- Specialist Consultation
- Root Canal Treatment
- Root Canal Retreatment
- Endodontic (Apical) Surgery
- Trauma Management
- Cracked Tooth Management
- Incision for Draining
- Internal Bleaching
- Resorption
Specialist Consultation
Often times your dentist will identify a condition with your tooth that he or she is uncertain of the best course of action. Perhaps it is an old root canal that appears to be re-infected. Or sometimes they see a shadow on the x-ray but they are unsure if it represents disease or if it is just a variation of normal.
In these scenarios, your dentist will likely refer you to San Clemente Endodontics for a consultation. This will allow Dr. Potter to evaluate the tooth with the expertise of a root specialist to help decide the best treatment plan for you. Additional angled x-rays will be taken so that she can get a good perspective of all aspects of the root.
She will also collect some information from testing done on the teeth and gums. Occasionally, she will request that a 3D scan (aka. CBCT) is taken to allow her to see the root in 3 dimensions.
Once all of the information is compiled, she will be able to make a professional recommendation for you and answer any questions to help guide you into making a decision that is right for you.
Sometimes a Root Canal is the Best Option for the Patient
Other Times Extraction & Placement of an Implant is Best
Root Canal Treatment
If your pulp or nerve space has become ill, endodontic treatment can be done to relieve you of pain and infection and maintain the natural tooth in the mouth. Root canal treatment can often be performed in one or two visits and involves the following steps:
1. The endodontist examines and x-rays the tooth to determine if root canal treatment is the best course of action. If it is local anesthetic is then administered to get you completely numb and comfortable. After the tooth is numb, the endodontist places a small protective sheet called a “rubber square” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2. The endodontist makes a small opening in the crown of the tooth to access into the root. 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 canals with a biocompatible material, usually a rubber-like material called “gutta-percha.” The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. At that point, either a temporary or permanent filling is placed to close the opening. If a temporary filling is placed, it will be removed by your dentist before the tooth is permanently 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 it and restore it to full function.
5. If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may recommend that a post be placed inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.
Root Canal Retreatment
While endodontic treatment, if done properly, has a success rate of over 90%, occasionally bacteria from your mouth can re-contaminate the roots even after a root canal. Many times people think that if a tooth has a root canal it no longer has a nerve so it can’t hurt. This is not always true.
If bacteria get back into the root, then pain can develop in the ligament and bone that surround the root. These tissues still have nerves attached to them. Therefore, occasionally a root canal needs to be re-done, or what we call a root canal retreatment.
After thoroughly numbing the area for complete patient comfort, a small hole is made through the crown of the tooth to re-access into the root. The old root canal filling material is then removed and the root is disinfected to try and kill any bacteria that have re-contaminated.
If the root is unable to be completely disinfected in one visit, a medication is placed in the root to continue to disinfect over the following week or two.
Once the root is completely disinfected, the new root filling can be placed. Just like the first root canal, this is usually a rubber-like material called “gutta-percha.” The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. At that point, either a temporary or permanent filling is placed to close the opening. If a temporary filling is placed, it will be removed by your dentist before the tooth is permanently restored.
Endodontic (Apical) Surgery
The most common endodontic surgical procedure is called an apical surgery 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 apical surgery if retreatment has not been successful or is not a good option. In this procedure, the endodontist opens the gum tissue near the tooth to expose the underlying bone, and the infected tissue is removed. The very end of the root is also removed, and a small filling is placed to seal the root canal.
Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day.
When apical surgery is recommended by Dr. Potter, she will usually request that a 3D scan (aka. CBCT) be taken so that she can have a full, 3-dimensional view of the root and surgery site.
This is also used sometimes to ensure that the patient is a good candidate for surgery. The patient is sometimes placed on an antibiotic and anti-bacterial mouth rinse prior to surgery to help clean the surgical site. Following surgery, the patient is seen again in 3-7 days for a post-op check up and suture removal, if necessary. Then, in 6 months, the patient is evaluated again to ensure that the bone around the tip of the root is healing adequately.
Trauma Management
After tooth decay, trauma is the most common reason why a tooth may need a root canal. This is most common in front teeth.
It could be from something hitting the tooth, chipping the tooth, making it become loose, or even knocking the tooth out!
