endodontist places a small protective sheet called a "dental dam" over the area to isolate the tooth and keep it clean and free of saliva during the procedure.


2. The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals, and to shape the space for filling.


3. After the space is cleaned and shaped, the endodontist fills the root canal with a biocompatible material called "gutta-percha." The gutta-percha is placed with adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.


4. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.


If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.

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WHY WOULD I NEED AN ENDODONTIC PROCEDURE?
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 absces.

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

HOW DOES ENDODONTIC TREATMENT SAVE THE TOOTH?
The endodontists removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth. Turn to pages six and seven for a step-by-step explanation of the procedure.

WILL I FEEL PAIN DURING OR AFTER THE PROCEDURE?
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics most patients report that they are comfortable during the procedure.

For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist's instructions carefully.

Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure, or pain that lasts more than a few days, call your endodontist. (BACK TO TOP)

WILL THE TOOTH NEED ANY SPECIAL CARE OR ADDITIONAL TREATMENT?
You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing and regular checkups and cleanings.

Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this happens, another endodontic procedure can save the tooth. (BACK TO TOP)


WHAT CAUSES AN ENDODONTICALLY TREATED TOOTH TO NEED ADDITIONAL TREATMENT?
New trauma, deep decay or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover very narrow or curved canals that could not be treated during the initial procedure.

CAN ALL TEETH BE TREATED ENDODONTICALLY?
Most teeth can be treated. Occasionally, a tooth can't be saved because the root canals are not accessible, the root is severely fractured , the tooth doesn't have adequate bone support or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. And, when endodontic treatment is not effective, endodontic surgery may be able to save the tooth.
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WHAT IS ENDODONTIC 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 edndodontist opens the gum tissue near the tooth to expose the underlying bone and 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.

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WHAT ARE THE ALTERNATIVES TO ENDODONTIC TREATMENT?
When the pulp of a tooth is damaged, the only alternative to endodontic treatment is extraction of the tooth. To restore chewing function and to prevent adjacent teeth from shifting, the extracted tooth must be replaced with an implant or bridge. This requires surgery or dental procedures on adjacent healthy teeth and can be far more costly and time-consuming than endodontic treatment and restoration of the natural teeth.

No matter how effective modern tooth replacements are-and they can be very effective- nothing is as good as a natural tooth. (BACK TO TOP)


YOUR GUIDE TO CRACKED TEETH

WHY DOES A CRACKED TOOTH HURT?
To understand why a cracked tooth hurts, 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 the inner soft tissue called the pulp. The pulp cantains blood vessels, nerves, and connective tissue.

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer hael itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth. (BACK TO TOP)

TYPES OF CRACKS
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and severity of the crack.

CRAZE LINES
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze llines are very shallow, cause no pain, and are of no concern beyond appearances.

FRACTURED CUSP
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be remaoved by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. The tooth will usually be restored by your dentist with a full crown.

CRACKED TOOTH
This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a full crown to bind and protect the cracked tooth. At times, the crack may extend below the gum line, requiring extraction.

Early diagnose is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progessively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.

SPLIT TOOTH
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth can never be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.

VERTICAL ROOT FRACTURE
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoooms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment usually involves extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.

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WILL MY TOOTH COMPLETELY HEAL?
Unlike a broken bone, the fracture in a cracked tooth will never heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximun protection but does not guarantee success in all cases.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your dentist and/or endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.


YOUR GUIDE TO RETREATMENT

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

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.

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

WHO PERFORMS ENDODONTIC RETREATMENT?
Endodontists are dentists with at least two additional years of advanced specialty education in diagnosis and root canal treatment. Because they limit their practices to endodontics, they treat these types of problems every day. Endodontists are experts in performing nonsurgical and surgical retreatment. They use their special training and experience in treatiing difficult cases, such as teeth with narrow or blocked canals or unusual anatomy. Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging, to perform these special services.
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WHY DO I NEED ANOTHER ENDODONTIC PROCEDURE?
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

• Narrow or curved canals were not treated during the initial procedure.
• Complicated canal anatomy went undetected in the first 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 ttreated. For example:
• New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
• A loose, cracked or broken crown or filling can expose the tooth to new infectiion.
• A tooth sustains a fracture.
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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 acces 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.

Aftter 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 tip 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 full function. (BACK TO TOP)

 

What are APEXIFICATION and APEXOGENESIS?
When there is pulpal involvement of permanent teeth with incompletely formed roots, techniques for the induction of apical closure should be completed before root canal therapy is begun. APEXIFICATION is a method of inducing a calcified barrier at the apex of a nonvital tooth with incomplete root formation. APEXOGENESIS refers to a vital pulp therapy procedure performed to encourage physiological development and formation of the root end.
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