Root Canal Treatment

Root Canal Treatment Canberra

At Comprehensive Dental Care we use modern best available technologies to perform root canal treatment. Root canal treatment is used to repair the damaged inside of a tooth. It is also called endodontic treatment.

 

 

We like to see your teeth in optimum health at all times, however in the case of infection we can treat the tooth to restore function. Teeth can become infected if you have poor oral hygiene, has a result of deep cavity cause by decay or from a severely cracked tooth.

 

 

In this case, you will need to visit your dentist promptly to receive root canal treatment to have any chance of saving your natural tooth. This will prevent any further corrosion to your tooth and nerve.

Endodontic treatment, otherwise known as root canal treatment aims to clean out the infected tooth pulp (inside of tooth) to prevent the nerve from dying.

Signs you may require root canal treatment:
  • Tooth sensitivity to hot and cold foods or beverages
  • Constant throbbing tooth pain
  • Pain when biting and chewing
  • Looseness of the tooth
  • Pus surrounding the tooth

The tooth is encased in a ‘rubber dam’ so the infection does not spread to surrounding teeth or gums.

A small incision is made inside the chamber of the tooth, to extract the infected matter from the tooth pulp. The inside of the cavity is then thoroughly cleaned and the debris is removed.
When the tooth is infection-free, it is then filled and sealed to leave a fully functioning and healthy tooth.

Microscope assisted Root Canal Treatment

The use of dental microscopes is the new standard of care for root canal therapy.  At Comprehensive Dental Care Queanbeyan, We use state-of-art modern techniques and tools including microscope for root canal treatment. This enhance the success rate of this procedure. The magnification and resolution of the microscope used to deliver the highest standard root canal treatment for our valued patients.

Technologies in use
Microscope

The microscope is an integral and important part of the performance of modern endodontics techniques. Microscope aid in root canal therapy as well as various other procedures requiring high magnification and precision.

Cone Beam CT

Our practice utilizes state-of-the-art, small volume cone-beam CT (computed tomography) technology that provides highly accurate, 3-D radiographic images for the diagnosis, planning and treatment of endodontic disease

Root-canal treatment, or endodontics, involves the expurgation of the pulp or removal of pulpal remnants of a tooth plus the subsequent cleaning of the root canals in order to remove as far as possible all bacterial infection before filling the canals with a suitable material to prevent any remaining bacteria from proliferating or migrating through the root apex into the surrounding tissues.

Endodontic treatment is the modern, preferred alternative to the extraction of a tooth where decay or trauma has adversely affected the tooth’s pulp, which is the conglomeration of tiny blood vessels and nerves which make up the live part of a healthy tooth, commonly referred to as “the nerve”.

If the tooth pulp is breached, either by bacterial ingress or by trauma then it has only limited powers of survival, and often the inflammatory process that occurs is insufficient to overcome a bacterial infection and the pulp dies off, sometimes quite quickly, but sometimes rather slowly over a period of weeks or even months. The process of the inflammatory response to infection in the tooth pulp is often self-defeating since the build-up of fluid caused is unable to escape from inside the enclosed cavity of the pulp chamber and can exert pressure back on small blood vessels to compress them and prevent blood flow, and also on nerve endings causing pain.

If such a situation is left untreated then inevitably bacteria or their waste products leak through the small opening at the end of the tooth root or roots and begin to cause inflammation in the bone in the immediate area. The confined nature of this infection and relatively poor blood supply through the bone of the jaw can lead to a build-up of infection termed an abscess and the consequent pressure from inflammatory liquid and pus can cause a great deal of pain. The first line of treatment for an abscess is to drain it and where this occurs in soft tissues can be achieved by incision, but where the jaw bone is fairly dense especially in the lower jaw, this may not be practical, and so the only way to drain a tooth abscess is either through the tooth by opening it up or by extracting the tooth and allowing the accumulated pus to flow out though the socket.

Where adequate drainage of an abscess can be achieved through an opened pulp cavity and root system of a tooth then there is a reasonable prognosis for root treatment, and it is virtually always preferable to save a tooth rather than extract, although certain other factors such as difficulty in actually restoring the crown of the tooth or medical problems may mitigate against the decision to try to save a tooth.

Thus root treatment aims to remove an inflamed or infected pulp and sterilise the whole canal system, and then obturate it to avoid any pockets where bacteria could flourish. It also needs to incorporate an effective seal to prevent bacteria from gaining entry into the system from the occlusal or biting surface.