Trauma Chipping Tooth
Trauma Loosening Tooth
Trauma Knocking Tooth Out
Trauma Causing a Root Fracture
Endodontists are experts in managing traumatic injuries to teeth, and if a tooth is traumatized an endodontist should be consulted immediately. Timely evaluation by an endodontist can mean the difference between saving the tooth and losing it.
Example of a Splint
Sometimes the recommendation will be to monitor the tooth, do a root canal on the tooth, splint the tooth, or all of the above.
Cracked Tooth Management
Sometimes if a tooth becomes cracked it can develop pain to biting. Other times, it may not hurt at all. Cracks develop in teeth just like they can develop in any other mineralized tissue. Bones can break, and teeth can too! Sometimes it is from a traumatic event like accidentally biting into a pebble or bone in your food. Other times, it can be from a lifetime of chewing ice or unknowingly grinding your teeth at night.
Regardless, when a crack develops in a tooth, it can be like a crack in a windshield: it can start off small and stay that way for a long time, but over time it can extend and propagate, causing a great deal of damage. When this happens, bacteria from your mouth can get deeper towards the pulp and start to cause symptoms. Usually when this happens, the best treatment is either a crown or a root canal and a crown (if the damage to the pulp has become so severe that a crown by itself will not resolve the issue).
Occasionally a crack can develop on the root surface. Unfortunately, when this happens, the best option for the patient is usually extraction. However, there may be other alternative options you can discuss with Dr. Potter.
Incision for Draining
If your tooth has developed an infection and that has started draining into the gum, sometimes an incision for drainage is indicated. This procedure is done to drain the fluid from the infected site and help relieve some of the pressure and pain associated with it. A small incision is made in the tissue over your tooth to allow drainage of infection. It is then usually rinsed with saline to clean out any remaining fluid. Moist gauze is placed over the site to provide pressure against the incision.
You may experience some bleeding for the next few hours. Use warm salt water rinses (1 glass of water with ½ teaspoon of salt) every 2 hours as needed, and also replace the gauze as needed. If medications are prescribed, take them as directed.
Internal Bleaching
If a tooth becomes severely discolored, but all of the other adjacent teeth appear normal, we can bleach just that individual tooth! This is called internal bleaching, and the goal is for that tooth to achieve a similar shade to those teeth surrounding it. After the root canal is completed, a bleaching material is placed within the tooth and left there for a period of time.
The amount of time depends on how discolored your tooth was and how white you desire it to become. The endodontist checks its progress every week or two and replenishes the bleach as needed. Once the desired brightness has been achieved, the bleach is removed and a permanent filling is placed.
Resorption
If your dentist referred you to Dr. Potter because he or she said you have “resorption,” you probably thought, “I have WHAT?” Tooth resorption is a process by which tooth structure starts to be removed by our own cells that normally remove bone (osteoclasts). This process is normal in bone because there are also cells that rebuild bone throughout our whole lives (osteoblasts). However, teeth lack these reciprocating cells and therefore tooth resorption is considered a disease process and can become very problematic. While the exact cause of resorption is unknown, it is usually associated with trauma, infection, bleaching, and even certain types of orthodontics.
Apical resorption is a type of external root resorption that is found at the tip of the root when there are bacteria present in the root area.
Invasive cervical resorption is a type of external root resorption that usually occurs just under the gumline.
If your dentist has referred you to Dr. Potter because they fear you have invasive cervical resorption, you may or may not have symptoms. This process sometimes creates inflammation in the nerve space which can cause a tooth ache or cold sensitivity, but it does not always cause this type of inflammation. Many times this process is found on routine radiographic exam. There are many treatment options for this type of resorption, and the option that is best for you depends on the location, size, and depth of the lesion. Dr. Potter will likely want a 3D CBCT scan of the tooth in order to clearly see the location, size, and depth so that you can come up with an individualized treatment plan that suits you best.
Many teeth with invasive cervical resorption can be saved with endodontic treatment. However, the process of resorption is a progressive disease, so we can sometimes see recurrence down the road. This does compromise the long-term prognosis of doing a root canal on a tooth like this. Occasionally, a small surgical procedure of the gum is needed in addition to endodontic treatment to give the tooth the best chances of long-term success. If the resorption is too extensive, the best treatment option may be extraction. Other times, the best course of action is no treatment. Have your tooth evaluated as soon as your dentist identifies resorption so that Dr. Potter can advise you on which course of action may be best for you.