Root Canal Therapy

Root Canal Therapy

Each of our teeth contains a long, thin strand of dental pulp that contains the nerves and blood supply that extends into the root canal system. The blood vessels provide nutrients to the tooth and the nerve provides sensation. When the nerve is intact the tooth is vital and healthy. Bacteria can penetrate into the pulp space through dental decay or tooth fracture. This causes destruction of the blood vessels and nerves within the pulp. As the tissue breaks down, an infectious process begins within the pulp that ultimately leads to the constriction of blood supply and death of the nerve. The infectious process causes a build up of pressure within the tooth usually causing pain and over time an abscess develops. There are situations where the nerve becomes infected causing an abscess visible in the gums or on a dental x-ray, but the patient perceives no pain or is asymptomatic. To halt the infectious process and prevent the destruction of bone and tissue, the degraded tissue needs to be removed.

Many people are perplexed when seemingly solid teeth with little or no dental work require root canal therapy. An often overlooked biological phenomenom is the calcification of the dental pulp. This process is almost identical to developing kidney stones. As we age, calcific deposits are laid down in the pulp chamber slowly constricting its size. This helps to shield the nerve and minimize sensitivity as we age. However, if the deposits reach the point where it cuts off the blood supply in the very thin cappilaries then the nerve will die and as the dead tissue leaks out of the canal system into the surrounding bone tissue a dental abcess forms. This type of nerve death does not require bacteria to form an abcess but does require root canal therapy to allow the bone to heal and reform.

Root canals may also be necessary when the patient is experiencing pain or severe sensitivity. Sensitivity to percussion or temperatures and difficulty in putting pressure on the tooth during eating are signs that the nerve is inflamed. The dentist must determine if the inflammatory process is reversible or irreversible. If the diagnosis is irreversible then the patient has only two options. Root canal therapy or extraction. 

Root canals are designed to help save compromised teeth. During the procedure the nerves within the roots are thoroughly cleaned and removed and the canal system is shaped to allow for permanent filling and sealing of the root canal system. 

 


Endodontic Surgery

There are cases where an abscess develops at the root tip even after root canal treatment. This occurs when all the infected bacteria could not be removed within the root or when the initial infection was severe. Surgery is an alternative option to root canal retreatment to remove the bacteria from the root tip without disturbing the crown of the tooth. An incision is made in the gum tissue and the apical portion of the root is located in the bone where the infection can then be cleaned out. The tip of the root is cut off in a procedure called an apioectomy and the root canal system is re-sealed with a small retrograde filling to help the bone reform. This procedure can be utilized as an alternative to conventional root canal therapy when the tooth has a good crown or cap on it due to previous dental work and re-treatment would cause an undue expense. Each case must be decided on its own merits. There are some cases where the procedure may be unsuccessful and the tooth may still require extraction. Where root canal therapy is approximately 90 to 95% successful, root canal surgery is only successsful in about 80% of cases. Due to Dr. Kirshen's involvement in Implant Dentistry since 1982 he has been bale to combine some bone grafting techniques into endodontic surgery and increase the success rate especially in re-treating cases which previously failed with standard endodontic surgery. It is exciting times we live in and experience can trump book learning alot of the time.