Sedation Dentist serving High Point, Greensboro, Winston-Salem and the Triad area.

Root Canals, Apicoectomies, and Extractions

At first glance, a tooth may seem like a piece of hard bone’that chews food. However, if cut in cross section, a healthy’tooth has a network of nerves, arteries, and veins that respond to stimulus from’the outside as well as from the inside. Repeated drilling or cavities on a tooth allow oral fluids, water, chemicals, and bacteria to find their way into channels called “dentinal tubules, and they could eventually affect the nerve inside the tooth. Sometimes the effect will manifest years aft er the initial insult.

Pulpitis is the inflammation of the pulp (inner part of the’tooth bearing the blood vessels and nerve). The condition of the pulp can be described using three words: reversible, irreversible, and necrotic. Reversible pulpitis refers to a fleeting and low-grade inflammation sometimes caused by’stimulation or sensitivity of the tooth. Irreversible pulpitis means the nerve is damaged or infected to the point’that the tooth will not recover unless pulpal treatment is performed. Necrotic pulp means damaged, infected pulpal tissue that may no longer be responsive to stimuli or is infected. Root canal treatment is usually reserved for irreversible pulpitis and necrotic teeth.

The root canal process involves preparing the tooth with instruments a little deeper than a large fi lling, in order to locate the pulp and identify the canals. Instruments like files and reamers, driven by motor or used by hand can remove the pulpal tissues. Solutions that clean and disinfect are used to irrigate the canals as the residue is suctioned away. The length of the roots is determined with the help of diagnostic equipment as well as radiographs (X-rays), and eventually if the clinician determines, the canals can be dried and filled with root-canal cement along with a non-metallic filler There are numerous materials that can be used, and some can be partially removed after the filling of the root to make a space for a cemented post’to support filling material and a crown. Materials and instruments are constantly being developed to make this’treatment faster and easier for the patient.

Intentional root canals are beneficial in several cases.”Sometimes the tooth is in a rotated position, and a cosmetic as well as functional solution would mean reducing’the area of the tooth that sticks out from the ideal arch form. When removal of the tooth structure will lead to encroachment on the nerve, an intentional root canal will ensure that the patient will not have to suffer undue pain later. Clinical judgment is also used when we approach close enough to the nerve that putting in a filling may irritate the nerves and cause the patient undue suffering.

There are people who think that root canal treatment’should not be done, because there are always residual bacteria in the complex network of the nerves of a tooth’that can lead to future infection and immune response.

I say the sooner problems are intercepted, the better the chances of having a good outcome.

Root canal (endodontic) therapy requires special skills and intimate knowledge of the structure of teeth. Most front’teeth have one canal; other teeth may have two, three, four, or more. Some lower front teeth have complex canal’systems that make it difficult to adequately fi nd and clean’them out. Calcifi ed canals result when the pulp chamber lays down calcium salts on the inside of the canal in response to an insult in order to protect itself.

Sometimes’these canals are hard to find and may require multiple visits or referral to a root-canal specialist (endodontist).

Some studies indicate that root canal treatment can have a93 percent success rate up to five years after the treatment was initiated. The other 7 percent of teeth may need to be retreated, extracted, or have an apicoectomy performed.”An abscess at the root of a tooth that had a root canal, a post placed and then a crown, may not lend itself readily’to being retreated. However, the gums can be lifted off’the bone and the abscess at the root removed. When the’tip of the infected root is removed, a filling is placed in’the remaining root to seal it from being re-infected. This is called an apicoectomy, where the apex is the end of’the root of the tooth. When a root canal fails or a tooth fractures vertically or horizontally below the level of the bone, the best option is to take the tooth out, remove the infection, place a bone graft in the area, and then place and restore an implant at a later date.

Extractions of teeth that had root canal treatments present’some special problems, because the tooth is more brittle and may break easily. This problem is common when a patient does not follow up aft er their root canal by having’the tooth crowned. The brittle tooth breaks and the tooth needs to be extracted. Cavities can also destroy a root canal tooth if the patient does not discover it in time; cavities’do not cause a root canal tooth to hurt and patients who do not see their dentist oft en may miss the fact that a cavity was developing.


Chapter 14: Current Dental Developments