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What is an Endodontist and what do they do?

Endodontists are dentists who specialize in maintaining teeth through endodontic therapy (root canal) 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 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.

Endodontic Treatment (Non-Surgical Root Canal) Rochester, Canandaigua and Fairport NY

A root canal is one of the most common dental procedures performed, well over 24 million procedures every year. With modern technology and specialists that focus solely on endodontics, over 95% of root canal treatments are successful. This simple treatment can save your natural teeth and prevent the need of dental implants or bridges. Remember, nothing is better than keeping your natural tooth!

When you look at your tooth in the mirror, what you see is the crown, which is made of enamel and dentin. The rest of the tooth is hidden beneath the gum line, which is called the root. Inside the root(s) are small, thin passageways containing pulp tissue that branch off from the top chamber through the root tip. The pulp tissue is soft and is a collection of connective tissue, blood vessels and nerves that help to build the surrounding hard tissues of the tooth during development. The pulp is important during a tooth's growth and development. Once a tooth is fully mature, it can survive without the pulp.

Sometimes the pulp inside the tooth becomes infected by disease or bacteria, or damaged by a traumatic injury. Fractures of the tooth, periodontal disease and even repeated dental procedures may contribute to pulpal degeneration. Sometimes the disease process or symptoms may not manifest until much later in time. Endodontic treatment is necessary when the pulp becomes inflamed or infected. If pulpal inflammation or infection is left untreated, it can cause pain or lead to an abscess. An infected and untreated root canal can allow bacteria in the mouth to enter the bloodstream where it will then lead to erosion of the bone beneath the tooth and cause infections to travel along facial spaces and spread further. Signs of pulp damage include pain in the tooth, prolonged sensitivity to cold or hot, and swelling in the nearby gums. Sometimes there may be no symptoms.

 

How is a root canal performed?

If you experience any of these symptoms or x-rays show an abscess, your general dentist will most likely recommend endodontic treatment to eliminate the diseased pulp. A rubber sheet also referred to as a rubberdam, (we have nonlatex ones also) is placed over your tooth to isolate the working field and prevent debris and instruments to fall into your mouth. A small access is made through the top of the tooth in posterior teeth, and behind the tooth in anterior teeth to access the pulp chamber and canals. After the diseased pulp is removed the root canal system is thoroughly cleaned, disinfected, and sealed. This therapy involves local anesthesia and may be completed in one visit. More complicated and diseased cases may require a 2nd visit in our office to achieve the highest level of quality care. If your tooth is not amenable to endodontic treatment or if the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident during or after treatment. Also, you will be able to drive home after your procedure.

What happens after treatment?

After root canal therapy has been completed, your tooth will be filled with a temporary restoration. A report of your treatment with x-ray will be sent to your general dentist. You should contact their office for a follow-up permanent restoration within a couple of weeks after treatment is completed at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment. However, if a problem does occur, or if you have questions, we are here to help you.

Certain teeth that are severely infected we will follow-up with an examination to evaluate the healing progress. The appointment will require only a few minutes and no additional fee will be charged.

Endodontic Retreatment

With the appropriate care, your teeth that have had root canal therapy will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal. Sometimes pain may continue to exist, and may only occur months or years after treatment. If so, Endodontic Retreatment may be needed.

Improper healing may be caused by:

    • Bacteria and diseased pulp tissue that could not be removed during the first treatment.
    • Complicated canals went undetected, or curved and narrow canals were not treated during the initial treatment.
    • The restoration or crown was not placed within the appropriate amount of time following the root canal procedure. Because of this, bacteria in saliva contaminated the root canal system.
    • An injury to the tooth.

In some cases, new problems can influence a tooth that was successfully treated:

    • New decay can expose the root canal filling material, causing infection.
    • A cracked or loose filling or crown can cause leakage into the tooth to new infection.
During retreatment, a rubber sheet is placed over your tooth. The doctor will then reopen your tooth and remove the restorative material to gain access to the root canal filling material. The inside of the canals will be cleaned and inspected. Once cleaned, the doctor will fill and seal the canals and place a temporary filling in the tooth. You will then return to your dentist within a few weeks in order to have a new final restoration or crown placed to resume the tooth's normal functions.

Apicoectomy

What is an apicoectomy?

This diagram should help clarify this simple procedure. A local anesthetic will be administered around the area of the tooth. The doctor makes an incision in the gum tissue to expose the bone and surrounding infected tissue. The damaged tissue is removed a long with the root end tip. A root-end filling is placed to prevent reinfection of the root and surrounding tissue and bone, and the gum is sutured. The bone naturally heals around the root over a period of months restoring normal function.

     
Retraction of gum tissue
Removal of inflamed/infected tissue
(root tip will be removed also)
     
Inspection of root end.
Root end filling placed. Bone healing will then occur.

This procedure is performed under the visualization of the endodontic microscope. Thus we tend to call apico surgery "Micro-surgery." The enhanced magnification and illumination allow us to perform this procedure with the utmost precision and thoroughness not capable with the naked eye or even loupes.

Following the surgical procedure, there may be some discomfort or slight swelling while the incision heals. This is not abnormal for any surgical procedure. Most patients return to work or normal daily activities within a short period of time.

Why would I need endodontic surgery?

