The aim of endodontic therapy is to save the tooth that has been badly damaged due to decay, disease or trauma. As a natural tooth generally functions better than any replacement options following extraction, endodontic therapy is the preferred treatment to retain the natural tooth.
The infected pulp is removed and medication is placed in the root canals to provide an antibacterial action between appointments. The medication in the root canals may need to be replaced at subsequent appointments depending on the individual case. The root canals are filled with a permanent filling at the final appointment.
In many cases, endodontic therapy will be successful and enable retention of the tooth for many years. However, all teeth are not equal and the lifespan of teeth can vary depending on many factors. Your Endodontist will assess the prognosis of your tooth on an individual basis and discuss the likely risks so that each patient can make an informed decision regarding proceeding with endodontic therapy. In some cases, endodontic therapy may not be the most ideal treatment option and other alternatives can be discussed.
With appropriate care, the endodontic therapy can remain successful for the entire life of a natural tooth. However, sometimes associated pain or further infection may re-occur months or years after a tooth has been treated. This may be due to a resistant infection, further deep decay, trauma or a cracked tooth or filling that allows bacteria to re-enter the root canals of the tooth and cause further infection. An additional course of endodontic treatment may be recommended that removes the initial root fillings, and allows further instrumentation and disinfection of the root canals before a new root filling is placed.
Injuries to the mouth can cause displacement of teeth or result in the tooth being knocked out of its socket requiring repositioning and stabilization of the teeth by your general dentist or Endodontist. If the pulp remains healthy then no other treatment may be required but if the pulp becomes damaged or infected, endodontic therapy may be required as soon as possible.
A traumatic blow may cause a fracture in crowns or roots of teeth. In these situations, assessment and review of the teeth is required to judge the need for endodontic therapy.
There are many types of cracks or fractures that can occur in teeth with symptoms not always experienced. Symptoms may include pain when chewing or temperature sensitivities and pain may come and go. Some cracks may not significantly affect the pulp and may only require a filling to resolve the painful symptoms. Alternatively, crack lines may extend to a depth that allows infection of the pulp tissues, requiring endodontic therapy. Careful assessment of each tooth is required to determine which treatment option is most ideal.
When teeth are damaged they can sometimes become discoloured. This can be caused by the damaged pulp bleeding into the tooth structure or some materials and medications used in previous treatments. Standard bleaching or tooth whitening is not enough to mask this discolouration. Endodontic bleaching restores the natural colour of the tooth by whitening it from the inside. The inside of the tooth is accessed through the hole that was originally used to carry out the root canal procedure. A gel or pellet of bleaching agent is inserted into this cavity then sealed in with a temporary filling. The bleaching agent is left for a period of days, and then removed. This process may need to be repeated several times to get the right amount of whiteness. The pellet or gel will be removed once the desired level of whiteness is met, and the tooth restored with a permanent filling.
Root Canal therapy is often all that is needed to treat infected or inflamed teeth although in some cases, large or very long standing infections also require surgical treatment to resolve the infection. Endodontists are specifically trained in this very specialised form of dental surgery which can save teeth that might have not otherwise responded to treatment.
The technical term for this type of surgery is an Apicectomy or Apicoectomy which literally means to remove the apex (or tip) of the tooth root. In addition to removing a small part of the root tip (typically around 3mm), the surrounding bone which harbours the abscessed or infected tissue is also removed and a seal is placed (retrofilling) in the root end of the remaining tooth. At Specialist Endodontics, we perform this procedure using an Operating Microscope together with specially developed instruments such as ultrasonics and Bioceramic materials to ensure the highest level of quality for predictable healing. For certain surgical procedures this can be carried out under local anaesthetic alone (similar to what is used for a simple dental filling) or can be done using Intravenous Sedation.
Dental Intravenous (IV) or twilight sedation (also known as moderate sedation or sleep dentistry) is available at our Charlestown practice for patients having routine endodontic therapy and/or surgical treatment. Whilst most endodontic treatments can be performed with little or no pain due to excellent anaesthesia, sedation is helpful for patients who are anxious, fearful, gaggers, extremely sensitive or who have difficulty tolerating longer procedures.
The main benefits of sedation are the relaxing and amnesic (memory loss) effects allowing patients to undergo treatment in a calm and restful state and at the end of treatment have limited memory of the process afterwards.
As with other forms of anaesthesia, you will need to fast for 6 hours leading up to your appointment and once you arrive; you will be made comfortable in the dental chair and given the sedation medication through a small plastic drip in your arm. You will be closely monitored throughout the appointment by a Dental Sedationist endorsed by the Dental Board of Australia to provide conscious sedation. Dental sedation does not cause the patient to lose consciousness so you will be able to communicate with the Endodontist throughout the procedure while being comfortable and relaxed. After completion of treatment and with about an hour to recover before you go home, you will need to have someone pick you up after your appointment and look after you while you rest for the remainder of the day.