The Endodontic Solution: Saving your natural teeth!

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Penn Dental Medicine

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Your natural teeth are worth saving. If you have tooth pain or were told by your dentist you need root canal therapy, we are here to comfortably help you. Nothing looks, feels, or functions like your natural tooth.

Your tooth consists of two main parts: the crown, which is visible above the gum, and the roots, that lie beneath the gum and are surrounded by bone. Inside each root is a chan-nel that runs the length of the tooth. This channel is the root canal and contains the pulp (nerves, blood vessels, and soft tissue). The pulp may be irreversibly damaged by bacteria from decay, deep fillings, fractures, trauma, or periodontal (gum) disease.

In order to save a tooth where this has occurred, it is necessary to remove the diseased pulp tissue. This procedure is known as endodontic or root canal therapy. Since endodontic therapy is concerned with removing only the pulp from the root canal, the root will continue to function normally because the supporting tissues remain intact. It is advisable to remove an injured pulp because it may become infected or act as an irritant to the tissues surrounding the tooth.

Watch this video from the American Association of Endodontists

Endodontists: the Superheroes of Saving Teeth

Endodontics: A Specialty Focused on Saving Your Natural Teeth.

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If you chose extraction over root canal treatment, you will need a dental bridge or implant to hold the place of the missing tooth. Replacement options can be quite expensive with more visits to the dentist, especially if you want one that looks and functions like your lost natural tooth.

Think replacement isn’t necessary? Not replacing the tooth is likely to inflate costs, and more importantly, cause other dental problems over the long term. These problems include:

• Shifting teeth. When a tooth is extracted, the adjacent teeth begin drifting into the open gap. This unbalance in the mouth leads to increased forces placed on adjacent teeth, making them more likely to fracture or break.

• Bone loss. Our daily biting and chewing stimulates the jawbone, keeping it healthy and strong. But when even one tooth is absent, this leads to a gradual breakdown in the bone. The longer you wait to replace a tooth, further bone loss will occur, making replacement challenging.

• Joint (TMJ) problems. Teeth that have shifted out of alignment can lead to temporomandibular joint and muscle disorder, a painful condition involving dysfunction of the joint and muscles controlling the jaw. Tooth loss creates unbalance that may cause or worsen a TMJ problem and create instability in the mouth.

The Hidden Cost of Tooth Extraction.

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Root Canals Aren’t What They Used to Be Get Up to Speed on Today’s Root Canal

Common Myths About Root Canal Treatment.

MYTH 1: Root canal treatment is expensive.

We’ve already addressed price in comparison with tooth extraction. At Penn Dental Medicine we’re uniquely positioned to offer affordable prices on all services. Our dental students and residents are nearing the end of their formal education and perform procedures under the supervision of experienced experts in the field. We transfer the saved costs of the dental service to our patients, which results in big discounts! That’s why we want to encourage all patients considering extraction to choose root canal therapy with Penn Dental Medicine, since we can offer the lowest prices available on the market.

MYTH 2: Root canal treatment is painful.

The goal of endodontic treatment is to stop dental pain, not cause it. Root canal treatment is virtually painless and often leaves you with less discomfort during recovery than if you have your natural tooth extracted. Thanks to modern techniques and effective anesthesia, patients who experience root canals are six times more likely to describe it as painless than patients who have a tooth extracted!

Watch These Videos from the American Association of Endodontists

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Endodontic Procedures at Penn Dental Medicine.

Root Canal Treatment.

Non-surgical root canal treatment is one of the most common dental procedures, saving millions of teeth each year. This simple treatment can save your natural tooth and prevent the need for dental implants or bridges. If you experience sensitivity to temperature, pain from biting or chewing, visible injury to the tooth’s structure, or swelling, non-surgical root canal treatment may be recommended.

Watch This Video from the American Association of Endodontists

Root Canal Treatment Step by Step

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Endodontic Procedures at Penn Dental Medicine.

