Endodontics is a branch of dentistry recognized by the American Dental Association dealing with treatment of the tooth, dental pulp and surrounding tissues.
When you look at your tooth in the mirror, what you see is the crown. The rest of the tooth, the portion hidden beneath the gum line, is the root. The outer portion of the root is a hard tissue called dentin. The inside channel, or root canal, contains the pulp, a soft tissue consisting of blood vessels, connective tissue and nerves. The pulp extends from the tip of the root(s) to the crown, and is an important component in the tooth’s growth and development. When the tooth becomes fully mature, the pulp can be successfully removed and the tooth will continue to be nourished by the surrounding tissues.
Bacteria introduced into the pulp because of tooth decay, periodontal disease, or a fracture can cause inflammation or infection, possibly resulting in pain and swelling. Damage to the pulp may also occur even if the tooth has no visible deterioration.
To save the tooth and prevent further problems, the root canal is treated. After successful therapy, your general dentist will restore the tooth to normal function.
What causes endodontic problems?
Root canal treatment is performed when the pulp becomes inflamed or infected. Usually the cause for inflammation or infection is a deep cavity, trauma to the tooth or extensive restorative treatment. The signs of pulpal damage can include pain, sensitivity to hot or cold, color changes and swelling or soreness in the gums.
Once the pulp becomes inflamed or infected, a root canal or extraction is necessary to remove the affected tissue and restore the area to health.
Most root canal procedures are non-surgical, and involve removing the injured pulp through the top surface of the tooth. Once the infected tissue is removed, the root canal system is cleansed and shaped to remove all traces of tissue and bacteria. Then a sterile, inert material is placed to seal the root canal system and prevent reinfection.
After the root canal procedure is completed, you will be directed to return to your restorative dentist for a permanent filling or crown. Please do not eat on the tooth until a permanent restoration has been placed.
Sometimes it is necessary to “retreat” or “revise” a root canal because of infection after initial treatment. Many cases are caused by incomplete prior root canal therapy, complicated canal anatomy or contamination with oral bacteria through a leaking restoration.
Our team is experienced in root canal retreatment procedures, and can usually return your tooth and surrounding tissues to health.
Once we perform an examination using 2D digital and 3D computed tomography, various treatment options will be explained. Then we will remove the previous root canal filling materials and carefully re-clean the canals using a special operating microscope along with digital radiography. Once your tooth has been cleaned and shaped, we will place filling materials into the canals to seal the root canal system. The clinical success of an endodontic retreatment depends on many factors, including whether alterations in the natural course of the root canals were caused by previous root-canal treatment.
Postoperatively, your restorative dentist will place a new restoration or repair your current restoration. Possible complications from this procedure are similar to those in the original endodontic procedure, however, the success rate for revision procedures is generally slightly lower.
Occasionally an infection can develop or persist after root canal therapy. If this occurs, revision (retreatment) of the root canal may be required. If revision therapy is not successful in eradicating the infection, it may be necessary to surgically remove the infected root tip(s) or apex and the surrounding tissue. This procedure is known as apical micro-surgery or an apicoectomy.
Before the procedure, a thorough examination and diagnosis will be performed. On the day of surgery, local anesthetic will be administered and an incision will be made to gain access to the infected area. The entire procedure is done using an surgical operating microscope with special coaxial lighting. Once the infected area around the apex is cleaned, the tip of your root will be sealed with a material called MTA. Then resorbable sutures will be placed.
You will be given medication to alleviate discomfort and return home for the rest of the day. Most patients will have minor swelling and occasional bruising. Healing will be followed carefully until new bone has formed around the root-end and the tooth is comfortable. Your safety and comfort during all phases of treatment is a priority of our team.
Emergency Care for Root Canal Therapy
For patients requiring emergency root canal treatment in Maryland, Washington DC and Virginia, please call our office as early in the day as possible to schedule an appointment. In case of an after-hours emergency, please call 301.654.6077 and the message will provide instructions for contacting the doctor.