What is Root Canal treatment?

Root Canal Treatment is the last resort for saving a tooth.  It removes infected or damaged tissue from inside a tooth. This tissue, called the pulp, contains nerves and blood vessels that help nourish the tooth. After the pulp is removed, the pulp chamber and root canals are cleaned, disinfected, filled and  sealed.

What are the benefits of the treatment?

Root Canal Treatment saves teeth that would otherwise need to be extracted. Although the pulp is removed, and the tooth is dead the treated tooth can remain in your mouth.

What caused the problem with my tooth?

The most common cause of pulp damage is severe decay or a fracture that exposes the pulp to bacteria that cause infection. Other causes of pulp damage include traumatic injury such as a blow to the mouth, a cracked or loose filling or repeated fillings in a tooth, and occasionally periodontal disease.

How many appointments are necessary?

Sometimes Root Canal Treatment is completed in one appointment but usually two or three visits may be necessary. It is important the tooth is sterilised before it is sealed.  Teeth which have been dead for a long time can require more appointments.

How long will the tooth last?

With proper restoration and care it may last a over 10 years. Proper dental care includes regular brushing and flossing, a healthy diet and periodic dental check-ups.

Does Root Canal Treatment hurt?

With the use of modern techniques, root canal therapy typically involves little or no discomfort. Often there is pain before treatment and endodontic therapy provides relief.

Will there be pain after procedure?

After the dentist cleans the root canals they may cause some slight tenderness but usually over-the-counter pain killers alleviate the discomfort. If pain persists or if you experience severe pain, call your dentist. 1 in 10 patients experience an infection following this treatment. The infection usually requires antibiotics.

How much does Root Canal Treatment cost?

The expense of an Root Canal Treatment varies depending on how severe the problem is and the type of tooth Molars with two or three canals are more difficult to treat and the fee will therefore be more. Root Canal Treatment is usually more economical in the long term than any other alternative treatment used to replace the missing tooth.

What are the alternatives to Root Canal Treatment?

The alternatives to Root Canal Treatment are

1.   extraction of the tooth,

2.   re-root filling the tooth,

3.   An apicetomy procedure.

If you decided to have the tooth removed the space left would concern you the tooth could be replaced with a

1.  bridge,

2.  denture,

3.  implant.

Loss of a tooth could create a functional problem such as chewing or an aesthetic problem. Restoring the lost tooth may involve the provision of a prosthetic replacement such as a denture, bridge or a dental implant the costs of which are variable.

Can all teeth be treated Root Canal Treatment?

Occasionally a tooth cannot be saved. Root Canal Treatment can be performed only if the root canals are accessible and can be adequately cleaned and sealed. The tooth must also have sufficient bone support. We only carry out treatment where we can give a good long term outlook.

Can the treatment fail?

Root Canal Treatment can have success rate of up to 90% depending on the success of the treatment. Even if the treatment is completed perfectly the infection may re-occur and the tooth require further treatment or extraction. Problems can occur if the tooth develops decay or the restoration on the tooth fails, or on occasions despite good care the tooth may not heal as expected. Further Root Canal Treatment or surgery may be carried out if appropriate.   A tooth that develops a crack can also be a cause of failure and may result in loss of the tooth.

Will I need to return for any additional treatment?

Your tooth should be examined at an interval after treatment to make sure that it has properly healed.

What do I do after root canal treatment is completed?

Usually a definitive restoration of the tooth is required and it may be that your dentists will advise on a restoration that protects the tooth from future fracture such as a crown if the remaining tooth left considerably weakened.

What is Root Canal Re-treatment?

Teeth that have had Root Canal Treatment  treatment can last as long as natural teeth, however, in some cases the treatment can fail or symptoms can persist. This may happen shortly after the treatment has been performed or even years following the treatment.

In these cases it may be possible to carry out the treatment again, a procedure called Root Canal re-treatment.

Why does the treatment fail?