With appropriate care, your root canal treated tooth will last as long as your other natural teeth. Yet, a tooth that has received treatment may fail to heal or discomfort may continue. Improper healing may be caused by:

• Curved or narrow canals that were not treated during the initial treatment. • Complicated canals that went undetected during the initial treatment. • The crown or restoration was not placed within the appropriate amount of time following the procedure. • The crown or restoration did not prevent saliva from contaminating the inside of the tooth.

New decay or a loose or cracked restoration can expose a root canal filling to new infection. To remedy this problem, endodontic retreatment may be a solution to your problem. The tooth will be reopened to gain access to the root canal filling material. Next, the canals will be cleaned and carefully examined. Once cleaned, the tooth will be filled and sealed and a temporary filling placed in the tooth. Retreatment is typically completed in two visits to allow medication to disinfect the root canals between appointments. After retreatment, the tooth will need to be properly restored by your general dentist or dental student.

Watch This Video from the American Association of Endodontists

Endodontic Retreatment Explained

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Endodontic Surgery

Sometimes, a root canal procedure by itself cannot save your tooth and a surgical procedure may be recommended. Surgical endodontic procedures may be used to diagnose problems that can not be seen on radiographs, for example small fractures in a root that may be need to be visualized by actually looking at the root, to provide adequate treatment.

Other situations that may require a surgical approach include “calcifications” of a root canal, in which case the canal can not be properly cleaned by a standard root canal treatment approach, and will be sealed at the end of a root using the surgical approach. The majority of teeth that had received root canal treatment can last the rest of your life and never need further endodontic treatment. However, in some instances, there are damaged root surfaces or surrounding bone, or a tooth may not heal or become infected, which may be even years after initially successful treatment. Endodontic surgery may help save your tooth.

Although there are various surgical procedures that may be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection remains present in the bone around the root of your tooth, an apicoectomy may be the indicated procedure.

Applying regular local dental anesthesia, the endodontist opens the gum tissue near the tooth to evaluate the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed and a small filling placed to seal the end of the root canal. A few stitches or sutures are placed in the gums so that the tissues can heal properly. Over a period of months, the bone heals around the end of the root. After the procedure some swelling and discomfort may be experienced over a short healing period. This is normal for any surgical procedure. Your endodontist will recommend appropriate pain medication to alleviate your discomfort, together with postoperative instructions to follow. Most patients return to work or other routine activities the next day.

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Other variations of surgery include procedures where a tooth is saved by removing an entire root or a treatment called intentional replantation, where a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then immediately replaced in its socket.

The specific type of procedure your tooth requires always will be discussed with your endodontist.

A recommendation for endodontic surgery is made because your endodontist believes it is the best option for saving your own natural tooth. While, of course, there are no guarantees for any surgical procedure and chances for success need to be discussed to make an i nformed decision, often the only alternative may be the extraction of the tooth. An extracted tooth must then be replaced with an implant, bridge, or a removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. However, alternative procedures may require surgery or dental procedures on adjacent healthy teeth. Thus, endodontic surgery may provide the most biologic and cost-effective option for maintaining your natural tooth and your oral health.

Watch This Video from the American Association of Endodontists

Endodontic Surgery

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Cracked Teeth.

Biting into something hard or having a clenching/grinding habit can lead to a cracked tooth. Cracked teeth may or may not have symptoms. Symptoms typically include sudden, sharp discomfort when biting or release from biting. Cracked teeth are often very sensitive to cold or hot when initially cracked. In many cases, symptoms are sporadic, making identifying the offending tooth challenging. If you experience any of these symptoms or suspect having a cracked tooth, it’s best to see an endodontist as soon as possible. Our dental microscopes provide high magnification to identify and evaluate any crack lines on your tooth. If left untreated, a small crack will lead to a split tooth, and eventual tooth loss. With this diagnosis, root canal treatment is recommended as soon as possible followed with a full-coverage crown by your general dentist or dental student to protect the tooth.

Watch This Video from the American Association of Endodontists

Cracked Teeth

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Traumatic Injuries

Endodontists, are specialists in treating traumatic dental injuries. Their advanced knowledge and technology can often save an injured tooth. Regardless of the extent of the injury, your tooth requires immediate examination by an endodontist. Sometimes, the neighboring teeth suffer an unnoticed injury that can only be detected by a thorough clinical and radiographic dental exam. Your dentist will give you the proper treatment options for your individual case. Follow-up appointments are essential for trauma cases to ensure a favorable outcome.