In the majority of cases a root canal or retreatment is all that is needed to save your tooth from extraction. Occasionally, these non-surgical procedures may not be sufficient to heal your tooth and your endodontist may recommend surgery. Endodontic surgery can be used to locate fractures or accessory canals that don't appear on the x-ray but still manifest pain and infection. Often the end of the root has embedded bacteria in the root structure or branching of the canal(s) where it was untreatable. Damaged root surfaces or persistent infection in the bone area after a root canal treatment may also be treated with this procedure.

Intentional Replantation

Intentional replantation involves careful extraction of the affected tooth and repairing the tooth endodontically outside the mouth. The tooth is then reinserted or replanted into the socket. This procedure is performed in situations when apico surgery is not possible.

Cracked Teeth

Cracked teeth are becoming more common than ever before. People are living longer, and dentists are helping keep teeth live longer as well. That means teeth are being exposed to more years of chewing hard things, clenching and grinding. Fractures/cracks typically do not show on x-rays, making it more difficult to locate. Depending on the severity of the crack, symptoms may include a momentary sharp pain to chewing, temperature sensitivity, or even the release of biting pressure.

Why does a cracked tooth hurt?

Not all cracked teeth hurt. When it does, chewing can cause movement of the cracked pieces of our tooth, which irritates the pulp within the tooth. Pain upon release of biting pressure can occur because the crack closes quickly, resulting in a transient sharp pain. Repeated chewing irritates the pulp. Also, the depth of the crack can cause irritation and possibly degeneration to the pulp tissue. Eventually when the pulp becomes damaged the tooth may consistently hurt. The pain may include hot or cold sensitivity as well.

Can a cracked tooth be saved?

It depends on the location and depth of the crack, as well as your symptoms. Sometimes only a restoration or crown is needed. At times root canal therapy followed by crown placement is needed to remove the damaged pulp to restore the tooth to normal function. We are specially trained to treat cracked teeth, and utilize the endodontic microscope to assist in visualization. Often we can determine the location and severity of the fracture, even into the depths of the root.

Types of Fractures

Crazelines

These are tiny cracks on the outer enamel and more common in adults. They are usually superficial and generally require no treatment unless for cosmetic purposes.

 

Fractured cusps

When a cusp becomes weakened, a fracture may result. Part of the cusp may break off or may need to be removed by your dentist. Depending upon the extent of the fracture, the pulp may also become damaged. Root canal therapy is needed if the pulp is damaged and subsequent crown by your dentist is placed. Often only a replacement crown by your dentist is needed to resolve the problem.

 

   
Fractured edge
Fractured cusp
 

Cracked Tooth

This type of crack extends from the chewing surface of the tooth down towards the root, and sometimes below the gum line. Usually endodontic therapy is necessary to repair the damaged pulp followed by crown placement. If left untreated a cracked tooth may worsen, resulting in the loss of the tooth.

 
 

Split tooth

This develops as a result from worsening of a cracked tooth. Now there are two segments of the tooth that can be separated from each other. Unfortunately, even with today's technology, a split tooth can never be saved intact. Unlike bone, cracked segments in teeth will never heal. Yet, the position and extent of the fracture will determine whether any portion of the tooth can be saved with endodontic treatment and further dental procedures.

 
 

Vertical root fractures

A vertical root fracture originates from the chewing surface and extends along the vertical root surface. Sometimes they are hard to spot and may show no or minimal symptoms. X-rays may show bone loss around the root. Often they involve trauma or teeth that has had endodontic therapy. If the tooth can be saved, treatment involves endodontic surgery.

 

Traumatic Injuries

Dislodged teeth

Injuries to the mouth can cause teeth to be forcefully moved in various directions. It can be pushed back in the socket or forced partially out of the socket in any direction. Do not delay in seeking treatment. Your general dentist or endodontist may need to reposition and stabilize your tooth. Depending on the severity of the pulp damage from tooth movement or symptoms, root canal treatment is usually started 1-2 weeks after.

 
     
 

Avulsed teeth

This is an injury where the tooth is completely knocked out of the socket. If this were to happen, time is of the utmost importance. The first hour is the most critical with the highest success rate for saving the tooth. Every hour that passes by decreases the chance of saving it. If possible, place it back into the socket. When handling an avulsed tooth that has fallen out of your mouth, remember to hold it only by the crown. The root has viable ligament cells that die easily if touched. Keep the tooth moist by placing it in milk, saline, or even water as a last resort (rather than let it dry out). If milk or saline is not available, keep it inside the cheek of your mouth. Contact your general dentist immediately to have the tooth repositioned and splinted. Root canal treatment will follow once the tooth is stabilized, generally within 1-2 weeks. Depending on the length of time the tooth was out of your mouth, how the tooth was handled, and how it was stored will influence the type of endodontic treatment needed.

 
     

 

Apexogenesis, Apexification, Resorption.

Advanced Endodontic Solutions, Dr. John Lepore, is also highly trained in diagnosing and treating various traumas in immature teeth (usually kids) as well as in mature teeth.

 
   
Mature tooth with thick root walls.
Immature tooth with thin root walls, induced by trauma or decay
Medication placed to help harden the root walls.
 

Other disorders of the tooth include resorption, which is as illustrated. Accidental perforations can also be repaired successfully without the loss of the tooth.

 
 
 

Non-vital bleaching

Teeth that have turned a darker color, in most cases from trauma, can be whitened to match your neighboring teeth. The materials used although very effective, can be quite disruptive to the surrounding tissues. To prevent possible gum irritation and tooth erosion, this procedure is performed under a rubber sheet and the endodontic microscope for precise application to gain optimal success.