Root Canal Treatment can fail for a number of reasons: It was not possible to treat narrow or curved canals well enough or the canals were not fully cleaned during the initial procedure. The tooth may have additional complicated anatomy that was not found on the initial treatment.

The final restoration was not placed quickly enough or the final restoration leaked due to a poor fit, fracture or recurrent decay around it.

Is re-treatment more complicated than initial root canal treatment?

Re-treatment is usually more complicated than initial root canal treatment as the tooth is normally fully restored with a permanent restoration. This can range from a simple restoration to a full coverage restoration such as a crown or as part of a bridge. In addition to this a post may have been placed inside the root prior to a final restoration being placed. This creates difficulty as access to the root canals is more difficult.

Additionally the canals will have been filled with root filling material and hence this has to be removed before they can be instrumented and cleaned again. All of these obstructions make the process more complicated.

Who does the re-treatment procedure?

All dentists can carry out endodontic treatment but many prefer not to carry out re-treatment procedures as this can be more challenging and may require additional equipment that may not be readily available.

Your dentist may opt to refer you to another practitioner who either has greater experience and training in the procedure or to a dedicated specialist endodontist for the procedure. A specialist endodontist is a dentist who is registered and approved by the General Dental Council to carry out all forms of endodontic treatment. The endodontist will have more additional training and dental equipment that may facilitate the procedure.

What will happen if I am referred to an endodontist?

The endodontist will assess your tooth and discuss with you the treatment options for your tooth. The endodontic procedure will be explained to you as well as the costs for the treatment.

What will happen during the re-treatment?

If you decide on re-treatment the endodontist will gain access to the root canals of the tooth to remove the root filling and clean the canals again prior to refilling the canals. In many cases the restoration on the tooth will have to be removed, including complex restorations such as crowns and posts to allow the procedure to be carried out.

Will the re-treatment be successful?

Retreated teeth can function for many years if the reasons for the initial failure can be overcome.  Advances in technology have allowed re-treatment to be carried out on complicate problems but like most medical and dental procedures difficulties can prevent some teeth from responding to the treatment.  The endodontist can advise on the likely success of the procedure and difficulties prior to the procedure.

How much will the procedure costs?

The cost of the re-treatment is usually dependant on how complex the procedure might be but would normally cost more than the original root canal treatment.

What are the alternatives to re-treatment?

Usually the alternatives would be removal of the tooth or endodontic surgery.  Patients' should accept that removal of the tooth would leave a space.  Depending upon the patient this may or may not be acceptable, both functionally and aesthetically.  A false tooth in the form of a denture, bridge or implant can be used to fill the space.

Endodontic surgery also called apicectomy involves lifting the gum or gingival tissue making a window to allow access  and removed the tooth’s root tip. It proposed  that the tip habours bacteria and is the cause of the persistent problem. The remaining root can then be treated and sealed. Endodontic surgery would allow the existing restoration to be retained.This procedure is usually combined with retreating  or re-root filling the canals.  Endodontic surgical treatment is unpredictable, it can not guarantee the infection at the root tip will not re-occur.  The procedure is last resort to keeping a tooth. It can leave scarring over the gums, the gums may recede.

            

For further information see  www.britishendodonticsociety.org.uk

Patient Information:  ROOT CANAL TREATMENT

“ Root canal treatment is the last tool we have to save a tooth. It has a bad reputation, but with local anaesthetic and a patient approach it should be as simple as having a large filling.   It’s a very technical procedure and becomes difficult to achieve a predictable result the further back the tooth lies  in the mouth as molar teeth have more than one root and sometimes more than one nerve for each root.  The longer the period the tooth has suffered infection also affects the prognosis and it’s vital you understand that basically at best root canal treatment is eight five percent successful.  For patients considering root canal treatment I would advise they compare the treatment options for replacing the tooth against the cost and success rate for root canal treatment and if they are determined to save the tooth consider a referral to a specialist endodontist to increase the chances of success “

    Bare Dental Clinic

     patient information

Root canal treatment leaflet