Penn Dental Medicine provides the facilities and experience to treat all incidences of dental trauma. Children with trauma to deciduous (baby) teeth should be seen by Penn Dental Pediatrics, trauma to a permanent tooth should be seen by by the Endodontic Department.

Dental trauma includes situations where teeth get chipped, displaced, or even knocked out from the mouth. After a dental trauma to a permanent tooth, your endodontist should be seen as soon as possible, ideally within the first hour after an accident. The endodontist will assess the extent of the damage that may have affected the tooth and evaluate:

If the vitality of the tooth can be preserved.

A filling therapy will be necessary.

Possible future complications.

The prognosis of the tooth.

It is of very high importance that all traumatic injuries are diagnosed, treated, and controlled over time (at least within five years).

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If a permanent tooth is broken or knocked out you should find the tooth. Make sure to hold the tooth by the crown (the white part), and not by the root (the yellow part). If the tooth is not contaminated you should attempt to place it back (replant) as soon as possible. If contami-nated, rinse shortly with cold tap water and put the tooth back in its place. Then hold the tooth in place by biting on a clean handkerchief and see a dentist immediately, preferably your en-dodontist. If the tooth can not be replanted, it should be placed in a storage solution for teeth that had been knocked out from its socket, such as “Save-a-Tooth” or a similar isotonic salt solution sold in pharmacies. If any of these solutions is not at hand, it is better to just put the tooth inside the cheek, than to use any other solutions that are often recommended, such as milk or water, as these dry out the tooth too much, reducing the prognosis of a successful replantation. Seek specialized dental treatment immediately.

Developing Permanent Teeth

When a young permanent tooth with incomplete root development is injured, root canal treatment is not the only intervening option. In many incidences modern techniques and materials make it possible to save the vital pulp and have the tooth continue normal root development. If a dental pulp has degenerated due to decay, pulp regeneration (revascularization) is a relatively new technique to restore vital tissue in a tooth. In an immature permanent tooth, the blood supply to the tooth and stem cells in the area may enable your endodontist to encourage continued root growth. Look to our specialists for more information and expertise if your child experiences a dental injury.

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What technology do we use at Penn Dental Medicine?

CBCT Imaging

Our goal is provide patients the most accurate and thorough diagnosis possible. As a result of superimposition, standard dental x-rays show only a limited, two-dimensional view of your true three-dimensional problem. This limitation is overcome by using small or limited volume cone beam computed tomography imaging techniques. CBCT imaging offers a large volume of information and subtle details that cannot be obtained from a two dimensional x-ray. A single 3D scan allows us to examine the region of concern with high resolution from many different perspectives.

Watch This Video from the American Association of Endodontists

Operating Microscopes

We utilize special operating microscopes during your treatment. This technology allows the endodontist to magnify and illuminate deep into the root canals of a tooth, often visualizing the source of infection. The operating microscope can also be used to record images of your tooth and communicate additional information to your restorative dentist.

How CBCT Helps Endodontists Expose the Source of Tooth Pain

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Bioceramics

A biocompatible material used for sealing root canals, pulp capping, resorption repairs, perforation repairs, apexification, and as a root-end filling during surgical treatment.

Ultrasonics

Ultrasonic instruments are used in conjunction with the microscope to selectively remove tooth structure or bypass obstructions within the root canal system.

The Success of Root Canal TherapyMany studies demonstrate the long-term success of endodontic procedures. An epidemiolog-ical study found that 97% of root-treated teeth survived for 8 or more years. Having a crown placed after treatment was one of the most important factors to improving tooth survival. Even in cases when the tooth is re-infected, retreatment and surgical procedures can provide a positive result. Remember, nothing will look, feel, or function like your natural tooth.

If you or a family member has been suffering tooth pain, we encourage you to make an appointment with one of our Penn Dental Medicine endodontists to evaluate your condition. Early assessment will ensure that you or your loved one will get the help you need.

Watch This Video from the American Association of Endodontists

Root Canal Safety