Endodontics

Cracks or fractures to teeth can be caused by trauma, biting on hard objects, and bruxism (grinding and clenching teeth). Cracks are increasingly common, because advances in home care, fluoridation and dental treatments are allowing people to retain their natural teeth longer than ever before.

The symptoms of a cracked tooth can be confusing and may include pain when eating, sensitivity to hot and cold foods, and tooth pain with difficulty pinpointing the location. When the crack occurs there may be debilitating pain. Pressure on the tooth will widen the crack, exposing the nerve and causing pain or irritation. But when pressure is absent, the crack may partially fuse back together, and the pain may subside. Eventually, the pulp inside the tooth may become inflamed or infected, and pain will be constant.

If a tooth crack causes damage to the inner parts of the tooth, endodontic (root canal) treatment may allow the tooth to be saved. The damaged pulp or nerves will be removed, and the resulting space will be filled, then sealed and protected by a restoration (crown).

In some cases, the crack may damage the structure of the tooth so that a root canal cannot be successful. If so, the tooth must be extracted to prevent pain and dangerous complications. An implant or bridge may be necessary to fill the gap left by the missing tooth

Root amputation is a dental surgery in which a single root is removed from a multi-root tooth. Root canal treatment involves the removal of pulp, tissue and nerves from their space (canal) within the tooth below the gumline (root). Root amputation removes one of the roots themselves from a multi-root tooth such as the molars at the back of the mouth, which have 2 or 3 roots each. As with other endodontic treatments, the intent is to save a tooth that would otherwise need to be extracted.

Root amputation may be recommended if a multi-root tooth that is otherwise healthy and strong has extensive damage to one root that cannot be corrected with only root canal treatment. The damage could be caused by embedded bacteria, concentrated tooth decay, trauma, or severe concentrated bone loss due to gum disease.

The procedure is performed under local anesthetic, and requires 1-3 visits. It begins with root canal treatment, to remove the pulp from the root that is to be amputated. Then an incision is made in the gum to expose the root. The root is cut from the tooth and removed. The exposed area is cleaned and sutured closed.

A temporary crown will be placed to protect the tooth while the gums heal. Over this healing period of 7-10 days, antibiotics and antimicrobial mouthwash may be prescribed to minimize the risk of infection and speed healing. Finally, the stitches are removed and a permanent crown completes the restoration.

Most root canal treatments are successful – the treated tooth lasts as long as the healthy teeth surrounding it. However, in some cases problems reoccur with the treated tooth, months or years after initial treatment. If this occurs, root canal retreatment may be recommended as an alternative to extraction. Patients are often referred to an endodontist for retreatment, as the retreatment is often more complex than the original root canal treatment.

Problems may reoccur for a variety of reasons. In some cases, the original treatment was not successful in removing all of the inflamed or infected tissue. If the crown was not placed soon enough after the procedure, or if the crown did not completely seal the pulp of the tooth, saliva can reach the pulp and cause another infection.

In other cases, the original treatment and restoration were initially successful, but new problems affect the tooth. New decay can expose the filling and cause infection, or the crown may become damaged and allow new infection.

Root canal retreatment involves the same basic steps as a root canal. The dentist or endodontist begins by applying local anesthesia and isolating the area with a rubber dam. Then they remove the crown to access the infected filling, and remove it and clean the area with specialized tools. After thoroughly examining the canals to be sure that all infected material is gone, the endodontist disinfects the canals and fills them with a filling material. Finally they must seal the surface of the tooth with a temporary crown to prevent further infection and restore the function and appearance of the tooth.

The root canal retreatment is typically performed in one visit. The patient typically returns to their dentist for a second appointment to place the permanent crown that will seal and protect the tooth from further infection.