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Peyman Vaziri, M.Sc., D.M.D., M.S.D.

Rachel James, D.D.S., M.S.


Treatment Explanations

Root canal treatment is a procedure in which the infected pulp is cleaned from the canals of a tooth. This treatment becomes necessary when the soft interior of the tooth, referred to as the pulp, which contains blood vessels, nerves, and connective tissue, develops an infection or becomes inflamed. This leads to pain and discomfort. Causes of infection may include deep tooth decay, damage caused by a crack, chip, or traumatic impact to the tooth, or even repeated dental procedures performed on the tooth. Once this damage occurs, prompt treatment is imperative in order to save the tooth and prevent further spread of the infection.

A root canal procedure begins with localized numbing in the area of the infected tooth. Once this area is numb, the patient will not feel pain during the treatment. The canals of the tooth are accessed through a hole drilled into the top of the tooth, or from behind if treating a front tooth. Once access to the canals is gained, an endodontist will clean out the roots, removing the infected pulp and nerves. The cleared canals are treated with an antibacterial solution, and then filled and sealed with a standard rubber-like root canal filling material. A temporary filling will be placed in the access opening made at the top of the tooth. If the tooth does not have the adequate structure needed to support the filling, a space, that will make room for a post, may be placed in a canal of the tooth for added support. The patient will then see a general dentist for placement of this post if needed, and for permanent restoration of the tooth structure which may be a filling and/or a crown.

Conventional root canal retreatment is performed on a tooth that has previously had root canal treatment. Retreatment becomes necessary when the tooth has become infected, due to cracks or openings in the crown or filling. In some cases, difficult canal structures may not have been treated during the initial root canal, or new trauma may possibly have been experienced in tooth. It is possible that this new infection may only be detected through x-rays that show a need for retreatment. Pain or discomfort is not always felt.

During a retreatment, the root canals will be accessed from the top of the tooth, or from the back if treating a front tooth. The permanent crown or filling will be re-opened to gain access to the inside of the tooth. The existing root canal fillings are also removed to clean the core of the tooth, and medication is placed. A second appointment will be needed, during which the core of the tooth will be cleaned once again and new root canal filling will be placed to seal the canals. This temporary filling will be placed in the access opening until a general dentist places the permanent restoration of the tooth structure.

Root canal surgery is an alternate form of retreatment, performed on a tooth with previous root canal treatment that has become re-infected. The procedure is also called an apicoectomy. This form of treatment may be chosen for cases in which a conventional retreatment is not possible or has a lower chance for success.

During this procedure, the infected root is accessed and treated from underneath the gum tissue. The endodontist will make a small incision in the gum tissue for direct access to the tip of the root, where the infection has occurred. The roots are then prepared from the back end, and a filling is placed to seal the root tip from further infection. The area around the roots will be cleaned, including any infected tissue that may be present. Sutures will be placed to help in the healing of the gum tissue. A follow up appointment will be arranged in two to three days, for the removal of the sutures.