Root Canal Treatment: Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when a cavity is allowed, through neglect, to reach all the way to this pulp. (Regular cleanings and checkups prevent and detect problems early) Sometimes deep restorations or trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy, also. Once this occurs the pulp becomes infected, and can even extend through the root tip and begin to eat away at the surrounding bone (this is an abscess). By the time the pulp is infected it must be treated, and cannot heal on its own. It can even weaken the entire immune system. This is dangerous, not to mention very painful. Symptoms that the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth. Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup. A root canal is then performed to clean out the infected tooth pulp, and disinfect the canals of the tooth. The only other treatment would be to extract the tooth. Once the infection is resolved, the canal(s) are filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has had root canal therapy.
Microscopic Endodontic Surgery (Apicoectomy): 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, microscopic magnification and advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic microsurgery may be able to save the tooth.
Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. Endodontists specialize in performing apicoectomies. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, Dr. Shojaei may have to perform an apicoectomy.
In this procedure, Dr. Shojaei opens the gum tissue near the tooth to see the underlying bone and removes any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly. Over a period of months, the bone heals around the end of the root.
What are the alternatives to endodontic Surgery?
Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.
No matter how effective modern artificial tooth replacements are-and they can be very effective-nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.
Microscopic Endodontic Retreatment: As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons. If you choose retreatment, Dr. Shojaei 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 access to the root canals.
After removing the canal filling, Dr. Shojaei 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. After cleaning the canals, she will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, Dr. Shojaei may recommend endodontic surgery.
After completion of the 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 its full function.