Endodontics is the branch of dentistry specializing in the tooth pulp (soft tissue of the tooth) and the tissues surrounding the root of a tooth. The endodontic procedure, also known as a root canal, treats the pulp of the tooth that has become inflamed or infected. The infection may be caused by deep decay, injury to the tooth, or repeated dental procedures on the tooth. Endodontic treatment removes the damaged pulp and cleans and fills the canals of the tooth. This procedure helps preserve the natural tooth. However, the success of Root Canal treatment can be challenged due to unaccessibility of accessory canals. Each tooth have one or more canals and each canal has many tiny branches from canal we called it accessory canals which usually is very difficult to get to. Because of inaccessible issue, sometimes, the tooth still remain infected regardless of Dentist’s experience or efforts to save the tooth. When this happened, the retreatment of Root Canal maybe necessary or even an extraction might be the choice we have to make in order to ensure from free of infection.
After properly remove decay and exposed the nerve with drill, we use files to remove nerves. During this debribement, we use Ozonated Olive Oil to lubricate canals so that the files can access to the canal easily to clean the infection. We also use Ozonated water as a irrigation instead of Hypo-Chroride as most dentists uses. While we debribe and clean the infected tooth, we also shape and enlarge canals so that we can fill all the way to the apex which is the base of the root. Then, we use paper points to dry the each canal and fumigate each canal with Ozone gas so that the Ozone can kill so that if possible bacteria remain in accessory canal also gets killed. We do this procedure several time until Doctor feels that the canal is clean and ready to fill. Then, we use either Gutta Percha or the Endocal to fill the canal to complete the root canal procedure.
It is usually the case that teeth that have undergone root canal treatment last quite long time, there are times when a tooth fails to heal, or the pain continues after endodontic treatment. In some cases, the tooth becomes painful or diseased months or even years after successful treatment. In these cases, endodontic retreatment may provide a second chance to help save the tooth. Since retreatment can be more challenging than providing initial treatment, Dr. Hong may decided to refer our patient to an endodontist.
Possible Reasons for Retreatment
There may be several reasons why another endodontic procedure is needed. Either a tooth has failed to heal after initial endodontic treatment, or a new problem has occurred that is harmful to a tooth that was successfully treated. These are some of the complications and problems that could have occurred:
- During the initial endodontic procedure, complicated anatomy went unnoticed, or narrow or curved canals were not treated.
- After the procedure the crown or other dental restoration was not placed quickly enough.
- Saliva contaminated the inside of the tooth, due to poor restoration procedure.
- New infection in the tooth has resulted as a consequence of decay or a loose or broken crown, exposing the root canal filling material to bacteria.
The Retreatment Procedure
If you choose to go for retreatment, the initial step that the endodontist will take is to reopen your tooth. More often than not, complex restorative materials including the crown and filling materials will be taken apart and removed. This will allow access to the root canals. The endodontist will clean the canals and examine the inside of the tooth to detect any additional canals or complicated canal anatomy that needs to be treated. The next step involves filling and sealing the canals, placing a temporary filling in the tooth. After the last visit to the endodontist, an appointment with your dentist is required as soon as possible to place a new crown or other dental restoration on the tooth. This will protect the tooth and restore it to full function.
Benefits of Retreatment
Endodontic retreatment has many advantages, the most significant one being retaining your natural tooth. The investment you make in saving your tooth, rather than going for an extraction, may result in a healthy tooth that can remain functional for years.
In addition, advances in technology mean that new techniques in the treatment of root canals may be available, which might not have existed when the first procedure was done to your tooth. Endodontic retreatment also allows for the remedial of problems faced with complicated root canal anatomy, which might not have been treated adequately during the first procedure.
The cost of endodontic retreatment depends on the degree of complication of the procedure. Since it involves the removal of your restoration and filling material, as well as examination for unusual canal anatomy, the procedure will be more complicated than the initial root canal treatment. Consequently, retreatment generally costs more than the initial treatment. On the other hand, endodontic retreatment may be more affordable than tooth extraction. Tooth extraction is usually more costly and time consuming.
This is because after extracting the tooth, the dentist replaces it with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. These dental procedures added up will cost more time and money.
As with any dental or medical procedure, there are no guarantees to success of the treatment. Discuss your options and chances of success with your endodontist if you are considering retreatment.
Endodontic surgery may be an alternative for those considering endodontic retreatment. Surgery may also be recommended in conjunction with the retreatment. In rare cases where endodontic treatment alone is insufficient to save the tooth, your dentist or endodontist may recommend surgery. Surgery involves making an incision near the end of the tooth root so that the very end of the root may be sealed.
Possible Reasons for Surgery
Endodontic surgery may be advised in a variety of situations:
- Sometimes problems with your tooth may not appear on your x-ray, even if you have persistent symptoms. Your tooth may have a tiny fracture or canal that your dentist could not detect using nonsurgical treatment. In this case, surgery may be used in detecting the problem in the root of your tooth and finding a solution.
- When calcium deposits settle in the canal of the tooth, the canal becomes too narrow and normal dental instruments are unable to reach the end of the root. Endodontic surgery can help to clean and seal the area of the canal that was previously inaccessible.
- It is usually the case that teeth that have undergone root canal treatment last as long as other natural teeth. However, there are times when a tooth fails to heal, or the pain continues after endodontic treatment. In some cases, the tooth becomes painful or diseased months or even years after successful treatment. Surgery may help save your tooth in these instances.
- Endodontic surgery may also be carried out to treat root surfaces or surrounding bone that are damaged.
The most common surgical procedure for root canals is an apicoectomy or root-end resection. An apicoectomy targets the bony area around the end of your tooth that has become inflamed or infected after it has undergone a root canal.
In this procedure, the gum tissue near the tooth is opened to reveal the underlying bone. The endodontist removes any inflamed or infected tissue as well as the very end of the root. The endodontist may seal the end of the root and perform a few stitches or sutures in the gum to help the tissue heal properly. The bone heals around the end of the root canal after a few months.
There are other types of endodontic surgery, which include dividing a tooth in half, repairing an injured root, or removing a tooth root. Another surgery called intentional replantation involves extracting a tooth and treating it with an endodontic procedure before it is replaced back in the mouth.
Endodontic surgery may be performed while you are under local anesthetic. During the healing period, you may feel some discomfort or experience slight swelling, which is common for any surgical procedure. Pain medication may be given to relieve the discomfort. While most people are able to drive themselves home, it may be necessary to make transportation arrangements after the surgery. Usually people return to work or their routine activities the next day.