Root Canal Therapy, Root Canals, or
NonSurgical Endodontic Therapy
I thought it was called a Root Canal!
It used to be called a root canal until the American Association of Endodontistists redesignated it nonsurgical endodontic therapy. It’s the same thing, same basic process, same materials. Instrumentation, irrigation, and filling techniques have changed enough to have alleviated alot of the ‘experiences’ folks used to have with ‘root canal’ treatment so the specialty decided to give the procedure a new name.
Why do I need it?
The pulp, or soft inner tissue is important during the tooth’s development. Once a tooth is fully mature, the tooth can survive without the pulp because the tooth is nourished by tissues surrounding it. The pulp is normally surrounded and protected by a layer of dentin.
Above the gumline, the dentin is protected by a layer of enamel; below the gum-line the dentin is covered by cementum. When a crack or cavity destroys these protective layers, the pulp is exposed to irritants and bacteria in your mouth. This can result in inflammation then infection, and, eventually, an abscess. Periodontal (gum) disease or a severe blow to the tooth can also damage the pulp. Endodontic therapy removes the damaged pulp and usually the tooth returns to a healthy condition.
If an abscess was present before treatment the healing process may take up to 2 years.
What Happens During Endodontic Treatment?
What is a Root Canal?
A local anesthetic will be given. A sheet of latex called the “rubber dam” (we’ve got nonlatex ones too) will be placed around the tooth to isolate it, hence keeping it clean and dry during treatment. The treatment consists of three or four basic steps, but the number of visits will depend on your particular case. Some treatments take 2 visits but many are just a single visit. Occasionally 3 appointments are needed. In any case, it depends on the degree of infection/inflammation and degree of treatment difficulty. To me, it’s more important to do it the very best we can then to meet a specific time criteria. Let’s look at the basic steps for nonsurgical endodontic therapy.
The Root Canal Process
(Access to Root Canals)
Root Canals Cleaned
Filled and Sealed
Step 1: An opening is made in the crown of the tooth. This allows access to the root canal system. It’s very important to have a large enough opening to find all the canals inside a tooth. Anatomy inside the tooth is variable. Some teeth have just one canal like most upper front teeth. Premolars have 1 or 2 usually. Molars or the back teeth typically have 3 or 4. Especially in back teeth, a surgical operating microscope with great illumination allows visualization much better to help find these canals.
Step 2: The pulp is removed from the pulp chamber and root canals. Tiny instruments are used to clean the root canals and to shape them to a form that will be easy to fill. Irrigants are used to disolve and flush debrie. If this step is not completed in one visit, medication will be placed in the canals and a temporary will be placed in the opening to protect the tooth between visits. Radiographs (X-rays) are taken periodically during the cleaning process to check if the instruments are cleaning near the end of the root.Step 3: When thoroughly cleaned the root canals are filled with a rubber like compound called gutta percha. A cement is also used to help seal the canals to prevent bacteria from reentering. In many cases, the opening in the crown of the tooth is sealed with a temporary filling. Either upon request from your dentist or when we feel it’s appropriate, the access opening in the crown is filled with a build up restoration as pictured. Occasionally, enought tooth structure is missing to warrent use of a post to help retain the final restoration. After endodontic treatment, radiographs (X-rays) are taken to verify that cleaning and filling of the canals is close to the end of the root.Step 4: If a temporary filling was placed it will be replaced by your regular dentist with a permanent filling and restoration as needed. A gold crown is shown for illustrative purposes but tooth colored crowns are often used. Crowns are required on teeth towards the back of your mouth since the opening made weakens the top part of the tooth which undergoes tremendous stress during eating. Front teeth may require restoration with a crown when not enough natural tooth structure is present but otherwise can often just be restored with a filling. Dr. Dovgan will discuss the requirements of your specific case after the endodontic examination and treatment planning.
What kind of Materials are placed in the process?
The resulting space inside the center portion of your tooth is filled with a rubber like material (gutta percha) and cement (zinc oxide + eugenol) to seal the root canals in vast majority of cases. In a few special cases, the root canal space may be filled with mineral trioxide aggregate (MTA) or a plastic resin . If a filling is placed to restore an area, it will NOT contain amalgam but usually one or more of the following: composite/glass/resin ionomer (glass and organic acid +/or plastic resin), MTA (portland cement), +/or zinc oxide/eugenol.
What if I have a Temporary or Build up placed after treatment?