The diagnosis of the pulp condition deteriorating or having already become necrotic is made from a consideration of the history, including the type of pain experienced and over what time frame, plus clinical signs and symptoms. A tooth “nerve” or pulp may become gradually more sensitive to cold drinks or food, then to hot, but the sensitivity disappearing once the stimulus has passed, but then progressively get worse to reach a stage where pain persists even after the stimulus is removed. This signifies an increased inflammatory state of the pulp to a degree where its condition is irreversible and it is unable to recover. If left this situation would inevitably progress to pulp necrosis which can then lead on to abscess formation. Before the pulp finally dies it may be acutely inflamed and cause continuous unremitting severe pain regardless of any stimulus. This is the condition commonly known as “toothache” and most often caused by gradually progressive dental decay which has penetrated far enough into the tooth to affect the pulp and set up inflammation. Other causes are a crack in the tooth, which may not be easy to detect, or acute trauma to the tooth.

As previously mentioned if pulpal inflammation is not addressed the pulp will eventually die at which point pain may disappear, but is likely to reappear, although be of a somewhat different nature, once the pulpal contents start to affect the apical area of the tooth root by bacteria or their products leaking through leading to the build-up of an abscess.

Root treatment aims to remove an inflamed vital pulp or the remnants of a dead one and institute a stepwise process of cleaning by mechanical debridement plus chemical disinfection of the pulp cavity and the entire root canal system followed by careful obturation of all space within the root system. The aim is to remove contaminated tissue and reduce the bacterial infection as far as possible and then seal the roots from further bacterial influx or leakage at either end.

This is made possible by use of flexible metal files and reamers which may be hand-held or used in a slowly rotating handpiece to gradually enlarge the diameter of the root canal(s) from the crown down to the root apex or apices, together with chemical disinfection repeatedly during the process. Once the canals are clean they are filled with a biocompatible material, the coronal entrance to the root system is sealed, and attention can then turn to restoring the crown of the tooth.

Sometimes the need for root treatment arises as a result of a routine examination without there having been any obvious symptoms, most often after examination of radiographs (x-rays) which can reveal areas of radiolucency at the apex of a tooth. This is usually the result of the pulp quietly dying off, without any noticeable symptoms, and then bacteria from the necrotic pulp extending down the root canal and causing toxins to be released through the root apex. This collection of periapical infection is quite likely to get worse and may eventually build up to the point where it suddenly erupts as an acute abscess at some point in the future. Once such a situation is diagnosed then steps are taken to provide endodontic treatment for that tooth before the situation deteriorates further, and once completed radiographs within a six month or twelve month period may be taken to confirm healing by the reduction in size of the radiolucent areas indicating bony infill. 

Root treatment has a high success rate provided it is carried out in a methodical manner with meticulous care in mechanically debriding and enlarging the root canals from the crown to the apex which is not always an easy task where roots are curved or there are constrictions or blockages in canals. The experience of the endodontist counts for a lot in the treatment of posterior teeth where these problems are more likely to be encountered, and the use of a microscope is virtually essential too in such cases.

How Root Canal Treatment is Carried Out

 

Root canal treatment is successful in over 90% of cases in saving a tooth that would otherwise have to be extracted, and involves thoroughly and meticulously cleaning out the root canal system of a tooth to remove bacterial infection and then filling the system to prevent further bacterial proliferation. Once root canal treatment is done the tooth is no longer alive but can still function as before although it may need subsequent treatment to strengthen the crown or to improve its appearance.

Any infection that had already progressed beyond the apex of the root or roots into periapical tissues will normally heal following successful root treatment as can be verified by radiographic evidence of bone regrowth into the areas where it had been resorbed.

The healing response varies from person to person depending on factors such as age and individual immune system health so root treatment cannot be guaranteed to always succeed. Indeed it is not always indicated, if there are overriding medical problems for instance, or if so little tooth would remain following treatment that the tooth would be impossible to restore. In such circumstances then extraction is usually indicated and then thought given as to the best way to replace the lost tooth.

When beginning root treatment an initial diagnosis includes a history of the condition together with investigations such as percussion, or vitality tests, plus intraoral radiographs or perhaps even a CT scan.

Treatment is carried out under local anaesthesia to avoid pain, and the tooth is usually isolated from the rest of the mouth by rubber dam which is a rubbery sheet stretched across the mouth and fastened to the neck of the tooth in question and to a metal frame at its periphery. The rubber dam is usually dark in colour to help the dentist visualize the tooth more easily and it also serves the purpose of protecting the patient from irrigating chemicals or from inhalation of metal instruments. Usually eye protectors are worn by the patient as well.

An opening is then prepared on the biting surface of the tooth with a high speed dental drill and then a high magnification dental operating microscope is often used to help identify the root canals of a tooth in the case of posterior teeth. Anterior teeth have straighter roots with wider canals that are relatively easy to find but molars can have quite narrow canals and it is sometimes difficult to locate their opening from the pulp chamber. 

