GUIDE TO ENDODONTIC TREATMENT
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.
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. (BACK
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.
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
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.
(BACK TO TOP)
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
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.
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
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
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.
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. (BACK
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.
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
YOUR GUIDE TO CRACKED TEETH
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
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
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 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.
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.
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.
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 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
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.
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
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. (BACK
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
• 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. (BACK
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.
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
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.