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Ryan B. McMahan, DDS, MS, PLLC

Gaylord, MI

 

Endodontics

What is an Endodontist and what do they do?

Endodontists are dentists who specialize in maintaining teeth through endodontic therapy -- procedures, involving the soft inner tissue of the teeth, called the pulp.  The word "endodontic" comes from "endo" meaning inside and "odont" meaning tooth.  All dentists are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat.  That’s why you may have been referred to an endodontic specialist.

In addition to dental school, endodontists receive two or more years of advanced education in this kind of treatment. They study root canal techniques and procedures in greater depth, for diagnosis and treatment of more difficult cases. For this reason, many dentists choose to refer their patients to endodontists.

Aside from providing treatment, Dr. McMahan is also an educator. It is important that patients understand why they require treatment, what treatment involves and what they can do to ensure the best possible outcome. Dr. McMahan believes that a properly informed patient has the best chance of achieving the optimal result.

What is Endodontics?

Endodontics is a specialty of Dentistry that deals with diseases of the dental pulp and its supporting structures. Endodontists are Dentists with special post-graduate training in this field. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.

In order to understand Endodontic treatment, it helps to know something about the anatomy of a tooth. Teeth have several layers. The outside layer of the tooth is composed of a hard layer called Enamel. Enamel is supported by an inner layer called Dentin, which has at its center a soft tissue known as the Pulp.

The pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding Dentin and Enamel during tooth development. The pulp receives its nourishment supply from vessels which enter the end of the root. Although the pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

Why would I need Endodontic treatment?
Endodontic treatment is necessary when the pulp becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities (caries), repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
Signs and Symptoms
Indications for treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth or adjacent gums. Sometimes there are no symptoms.
Root Canal Therapy

Millions of teeth are treated and saved each year with root canal, or endodontic, treatment. Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, faulty crowns, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulpal inflammation or infection is left untreated, it can cause pain or lead to an abscess.

During root canal treatment, the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterwards, the tooth is restored with a crown or permanent filling for protection. After restoration, the tooth continues to function like any other tooth.

Modern root canal treatment is very similar to having a routine filling and usually can be completed in one or two appointments, depending on the condition of your tooth and your personal circumstances. You can expect a comfortable experience during and after your appointment.

 

How does endodontic treatment save the tooth?

Saving the natural tooth with root canal treatment has many advantages:

  • Efficient chewing
  • Normal biting force and sensation
  • Natural appearance
  • Protects other teeth from excessive wear or strain

Endodontic treatment helps you maintain your natural smile, and continue to eat the foods you love. With proper care, most teeth that have had root canal treatment can last as long as other natural teeth, and often for a lifetime.

https://youtu.be/nDlS72Dt93s

Endodontic Retreatment

Why do I need another endodontic procedure?

Occasionally, a tooth may not heal as expected after initial treatment for a variety of reasons:

  • Narrow or curved canals were unable to be treated during the initial procedure.
  • Complicated canal anatomy went undetected in the first procedure.
  • The placement of the crown or other restoration was excessively delayed following the endodontic treatment.
  • The restoration did not prevent salivary contamination to the inside of the tooth.

In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:

  • New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
  • A loose, cracked or broken crown or filling can expose the tooth to new infection.
  • A tooth sustains a fracture.

What will happen during retreatment?

First, our doctors will discuss your treatment options. If you choose retreatment, your tooth is reopened and the filling materials that were placed in the root canals during the first procedure are removed. In many cases, complex restorative materials—crown, post and core material—must also be disassembled and removed to permit access to the root canals.

After removing the canal filling, our doctors clean and shape the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any unusual anatomy that requires treatment. Any infection, is also removed at this time and new filling material is placed. The opening is then sealed with a temporary filling. After retreatment is completed, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.

Is retreatment the best choice for me?

Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime.

Advances in technology are constantly changing the way root canal treatment is performed, so new techniques may be employed that were not available when you had your first procedure. Retreatment alone may solve the issue with your tooth, however, as with any dental or medical procedure, there are no guarantees. Our doctors will discuss your options and the chances of success before beginning retreatment.

What are the alternatives to retreatment?

If nonsurgical retreatment is not an option, then endodontic surgery should be considered. This surgery involves making an incision to allow access to the tip of the root. Endodontic surgery may also be recommended in conjunction with retreatment or as an alternative. Our doctors will discuss your options and recommend appropriate treatment.

What are the alternatives to endodontic retreatment 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 retreatment and restoration of the natural tooth. Each tooth and set of circumstances is different and thus treatment options are tailored accordingly.

https://youtu.be/PHxlvvo0-Po

Endodontic Surgery/Apicoectomy

Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and surgery will be recommended. Endodontic surgery can be used to locate small fractures or hidden canals that weren’t detected on dental images or during previous treatment. Surgery may also be needed to remove calcification in root canals, or to treat damaged root surfaces or the surrounding bone of the tooth.

 

There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which is occasionally needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure. In this microsurgical procedure, our doctor opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed to seal the end of the root canal and few stitches or sutures are placed to help the tissue heal. Over a period of months, the bone heals around the end of the root.

 

Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day. Postsurgical discomfort is generally mild. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Our doctors will recommend appropriate pain medication to alleviate your discomfort.

Traumatic Dental Injuries

Traumatic dental injuries often occur in accidents or sports-related injuries. Treatment depends on the type, location and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Endodontists are dentists who specialize in treating traumatic dental injuries. With their advanced skills, techniques and technologies they can often save injured teeth.

 

Chipped or Fractured Teeth

Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or “cap” may be needed to restore the tooth.

 

If the pulp/nerve is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention.

 

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.

 

Dislodged (Luxated) Teeth

A dislodged, or luxated, tooth is one that has been partially pushed into or out of its socket, or sideways, during an injury. The tooth will be repositioned and stabilized. Root canal treatment is usually needed for permanent teeth that have been dislodged.

 

Children may not need root canal treatment since their teeth are still developing. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection. An endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed.

 

Knocked-Out (Avulsed) Teeth

With proper emergency action, a tooth that has been knocked out of its socket can be successfully replanted and last for years. It’s important to see a dentist or endodontist as soon as possible after the tooth is knocked out. Quick action will increase the likelihood of saving the tooth.

 

SAVING A KNOCKED-OUT TOOTH

Pick up tooth by the crown (the chewing surface) not the root.

Locate the tooth immediately; do not leave it at the site of the accident. The tooth should be handled carefully to minimize injury to the root.

If dirty, gently rinse tooth with water.

Do not use soap or chemicals. Do not scrub the tooth. Do not dry the tooth. Do not wrap it in a tissue or cloth.

Reposition tooth in socket immediately, if possible.

The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.

Keep tooth moist at all times.

The tooth must not be left outside the mouth to dry. If it cannot be replaced in the socket, put it in one of the following: 1) Emergency tooth preservation kit (such as Save-a-Tooth®), 2) Milk, or 3) Mouth (next to cheek).

Regular tap water is not recommended for long-term storage because the root surface cells do not tolerate water for long periods of time.

 

See an endodontist or the nearest available dentist within 30 minutes.

Once you arrive at our office, the tooth will be evaluated, placed back in its socket and examined for any other dental and facial injuries. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, root canal treatment may be initiated a week or two later.

 

Root Fractures

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.

Vertical root fractures, however, often require extraction of the tooth.