A working length is established for each canal by means of radiographs and/or electronic measuring instruments, with the intention of cleaning the canal to just short of the apex. The root canals are then enlarged gradually with very flexible nickel titanium reamers and files. These may be hand held in the case of anterior teeth but may be used in a purpose-made slowly revolving hand-piece in posterior teeth. The canals are gradually enlarged in diameter in a stepwise manner with sequentially larger reamers and files to allow space for disinfection by means of a solution of sodium hypochlorite and to make space for the final obturation material, usually gutta percha. The enlargement of the root canals also achieves removal of contaminated tooth tissue along the way.

Once the root canals have been adequately enlarged and disinfected along their entire working length they are usually filled with a rubber-like bio-compatible root filling material called gutta percha plus a sealant cement to completely obliterate all available space and prevent re-infection or proliferation of any remaining microorganisms.

The root canal is sealed at the coronal end and a temporary filing inserted into the tooth. The next step will be the restoration of the crown of the tooth which may involve the need for a post to be inserted into the root, and it is usual practice to allow a suitable period of time for the tooth to settle down before this phase is started. The amount of time will depend on the severity of the situation in the first instance. If there were no symptoms it is usually possible to start restorative work within a week or two but where there was a serious abscess it may take longer for swelling to subside and for healing to be established.

It is not uncommon to have a degree of discomfort or tenderness of the tooth, and possibly swelling for one or two weeks after root treatment has been completed.  Analgesics may be required to control pain and sometimes antibiotics are prescribed to control infection in the case of a severe abscess. Antibiotics alone will not, however, cure an abscess since it is necessary to remove the source of the infection which is the tooth pulp.

Due to the intricate nature of root canal treatment it usually takes one or two appointments of about an hour each. The amount of time depends very much on the degree of difficulty encountered in identifying the root canals and adequately negotiating them with instrumentation. There are sometimes constrictions or calcified blockages in molar canals that have to be overcome by exercising patience and persistence.

Although all dentists receive basic training in root canal treatment in dental school and are able to handle most cases, there are instances where they refer on to a specialist practitioner. These may be cases where difficulties in instrumentation of canals are encountered, or where there is a particularly obstinate periapical swelling, for example.

Root treated teeth are more brittle than vital teeth and so are susceptible to fracture, and it is therefore important to have the tooth crowned as soon as is reasonably practical.

If root canal treatment seems like an awful lot of trouble to go to in order to save a tooth then you have to consider the alternative which would be extraction. This leaves the patient with the choice of a denture, bridge or implant. The bridge and implant are both complex and expensive treatments themselves, whilst the denture is less than satisfactory in many people’s opinion; so saving your tooth by means of root treatment is much the best option wherever possible. Root treating a tooth and the subsequent restoration with a post crown has a similar success rate to an implant and is likely to take less time, maybe three to four weeks or so whereas an implant will normally take several months to complete.

Root Canal Filling Materials

The actual filling material used to obturate a root canal is considered to be less important than the control of infection which is paramount for success, although adequately filling and sealing the root canal is a significant factor in achieving a lasting result. This means that the mechanical debridement and cleaning of the root canal system needs to be as thorough as possible and then the apex of the canals sealed to prevent egress of any few remaining bacteria which have not been eliminated, as there are always bound to be some.

Various studies have concluded that at least half of unsuccessful endodontic treatments can be ascribed to incomplete obturation of all canals. Shaping and cleaning are the most important factors in not only reducing the bacterial population in an infected pulp and root canal system but also in allowing for efficient and complete obturation.

The established criteria for endodontic success are that the canals are thoroughly cleaned and that there should be complete and dense filling of the canals to within 2 mm of the radiographic apex.

Care in securing infection control at every step of root canal preparation is key to success, and the final filling most often recommended is gutta percha, either laterally condensed, or inserted thermoplastically. Cold or warm condensation of GP is regarded as the safest method since thermoplastic GP is relatively hard to control and can easily penetrate the root apex.

The general overriding principle with most methods of root sealing is to try to get a good and permanent seal at the apex of the canal plus maximum density of the core material together with minimum volume of sealant, although there seems scant definitive evidence that this produces better healing, but it does seem logical.

The most generally advocated system at present for root canal obturation is to use a master cone and then accessory cones together with a lateral condensation technique and a sealant of choice from amongst a small number of established materials. The sealant should preferably be slow setting to allow for easy accessory point insertion and for further condensation if immediate radiographs should reveal voids.

The ideal root filling material should be bland, bio-compatible, stable, insoluble in tissue fluid, but above all able to provide a perfect hermetic seal. The materials previously mentioned can virtually all come close to achieving these aims in the hands of an experienced operator, and so the final choice may come down to individual preference.

