Endocare Procedures
EndoCare procedures and treatments involve diagnosing the source of any dental pain, reducing infection and stopping oral discomfort. This may also include re-treating and improving previous procedures.
In the first instance, our experienced reception staff will try to explain what to expect during treatment, which often helps allay many of the initial anxieties patients can experience. We aim to treat every patient in the manner that we would like to be treated ourselves, with warmth, courtesy and honest empathy.
The Normal (Healthy) Situation
The visible part of the tooth is protected by hard enamel, covering a layer of dentin. Inside the tooth is the pulp, a collection of nerve and blood vessels in a jelly-like connective tissue, extending from the crown of the tooth to the tip of the roots where it connects to surrounding tissue. This pulp, often called ‘the nerve’, is important, keeping the tooth healthy by bringing in nutrients, which helps the tooth to repair itself to some extent. The nerves act as an early warning system, alerting us to problems primarily through pain messages.
The Disease Process
Root canal treatment becomes necessary when the soft pulp inside the root canal becomes inflamed or infected, due to deep decay, cracks or fractures in the tooth, or even actual dental treatment such as bleaching. Symptoms of inflammation may include tenderness and pain, with sensitivity to heat and cold or pain on biting. Treatment involves removal of the inflamed tissue and generally has a very high success rate. If the damage is more prolonged or severe, the pulp can break down and bacteria can grow, causing infection and abscesses - pus forming in the bone. Treatment for this is more difficult, as very thorough bacterial control is required. Symptoms may involve pain and swelling in the nearby bone and gingival tissues.
Alternatives to endodontic re-treatment and/or endodontic surgery
The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time-consuming than re-treatment and restoration of the natural tooth. The bottom line is, no matter how effective tooth replacements are—nothing is as good as your own natural tooth.
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Treatment
Filling of The Root Canals
After the space is cleaned and shaped, the root canals are filled with a rubber-like material called 'gutta-percha' and adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is used to close the opening. After the final visit with your endodontist, you must return to your dentist to have the temporary filling replaced and the tooth restored to further protect and seal it from bacteria contaminating the canals. If the tooth lacks sufficient structure to hold the restoration in place, your dentist may place a post inside the tooth before the tooth is built up with a solid core.
Preparation of the Root Canals
Endodontic treatment can often be performed in one or two visits and involves the following steps:
1. First the area is carefully anaesthetised and then a small protective sheet called a 'dental dam' is placed over the teeth to keep the area clean and dry. 2. A small opening is made in the crown of the tooth to allow cleaning of the pulp from the pulp chamber
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Retreatment
Endodontic Retreatment
Occasionally, a tooth may not heal as expected after initial treatment for a variety of reasons:
- Difficulty in cleaning very fine, narrow canals, leaving unclean portions of the root - Complicated canal anatomy - perhaps with extra, undetected canals - Further bacterial leakage around the filling/crown or a fracture allowing contamination
A re-treated tooth can function well for years – even a lifetime. However, once a tooth has been previously instrumented, the success rates of further re-treatments drop to about 80%. Advances in technology, new techniques and instruments can certainly improve the outcome of a previous procedure though
Procedures for Re-Treatment
After the space is cleaned and shaped, the root canals are filled with a rubber-like material called 'gutta-percha' and adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is used to close the opening. After the final visit with your endodontist, you must return to your dentist to have the temporary filling replaced and the tooth restored to further protect and seal it from bacteria contaminating the canals. If the tooth lacks sufficient structure to hold the restoration in place, your dentist may place a post inside the tooth before the tooth is built up with a solid core.
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Surgery
Surgery is often a final option for teeth that remain infected or have an otherwise inaccessible area. This surgery involves making an incision in the gum to allow the other end of the root to be sealed. It may be done as a stand-alone procedure or in conjunction with conventional root canal treatment. The most common procedure is an apicectomy or a root resection procedure. A small cut is made in the gum to expose any infected bone around the tip of the tooth. This area is cleaned and any inflamed or infected tissue removed. The very end of the root is also removed. The end of the root canal may be sealed with a small filling. A few stitches or sutures, normally removed after a week, are made to help the tissue heal properly. Other surgeries may include dividing a tooth in half, repairing an injured root, or even removing one or more roots. All these procedures are designed to help save your tooth.
