What is a Root Canal?
Root canal treatment is the removal of the tooth's pulp, a small, thread-like tissue in the center of the tooth. Once the damaged, diseased or dead pulp is removed, the remaining space is cleaned, shaped and filled. This procedure seals off the root canal. Years ago, teeth with diseased or injured pulps were removed. Today, root canal treatment saves many teeth that would otherwise be lost.
The most common causes of pulp damage or death are:
- A cracked tooth
- A deep cavity
- An injury to a tooth, such as a severe knock to the tooth, either recent or in the past
Once the pulp is infected or dead, if left untreated, pus can build up at the root tip in the jawbone, forming an abscess. An abscess can destroy the bone surrounding the tooth and cause pain.
How is a Root Canal Done?
Root canal treatment consists of several steps that take place over several office visits, depending on the situation. These steps are:
- First, an opening is made through the back of a front tooth or the crown of a molar or pre-molar.
- After the diseased pulp is removed (a pulpectomy ), the pulp chamber and root canals are cleaned, enlarged and shaped in preparation for being filled.
- If more than one visit is needed, a temporary filling is placed in the crown opening to protect the tooth between dental visits.
- The temporary filling is removed and the pulp chamber and root canal permanently filled. A tapered, rubbery material called gutta-percha is inserted into each of the canals and is often sealed into place with cement. Sometimes a metal or plastic rod is placed in the canal for structural support.
- In the final step, a crown is usually placed over the tooth to restore its natural shape and appearance. If the tooth is very broken down, a post may be required to build it up prior to placing a crown.
How Long Will the Restored Tooth Last?
Your treated and restored tooth/teeth can last a lifetime with proper care. Because tooth decay can still occur in treated teeth, good oral hygiene and regular dental exams are necessary to prevent further problems.
As there is no longer a pulp keeping the tooth alive, root-treated teeth can become brittle and are more prone to fracture. This is an important consideration when deciding whether to crown or fill a tooth after root canal treatment.
To determine the success or failure of root canal treatment, the most relied-upon method is to compare new X-rays with those taken prior to treatment. This comparison will show whether bone continues to be lost or is being regenerated.
Why would I need endodontic surgery?
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.
What is a apicoectomy?
If a root canal procedure has been done in the past and it becomes infected again, it's often because of a problem near the apex of the root. In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect other canals that were not adequately treated. In this case, they may be able to clear up the infection by doing a second root canal procedure. This will avoid the need for an apicoectomy. Your dentist can do an apicoectomy to fix the problem so the tooth doesn't need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure and retreatment has not been successful or is not possible. For example, retreatment is often not a good option when a tooth has a crown or is part of a bridge. Retreatment of the root canal would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. An apicoectomy is often considered in a situation like this.
How is an apicoectomy done?
The endodontist will make a small incision (cut) in your gum and lift the gum away from the tooth and bone. The dentist may need to use a drill to gain access to the root. The infected tissue will be removed along with the last few millimeters of the root tip. The endodontist may use a dye to highlight cracks and breaks in the tooth. If the tooth has large cracks or breaks, it may need to be extracted. In this case, the apicoectomy will not continue. To complete the apicoectomy, the endodontist will clean and seal the end of the tooth's canal. The cleaning usually is done under a special microscope using ultrasonic instruments. The light and magnification allow the endodontist to see the area clearly. This increases the chance that the procedure will succeed. The endodontist then will take an X-ray of the area before stitching the tissue back in place. Most apicoectomies take 30 to 90 minutes. The length will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.