Cracked Tooth Syndrome

Are you facing the cracked tooth syndrome? First you need to understand what cracked tooth syndrome is in order to get the correct treatment from the dentist. A tooth may crack from a variety of different scenarios, and it is important to remember that most of the time, a cracked tooth can be saved, if it is treated early.

The dentist may use different terminologies to define your cracked tooth, the most common of which are fractures, split, crack or craze. In order to help you understand the cracked tooth syndrome better here are some of the frequently asked questions.

Frequently Asked Questions about Cracked Tooth Syndrome!

In order to get effective treatment for a cracked tooth, you need to understand what the symptoms of a cracked tooth are. Here are some of the most common symptoms you need to watch out for a cracked tooth:

  • Sudden sensitivity to sweet foods
  • Sharp pain when chewing
  • Discomfort or pain when crack is exposed to liquids or hot food
  • Difficulty in identifying the source of the pain in the teeth

All these symptoms suggest that you may have a cracked tooth and therefore, should look to get effective treatment from the dentist as quickly as possible.

There are lots of causes for a cracked tooth, and it is important that you keep your teeth in good condition in order to prevent a cracked tooth. Here are some things that may cause a cracked tooth:

  • A blow to the teeth
  • Clenching, grinding and chewing
  • Bruxism
  • Tooth decay & large fillings

These are just some of the causes of a cracked tooth, and you should consider getting the tooth treated quickly in order to avoid looking the tooth forever.

The diagnosis of a cracked tooth can be quite confusing for a dentist, which is why it is advised that you should visit the dentist as early as possible. Sometimes the cracks may not be visible, and the symptoms may not be consistent, which can throw the dentist off their game. In such situations, the dentist will look at the following measures:

  • Dental examination
  • Bite tests
  • Radiographic exam (X-Rays)
  • Removal of fillings
  • Staining the teeth
  • Temperature change test
  • Transillumination

It is important to diagnose the cracked tooth in the correct manner, so that the dentist may find a suitable treatment for the tooth.

It is important that you get treatment for a cracked tooth as early as possible, which mostly depends upon the type of crack that you have experienced. There are basically 2 types of cracks:

A Simple Crack

If you have a simple cracked tooth, it will only require placing a filling on the tooth, so that the crack doesn’t spread and you don’t feel any more discomfort from the tooth.

A Complex Crack

In the event that you have a complex cracked tooth, your dentist may refer you to a prosthodontist or an endotontist. It is possible that you may require root canal treatment for the cracked tooth.

Frequently Asked Questions about Root Canal Treatment!

One of the most common dental treatments today is the root canal treatment, also known as the endodontic treatment. It is used primarily to save the teeth from extraction, and treat the damage caused by tooth decay, injury or any other disease.

People who choose to save their teeth, rather than opt for artificial teeth, often choose root canal, since they want to keep their natural teeth. It is also because your natural teeth are stronger and provide you with better chewing and biting capacity than artificial teeth. It is a highly successful dental treatment and one which provides good results, which is why so many people prefer root canals. If you are getting a root canal, here are some frequently asked questions about the treatment.

Lots of people choose to get root canals; some of the major reasons for getting this dental treatment are due to an inflammation or infection of the pulp. Here are some common factors leading to infection or inflammation of the pulp:

  • A deep cavity
  • Extreme wear
  • Gum disease
  • Trauma
  • Breakdown of a crown or filling

These are just some of the main reasons that may cause an infection. The symptoms can be extremely painful and include tooth discolouration, swelling, soreness in the gums, and sensitivity. In order to save the teeth in such circumstances, a root canal is the only practical option left for people.

Once you decide to get root canal treatment, your dentist will examine the tooth and may request an X-Ray of the teeth in order to determine the extent of the damage. A dental drill will be required to reach the pulp and the dentist will then remove the infected or inflamed pulp. It will require several visits to the dentist during root canal treatment, and you will experience discomfort and pain during that time.

After the removal of the pulp completely, the tissues surrounding the area will start to heal the affected portion. The dentist will request further X-Rays in order to check whether the root canal treatment was successful or not. In some cases, it may be required to remove a major portion of root and it is known as root resection. Your root canal will be filled after the treatment, and you may also require an artificial crown in order to protect and strengthen the teeth.

When you are getting a root canal, it is possible that you may face certain complications. This is why you should familiarise yourself with them, so that you don’t end up being surprised by them in the end. Here are some of the major complications that you may face with root canal treatment:

  • Loss of tooth
  • Discomfort or pain
  • Altered feeling
  • File fracture
  • Weakness
  • Re-treatment

All these complications are a part of the root canal treatment, but that does not necessarily mean that these complications will occur during your treatment.

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