|
Saving
teeth from extraction with root canal treatment
Endodontics
- what is that?
Endodontics
is the field of dentistry that deals with treating disease inside the
tooth.
| The
healthy tooth |
|
The
diseased tooth |
 |
|
 |
|
If
a tooth has been badly decayed or traumatized the pulp inside
the tooth can become infected. When toxins and bacteria
leak out the openings at the tips of the root a dental abscess
can form. In order to treat or prevent this abscess the
dentist cleans out all the necrotic pulp tissue from within
the pulp chamber and root canals. Once the tooth is
sufficiently cleaned out and as sterile as possible, the root
canal system is sealed off. Bacteria are prevented from
infecting the tooth again in most cases (a small percentage of
root treatments do fail, especially if they are only done long
after the abscess develops. However, many teeth are
successfully saved from extraction, and root treatments are a
valuable treatment option.)
|
Steps
in completing a root canal treatment
Radiographs
Throughout
a root canal treatment the dentist will need several x-ray pictures of
the tooth to determine the position of the instruments and filling
material inside the canals. It is also advisable to have a good
pre-operative picture to determine the approximate length of the roots
and their particular shapes and curvatures.
 Access
opening
First the
dentist will remove any decayed and weak tooth structure. A
suitable opening into the pulp chamber is prepared to allow access to
the openings of the root canals in the pulp chamber floor.
Instrumentation
The root
canals are identified and then cleaned out with special root canal
instruments. Some are used by hand, others rotate in a handpiece.
They all have the function of removing debris from the canal and
smoothing and shaping the walls of the canals to create a smooth, clean
surface along the entire length of the canal. The canals are
constantly rinsed to aid in debris removal and canal sterilization.
In some, but not all cases, the canals may be dressed with various
medications and sealed with a temporary filling material to allow time
for the infection to clear.
Sealing
Once the
canals are suitably cleaned and shaped and infection free they can be
sealed off. A root filling material (usually a rubbery material
called gutta percha) is placed into each canal with a special sealer.
Final
restoration
Placing a
suitable final restoration is almost as important as the root treatment
itself. If the restoration leaks bacteria can migrate down the
side of the root sealer and re-infect the tooth. A suitable
permanent filling is placed into the access opening. Teeth with
large amounts of damage may need a post (a metal or fiber reinforced
resin rod) down one or more canals to anchor the filling securely onto
the root of the tooth.
However
the access opening is closed, root treated teeth will always be weaker
than natural teeth and prone to cracking or splitting. A serious
fracture could mean removing the tooth that was so carefully saved with
the root treatment. A good way to insure against such a disaster
is to crown
the tooth.
Risks and
complications
Despite
our best efforts a small percentage of root treatments do fail,
especially if they are only done long after the abscess develops.
The failure rate increases if the root treatment is a repeat treatment
of a previously failed root canal, or if some damage has occurred to the
root during reaming. However, many teeth are successfully saved from
extraction, and root treatments are a valuable treatment option.
During
treatment very delicate instruments are used to clean and shape the
tooth. Very occasionally these instruments can separate (break) in
the canals. This does not necessarily mean the entire treatment is
a failure. Most often the fractured piece can be removed or
by-passed, and a normal root filling placed. Sometimes the
treatment is completed leaving the piece of instrument in the root.
Most often this is not a problem. If the treatment does fail one
can consider an alternate surgical solution: either extracting the tooth
or doing an apicoectomy (cutting off the tip of the problem root and
sealing it from the outside).
Because
of the infected nature of the abscess there can be some discomfort or
swelling. This will be controlled with antibiotics and anti-inflammatories
as needed.
What
happens if I don't have a root canal treatment?
If a
tooth has an abscess it can firstly cause severe pain, but not always.
Some abscesses can be surprisingly painless. Nevertheless, the
infection at the root tips can spread into the surrounding bone and soft
tissues and cause more serious infections there that could cause
swelling and pain. Bacteria also enter the blood stream and can
infect other parts of the body. Prosthetic hip and knee joints and
heart valves are particularly prone to infection. Patients with
other health problems could also be at higher risk.
Root
canal treatment is too costly. What alternative treatments are there?
Unfortunately,
usually the only alternative is to remove the infected tooth.
Often teeth requiring root canal treatments are weakened from the large
tooth decay cavity and cannot easily be simply extracted. Many
require surgical removal. Initially the removal of the tooth may
save costs, but in the long term replacing the missing
tooth is far more costly than root treating it and restoring it with
a suitable restoration, usually a crown.
Dentists advise against leaving gaps.
To learn
more about why missing teeth should be replaced whenever possible read
this page. |
