Endodontics

Endodontics is the branch of dentistry concerning dental pulp and tissues surrounding the roots of a tooth. “Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.”

Endodontists like Dr. Garland are specialists in saving teeth, committed to helping you maintain your natural smile for a lifetime. Here are some of the endodontic procedures we offer:

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Root Canal Therapy

Dentists and endodontists typically recommend root canal therapy for one of three reasons:

  • Decay has reached the tooth pulp (the living tissue inside the tooth)
  • An infection or abscess has developed inside the tooth or at the root tip
  • Injury or trauma has occurred to the tooth

 

In order to save the tooth, we remove the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay. We then fill the resulting space with special medicated dental materials, which restore the tooth to its full functionality.

 

Root canal therapy is highly successful and can last a lifetime, although a tooth will sometimes need to be retreated due to new infections.

WHY A ROOT CANAL?

A root canal is the treatment of choice in order to save a tooth that would otherwise die and need to be extracted. Many patients believe that removing the problematic tooth is the solution, but in reality, extracting a tooth may cause significant problems for adjacent teeth, and ultimately be more costly.

SIGNS & SYMPTOMS

You may need a root canal if you have any of the following symptoms:

 

  • An abscess on the gum
  • Sensitivity to hot or cold
  • Severe toothache pain
  • Swelling and/or tenderness

 

It’s important to remember that some people who need a root canal may never have any symptoms. That’s why regular checkups with your general dentist are so important.

TREATMENT

A root canal procedure is typically performed by an endodontist (root canal specialist). The procedure begins with numbing the tooth, then opening the top of it in order to access and clean. Dr. Garland is well-versed on the latest root canal techniques and uses the GentleWave® system to clean the tooth’s root system more efficiently, with less pain and a lot less chair time than the older, more traditional technique. Once the tooth is thoroughly cleaned, the roots are filled and sealed with a rubber-like material called gutta-percha. Dr. Garland then places a temporary filling to cover the opening on top of the tooth until a crown can be placed. The crown will protect the tooth and prevent the root canal from breaking while restoring it to its full function.

 

After treatment, your tooth may be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

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Root Canal Retreatment

In rare cases, a root canal may fail to work as expected. This can happen for a number of different reasons:

 

  • Treated tooth may not have healed properly
  • A patient might experience post-surgical complications that jeopardize the tooth
  • Cracked crown or leaking filling material
  • Curved or narrow canals not treated during the original procedure.
  • New decay to the tooth
  • New fracture in the treated tooth
  • Saliva entered the restorative structure
  • Undetected complex canal structures

 

A root canal retreatment involves the removal of the previous packing material, cleansing the root canals, re-packing the tooth, and possibly re-crowning. In short, root canal retreatment is almost identical to the original procedure, aside from the structural removal.

WHY A ROOT CANAL RETREATMENT?

For most individuals, root canal retreatment is a better alternative than extraction. If a tooth has good bone support, a solid surface and healthy gums beneath it, it stands a good chance of being saved. Opting for root canal retreatment can be far less expensive than the alternatives. Dental implants, extensive bridgework and the creation of aesthetically pleasing prosthetic teeth cost far more than working with the natural tooth. They also require maintenance and feel less natural than a “real” tooth.

 

Though the prospect of more endodontic surgery might not be pleasant, root canal retreatment is fairly simple. In general, the whole treatment can usually be completed in 1-2 visits.

TREATMENT

The first step in a root canal retreatment is to administer a local anesthetic. Next, Dr. Garland will gain access to the inner tooth by removing any crown or post that has been placed. He will then remove the filling material and obstructions that block the root canals by using an ultrasonic handpiece that vibrates loose any unwanted material. Tiny, specialized instruments will then be used to clean and reshape the root canals. When Dr. Garland is confident the root canals are completely clean, he will pack the space with gutta-percha. This rubbery material seals the canals to prevent bacterial invasion. Finally, a temporary crown or filling is applied to tooth. Your general dentist will make a crown for the tooth, if needed.  Many times the existing crown can be saved and a permanent filling is used to fill in the access opening.

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Cracked Teeth

With today’s advances in dental technology, more people are retaining their natural teeth longer. And the longer people retain their natural teeth, the greater the likelihood of developing a cracked tooth. There are many reasons why teeth may crack, including:

  • Biting down on hard objects
  • Trauma
  • Grinding and/or clenching teeth

 

All of these behaviors place the teeth under extra strain and render them more susceptible to cracking:

  • When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together, and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.
SYMPTOMS

Symptoms of a cracked tooth may include:

  • Unexplained pain when eating
  • Sensitivity to warm and cold foods
  • Pain with no obvious cause
  • Difficulty pinpointing the location of the pain
TYPES OF CRACKS

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In many cases, if the crack is not too deep, root canal therapy can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.

 

Here is a brief overview of some of the most common types of cracks:

 

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.

Oblique subgingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.

Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.

Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and within the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

TREATMENT

There are many different types of cracked teeth. Some can only be exposed using x-ray machines, while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves, and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal.

 

When the crack is too severe for the tooth to be saved, you will be referred to an oral surgeon for an extraction. There are a number of restorative options in this case, such as bridges, dental implants, and partial dentures. All of these structures can restore biting, chewing and speaking functions.

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Apicoectomy

Your teeth are held firmly in place by strong roots that extend into the jawbone. The end – or tip – of each root is called an apex. This is where the nerves and blood vessels enter the tooth from the jaw deliver blood to the crown (the part of the tooth you can see in your mouth).

 

A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When the inflammation or infection persists after the root canal treatment, an apicoectomy may be required. An apicoectomy is essentially the removal of the apex, followed by a filling procedure to seal the root from further infection. When left untreated, infected roots can damage other teeth, spread infection, and cause regression of the jawbone.

WHY AN APICOECTOMY?

Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful and debilitating. The purpose of an apicoectomy is to eliminate the infection in the tissue, preserve the function of the tooth, and save it from extraction. An apicoectomy is rarely considered unless a prior root canal treatment has failed.

 

There are several reasons why an apicoectomy may be necessary:

  • Small Adjoining Root Branches– Roots are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
  • Blocked Root Canal– In some cases, the dentist is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment. Infection and debris can quickly affect adjacent teeth.
  • Narrow or Curved Root Canals– When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.
TREATMENT

Prior to the surgery, Dr. Garland will generally prescribe an antibiotic or anti-inflammatory medication to treat the underlying infection. We will then take 3D x-rays (Cone Beam CT)  to enable Dr. Garland to plan the apicoectomy, which he will perform under local anesthesia.

 

A small incision will be made in the gum to expose the root. In some cases, it may be necessary to remove a tiny fraction of the jawbone to properly expose the root. The edge of the root tip and any infected connective tissue will be removed using ultrasonic instruments. The root will be sealed using a retrofill (filling material) and Dr. Garland will suture the gum with several stitches. In many cases, a bone graft material will be placed before suturing to promote ideal bone healing.

 

This surgery doesn’t require an overnight stay, and full aftercare instructions and pain medications will be provided as needed. After several days, the stitches will be removed, and the connective tissues will fully heal several months after the procedure.

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