Root Canal Treatment

Root canal treatment is designed to eliminate infection, prevent future bacterial contamination, and preserve your natural tooth. During the procedure, infected or inflamed tissue is removed, the canals are cleaned and disinfected, and the tooth is sealed to promote healing. Most treatments are completed in one or two visits and are followed by a permanent restoration, often a crown, to protect the tooth and restore function. A follow-up examination is typically recommended after one year to confirm healing.

Upper molars cause problems due to the second canal located in the mesiobuccal root.  Failure to locate and instrument this second canal can result in the development of post-treatment endodontic disease.  

Root Canal Retreatment

Occasionally, a root canal–treated tooth may not heal completely or can become re-infected due to persistent bacteria, a leaking restoration, recurrent decay, or a crack in the tooth. In these cases, root canal retreatment may be recommended. Retreatment involves removing the previous filling material, thoroughly disinfecting the canals, addressing any missed anatomy or sources of infection, and resealing the root canal system. This procedure can often eliminate infection, promote healing, and preserve the natural tooth for many years.

Lower premolars can present a challenge when containing multiple canals.  The following case demonstrates how the bone around an infected root canal treated tooth healed following non-surgical retreatment.
 

Apicoectomy

When infection cannot be predictably treated with conventional root canal therapy or retreatment, endodontic surgery may be recommended. During an apicoectomy, the infected tissue and tip of the root are removed, and the end of the root is sealed to prevent reinfection. This procedure can often preserve a natural tooth that might otherwise require extraction.

The following tooth #14 received two non-surgical retreatment procedures, both of which failed to eliminate the source of the infection.  Following an apicoectomy, the bone around the root tips completely healed. The diagnosis of the apical tissue was a periapical cyst.
 

Traumatic Injury and Cracked Teeth Management

Endodontists are specially trained to treat traumatic dental injuries, including fractured, displaced, and knocked-out teeth. Prompt treatment is critical and can greatly improve the chances of saving the tooth and supporting structures.

Sensitivity to cold, biting, or chewing may be an early sign of a cracked tooth. Because cracks can worsen over time and lead to infection or tooth loss, early diagnosis and treatment offer the best opportunity to preserve your natural tooth.

Emergency Treatment

Tooth infections may develop without symptoms or can cause sudden pain, swelling, and pressure. Emergency endodontic treatment is focused on relieving pain, controlling infection, and preserving the natural tooth. Through root canal disinfection, appropriate medications when needed, and modern anesthetic techniques, treatment can be performed comfortably and effectively.

This patient below knocked out her front tooth on the playground.  The tooth was not replanted at the scene of the accident, so therefore root canal therapy was performed on the tooth prior to its replantation.  Considering this tooth spent more than 24 hours out of the socket, the prognosis is guarded and the tooth may eventually require replacement with an implant.  But at a young age, the root canal treated tooth will serve to preserve the bone until a more definitive restoration can be done.  Special thanks to James Han, D.D.S, M.B.A. for his integral role in this case.

Revascularization/Regeneration

When an immature tooth becomes infected, root development can stop prematurely, leaving the tooth weaker and more prone to fracture. Revascularization, or regenerative endodontic therapy, disinfects the root canal while encouraging the growth of new vital tissue. This may allow continued root development, strengthening the tooth and improving its long-term prognosis. Regenerative endodontics is an exciting advancement that harnesses the body’s natural healing potential to preserve developing teeth.

The following case depicts closure of a wide canal apex with MTA.  After thorough disinfection of the canal space, an MTA plug was place at the canal apex.  The MTA sealed the apex and allowed the compaction of gutta percha to fill the rest of the canal space.  Significant healing was seen at the 18-mo follow-up.

Internal Bleaching

Teeth can become discolored from trauma, pulpal degeneration, or previous dental treatment. Internal bleaching is a conservative procedure that lightens a root canal–treated tooth from the inside by placing a whitening agent within the tooth. Unlike traditional whitening treatments that affect multiple teeth externally, internal bleaching targets a single discolored tooth and can often restore a natural appearance without the need for more extensive restorative treatment.

Additional Endodontic Case Examples

This case involved internal resorption of both the mesial and distal roots of tooth #30. These cases require a vital pulp and often present as asymptomatic. Upon completion of root canal therapy, the pulpal cells responsible for the resorption were removed and the resorptive process stopped.

The following molar represents a case of radix entomolaris, which simply means an extra root in a mandibular molar tooth. Most mandibular molar teeth have two roots. This tooth had three roots and four canals.

This patient presented with mild symptoms associated with the maxillary incisors. Radiographs showed periapical radiolucencies on teeth #’s 8, 9, and 10, indicating the presence of post-treatment endodontic disease. The decision to perform apicoectomies was chosen over non-surgical retreatments mostly due to financial considerations. Apicoectomy also affords the ability to not disturb the coronal restoration that can save the patient from potential costly restorative treatment. Complete healing of the periapical tissues was seen at the 9-month recall visit.

Wisdom teeth can also be treated with root canal therapy if the symptoms should indicate the need, and the tooth is functional and restorable. Tooth #32 served as a distal abutment for a 4-unit bridge, and was symptomatic to hot and cold. Pulpal sensitivity testing produced results consistent with irreversible pulpitis.

This patient presented with post-treatment endodontic disease.  A separated instrument was noted at the apex of the mesial root.  Non-surgical retreatment was first performed under the assumption that the separated instrument was not going to be retrieved or potentially bypassed. Despite not removing the instrument, reducing the bacterial load below a certain threshold is sometimes enough to allow for apical healing. Nine months following the retreatment, apical healing was not apparent and therefore apicoectomy was performed. The 12-month recall showed that the apical tissues completely healed.