A clinical
examination and a series of tests that include
digital radiographs will be performed to isolate
your chief complaint of pain to a specific tooth
requiring treatment. The determination that there is
enough tooth structure to save and ultimately
restore the tooth to function will be made. Most
"routine" root canal procedures can be performed in
one appointment (2 hours or less); however, there
are situations where two appointments are necessary
to ensure sterility of the canal space before
completion of the case. These include retreatments,
cases where the pulp is necrotic or where there is
an abcess evident at the base of the root.
Intracanal medicaments are left within the canal
space for one to four weeks between appointments to
facilitate elimination of all residual bacteria
before sealing the root canal space.
Access
An
opening is made in the back or top of the visible
portion of the tooth (the crown) to gain entry into
the root canal system. The use of loupes or
microscopes to enhance magnification and
illumination is essential in identifying the complex
morphology of the root canal system.
Instrumentation
(Shaping and Cleaning of the Root Canal Space)
The
preparation of the root canal space is performed to
the end of each root. The added flexibility of
nickel-titanium files (small wire like instruments)
and irrigation (continuous flushing) is used to
remove tissue, debris, and bacterial contamination.
The length of the tooth is determined either by a
computer assisted device or by x-rays.
Various
medications and ultrasonic instruments are used to
sterilize the tooth structure of the root canal
system. All instruments used within the canal are
used only once. The other instruments again, such as
the dental drills, are autoclaved and sterilized
with the most sophisticated equipment available.
Obturation
(Filling the Root Canal Space)
This step
involves placing a thermo-softened filling material
(gutta-percha) along with a sealing cement to fill
the canal(s) and prevent future contamination. This
material is injected into the canals and condensed
with special instruments to create a perfectly
adapted and impervious seal in the root canal
system. In the radiographs, this polymeric material
appears as the white area within the root canal
space.4
Restoration
(Crown or Inlay)
After the
endodontic treatment is completed you will be
referred back to your general dentist for a final
restoration such as a crown, cap, or inlay/onlay.
Your family dentist is best qualified to determine
the best restoration to use to restore your tooth. A
note and a copy of your final digital x-rays are
sent by our office to your dentist, informing them
that treatment has been completed.
Re-evaluation
Appointment
You will be
asked to return to our office in 3 to 6 months so
that we may review the success of the root canal
procedure. There is no additional charge for this
visit.
Post Operative
Discomfort
The nature
and degree of discomfort experienced after root
canal therapy depends upon a number of factors; the
original diagnosis, your unique reaction to dental
trauma, the amount of pain you had prior to
treatment, and the amount of manipulation necessary
to treat the tooth. A regimen of anti-inflammatories,
analgesics and antibiotics may be required and
should be taken as directed. The tooth is expected
to be sore when chewing for up to a week after
treatment. To help diminish this discomfort, the
'bite' on the tooth may be relieved from occlusion
and you are asked to avoid the side while eating
until it is comfortable again.
Alternative
treatment options
If you are
not committed to having the tooth properly restored
after the root canal procedure and you do not mind
the thought of losing a tooth, then endodontic
therapy may not be the treatment of choice for you.
Sadly, extraction is a short term fix with long term
consequences. Teeth like every other part of our
body were put there by a higher power for a reason.
We have decided that they are expendable; the price
incurred for this simplistic approach may ultimately
prove very costly in the long run.
Review
We try our
best to attend to you at the time reserved for your
appointment; we are successful in the vast majority
of cases. There are however, circumstances beyond
our control which may preclude this possibility. We
try our best to present the full scope of what you
may expect from the treatment, however, in some
cases, not everything plays out as expected. It is
understood that endodontic treatment is a procedure
to retain a tooth which may otherwise require
extraction. Although this treatment has a very high
degree of clinical success, it is still a biological
procedure so it cannot be guaranteed. Occasionally a
tooth which has had endodontic treatment may require
retreatment, surgery, or even extraction. As
previously indicated, once treatment is completed,
your tooth will need a final restoration (filling,
cap, or crown). Our fee does not include this
service.
For more
information, please contact us with any further
questions.