If a temporary was placed after completion of treatment, it is imperative to return to your restorative dentist for treatment. Because a temporary filling is designed to last only a short time (about four weeks), failing to return to your dentist as directed to have the tooth sealed permanently with a crown can lead to the deterioration of the seal, resulting in fracture, decay, infection, gum disease and/or the possible premature loss of the tooth and require additonal treatment like another retreatment or extraction. If your temporary comes out, it needs to be replaced right away. You’ve invested in maintaining the tooth, so return to your restorative dentist as soon as possible (within a month)!
If a build up was placed after completion of treatment, it’s important to return to your restorative dentist for completing the restoration of the tooth. Failing to return to your dentist as directed can result in fracture of the tooth, which in some instances is not repairable and tooth will have to be extracted. Other things that can happen are deterioration of the seal, decay, infection, and gum disease not to mention potentially premature loss of the tooth. You’ve already invested in maintaining the tooth, so return to your restorative dentist as soon as possible (within 1 month) for final restoration.
Will I need to return to your office for Additional Visits?
Once endodontic therapy is completed your tooth should be examined periodically, usually every 6 – 12 months. This allows us to make sure the tooth has healed or is healing properly. You will be sent a notice in the mail when we feel it is appropriate to reevaluate the area. Since an abscess may take 2 years to heal, our office will reevaluate the tooth for at least 2 years
Immediately after treatment
on tooth with an “Abscess”
2 years after treatment
with complete healing
How do I know the Endodontic Procedure will be Successful?
There are, of course, no guarantees. Root canal or endodontic therapy has a very high degree of success, up to 90%. Teeth which can be treated near ideal have a success rate up to ninety percent! Dr. Joseph Dovgan will discuss with you the chances of success before any endodontic procedure to help you make an informed decision. If a root canal or endodontic therapy is unsuccessful or fails you still have options. See When Nonsurgical Endodontic Therapy (RCT) is unsuccessful.
Watch a simulated NSET or Root Canal procedure in an Acrylic Block!
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How does endodontic treatment maintain a tooth?
The nonsurgical endodontic therapy or root canal removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you return to your general dentist, who will place a crown or other restoration on the tooth to protect it and restore it to full function.
Will I feel pain during or after the procedure?
While many patients may be in great pain before seeing an endodontist, most report that the pain is relieved by the treatment and that they are very comfortable during the procedure. The vast majority of patients can be anesthized so the procedure is almost “painless”. Sometimes anesthetic must be placed directly into a given area to achieve anesthesia or complete numbness. For the first few days after treatment, the tooth will probably feel sensitive especially to biting and commonly a slight dull ache for a few days. If there was pain or infection before the procedure, it may take a couple of days to return to normal. This discomfort can be relieved with over-the-counter or prescription medications. The endodontist will tell you how to care for your tooth at home.
Are there any alternatives to Nonsurgical Endodontic Treatment
or Root Canal Therapy?
The only alternative is typically extraction.
What happens if I have no treatment at all? Your present oral condition will probably worsen with time, and the risks to your health may include, but are not limited to: pain, swelling, infection, cyst formation, loss of supporting bone around my teeth, and premature loss of tooth/teeth. So don’t wait, get treatment as soon as possible!
What happens if I have an Extraction with nothing to fill the space? This may result in: shifting of teeth, change in bite, and potentially periodontal disease
Is there some way to fill the space if I have the tooth extracted? Yes. You could have a bridge, partial denture, or implant to fill the space.
How much will the procedure cost?
The cost varies depending on how severe the problem is and which tooth is affected. Many dental insurance policies cover endodontic treatment. Generally, treatment and restoration of your natural tooth is the least expensive option. The only alternative is having the tooth extracted. Most teeth will need to be replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting.
Does Insurance pay for Endodontic Therapy?
Most insurance plans do cover endodontic therapy. Each insurance plan is different, however. As a patient in our office, we offer the courtesy of calling and confirming your insurance. We will also inquire about it’s coverage of endodontic procedures.
Will the tooth need any Special Care?
You should not chew or bite on the treated tooth until you have had it restored by your general dentist because your tooth could fracture. Otherwise, just practice good oral hygiene – brushing, flossing and regular checkups and cleanings. Endodontically treated teeth can last for many years, even a lifetime.
What causes an endodontically treated tooth to need additional treatment?
Periodontal disease or gum disease can require the need for periodontal procedures. New trauma, deep decay, a loose, cracked or broken filling can cause new infection in your tooth. In some cases, your endodontist may discover very narrow or curved canals that could not be treated during the initial procedure. See When Nonsurgical Endodontics (root canals) are unsuccessful.
Will I be able to drive myself home?
Patients who have had endodontic therapy are usually able to drive themselves home. Those patients that take oral sedative drugs will have to have transportation arrangements made to and from our office. It is a good idea to talk to us about this prior to your appointment if your thinking about oral sedation.