Why do I need an endodontist?

 

Endodontists are dentists with a specialization in root canal treatments. They deal exclusively with the diagnosis and treatment of endodontic problems and therefore have extensive experience in this area. Endodontists have the scientific knowledge, education but also the necessary equipment which helps them deal with endodontic problems the management of which was considered impossible in the past. Your dentist has decided that your tooth needs special care and has referred you to an endodontist. By referring you to a specialist, your dentist has shown a personal concern for the quality of your dental care.  

 

How is root canal treatment done?

 

Our aim during root canal treatment is to remove the bacteria and pulpal remnants from the root canals in order to disinfect them. The tooth is properly anaesthetized and a rubber dam is placed which isolates the tooth from the oral cavity and keeps it free of saliva and microbial contamination during the procedure. Following this, a small hole is made through the tooth and the root canals are disinfected with mechanical and chemical means and they are then sealed off with a special filling material called guttapercha. The tooth is then sealed with a temporary paste and the patient returns back to his general dental practitioner who provides the definitive filling and any further necessary treatment (e.g a crown).

 

Is it painful?

 

No. We always use local anaesthetic in order for the treatment to be as comfortable as possible for the patient. Occasionally, some teeth (especially lower molars) can be particularly sensitive due to acute pulpal inflammation, however a number of special techniques are available for them to be managed without pain.

 

Will I have pain after treatment?

 

After root canal, the endodontist will inform you in detail about the chance of experiencing discomfort or pain from the tooth. There is usually mild discomfort or pain from the tooth for 1-2 days. Occasionally (around 5% of the cases) the tooth can present an acute flare-up and give rise to severe pain and/or swelling. In this case, the acute symptoms are managed with antibiotics and anti-inflammatories. Although this flare up is unpleasant and disturbing, it does not mean that your treatment will have lower chances of success.

 

How many visits are necessary?

 

This depends on the complexity of the root canal system, the presence of infection and whether a re-treatment is being carried out. Some times treatment can be completed in one visit, but usually an anti-microbial medicine needs to be placed in the root canals which stays for 10-15 days and root canal treatment is completed at a second visit.

 

Is treatment success guaranteed?

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This is a very commonly posed question. Root canal treatment nowadays has a very high success rate. However, as with all other medical and dental procedures, it is impossible to guarantee its success. Even with the highest quality root canal treatment protocol, healing may not occur due to factors beyond the control of the endodontist. Teeth with pulpal inflammation or pulpal necrosis without a periapical lesion have very high success rates (85-95%). Infected teeth with periapical lesions or teeth undergoing root canal re-treatment have lower success rates (75-85%). In case of future treatment failure (re-occurrence of pain symptoms or no healing evident on review x-rays), further dental procedures may be necessary to manage the infection, such as surgical procedures (apicectomy) or even extraction of the tooth.

 

What happens after root canal treatment?

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Root canal treated teeth are prone to fracture for several reasons. That is why, especially in back teeth which do the heavy chewing, it is very important to protect the tooth soon after treatment with a permanent filling and then a crown (cap). Until the tooth is protected with a crown, you should take care not to bite heavily on it because if your root treated tooth fractures badly, it may not be restorable and may even require extraction.

 

When is root canal treatment not indicated?

 

Root canal treatment cannot be carried out when:

- The remaining healthy tooth structure is not sufficient to allow isolation of the tooth for root canal treatment and support a satisfactory restoration (filling or crown)

- There is insufficient bone support due to periodontal disease.

- There is a an extensive crack/fracture of the tooth.

- The root canal system is inaccessible due to extensive calcification or presence of other obstructions from a previous root canal treatment attempt.

 

Why does my tooth need a root canal re-treatment?

 

A root canal re-treatment is necessary when the root canal system has become re-infected. This may occur when:

- Eradication of the initial infection and healing has not been accomplished after the primary root canal treatment due to iatrogenic factors or complex anatomy of the root canal system (especially in cases where a crown or bridge is planned to be placed on a root canal treated tooth with technically inadequate root canal treatment).

- The definitive restoration of the tooth after treatment was delayed or was inadequate in sealing-off bacteria.

- New cavity (decay) occurred.

- Crack or fracture of the tooth occurred.

 

What alternatives do I have?

 

If root canal re-treatment is not indicated or is impossible, one alternative treatment option is a surgical procedure called apicectomy (if indicated). During this procedure, an incision is made on the gums in order to gain access to the infected end of the root (root apex) and the periapical lesion and adequately clean the area. The other alternative for teeth with poor prognosis is extraction of the tooth. The missing tooth may then be replaced with a dental implant, a bridge or a removable partial denture in order to restore aesthetics and function.