Endodontic treatment, also known as a root canal treatment, is a treatment of the tooth aimed at clearing infection as well as protecting the tooth from subsequent infections.

When a tooth is cracked or has a deep cavity, bacteria can enter the pulp tissue and germs can cause an infection inside the tooth. If left untreated, an abscess may form. If the infected tissue is not removed, pain and swelling can result. This can not only injure your jawbones, but is detrimental to your overall health as well. Without the proper treatment, your tooth may have to be removed.

TEETH THAT REQUIRE ENDODONTIC TREATMENT ARE NOT ALWAYS PAINFUL. HOWEVER, SIGNS YOU MAY NEED A ROOT CANAL INCLUDE:

• Severe toothache
• Pain upon chewing or application of pressure
• Prolonged sensitivity to heat or cold
• Dark discoloration of the tooth
• Swelling and tenderness in the nearby gums

WHAT HAPPENS DURING ENDODONTIC TREATMENT?

Root canal treatment involves one to three visits, during which your endodontist removes the affected tissue. After the tissue is removed, the interior of the tooth will be cleaned and sealed. Finally, the tooth is filled with a dental restoration. If your tooth had extensive decay, your doctor may suggest placing a crown to strengthen and protect the tooth from breaking. As long as you continue to care for your teeth and gums with regular brushing, flossing, and checkups, your restored tooth can last a lifetime.

MOST TEETH CAN BE SAVED BY ENDODONTIC TREATMENT BUT TOOTH EXTRACTION MAY BE NECESSARY IF:

• Roots are severely fractured
• The tooth does not have adequate bone support
• The tooth cannot be restored
• Root canals are inaccessible

Endodontic treatment is intended to help save your tooth from extraction. Missing teeth can make you self-conscious, affect your ability to bite and chew, cause other healthy teeth to shift, and have a negative impact on your overall health. By choosing to receive endodontic treatment, you are choosing to keep your smile healthy and beautiful for years to come.

Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or may become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.

Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. Your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.

Surgery may be used as a diagnostic tool if you have persistent symptoms but no problems appear on your X-ray. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.

Surgery may also be performed to treat damaged root surfaces or surrounding bone.

APICOECTOMY (ROOT-END RESECTION)

Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy, or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy.

In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gums to help the tissue heal properly. Over a period of months, the bone heals around the end of the root.

OTHER TYPES OF ENDODONTIC SURGERY

In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.

Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.

ENDODONTIC SURGERY ALTERNATIVES

Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. No matter how effective modern artificial tooth replacements are, nothing is as good as your natural tooth.

TREATMENT OPTIONS

If you’ve been diagnosed with gum disease, there are a variety of treatment options depending on the details of your situation and the severity of the problem. We always start with the least invasive options, which are non-surgical. However, in more serious cases, surgery may be necessary.

NON-SURGICAL TREATMENT

The first line of defense against gum disease is a unique type of cleaning called “scaling and root planing.” In this procedure, an ultrasonic cleaning device is used to remove plaque and tartar from your teeth where regular cleaning devices can’t reach: under the gum line, on the tooth, and around the root. Then, the rough surface of the tooth and the root are smoothed out (planed). This provides a healthy, clean surface that makes it easier for the gum tissue to reattach to the tooth.

If you address your gum disease before it becomes severe, scaling and root planing may be the only treatment you need. However, as with any dental procedure, after-care is vital. In order to keep your teeth in good shape and resist future occurrences of gum disease, you must brush and floss daily, eat a healthy diet, avoid tobacco use, and have regular dental checkups. Even after a successful scaling and root planing, if you don’t attend to your teeth properly, it’s quite likely that you’ll develop gum disease again.

SURGICAL TREATMENT OPTIONS

If the tissue or bone surrounding your teeth is too damaged to be repaired with non-surgical treatment, several surgical procedures are available to prevent severe damage and to restore a healthy smile. We will recommend the procedure that is best suited to the condition of your teeth and gums. Following is a list of common types of periodontal surgery:

• Pocket Depth Reduction
  In a healthy mouth, the teeth are firmly surrounded by gum tissue and securely supported by the bones of the jaw. Periodontal disease damages these tissues and bones, leaving open spaces around the teeth that we call pockets. The larger these pockets are, the easier it is for bacteria to collect inside them, leading to more and more damage over time. Eventually the supportive structure degrades to the point that the tooth either falls out or needs to be removed.

  During pocket reduction procedures (also known as “flap surgery”), we fold back the gum tissue and remove the bacteria hiding underneath, as well as the hardened plaque and tartar that have collected. We may also remove any tissue that is too damaged to survive. We then sew the healthy tissue back into place. Now that the tooth and root are free of bacteria, plaque, and tartar, and the pockets have been reduced, the gums can reattach to the teeth.

• Regeneration
  When the bone and tissue supporting the teeth have been lost due to severe gum disease, we can restore these areas with a regeneration procedure. During this process, we begin by folding back the gum tissue and removing the bacteria, plaque and tartar. Depending on your situation, we may then perform a bone graft to stimulate new bone growth, or we may apply a special kind of protein that stimulates tissue growth to repair the areas that have been destroyed by the disease.
• Soft-Tissue Graft
  A frequent symptom of gum disease is gum recession (also called gingival recession). As the gums recede, more of the roots are revealed. This can make teeth appear longer and can also create sensitivity to hot or cold liquids or food. It also exposes the tooth to increased damage from gum disease, as bacteria, plaque, and tartar attack the surface of the tooth and the root.

  During a soft-tissue graft, tissue from the top of your mouth or another source is sewed to the gum area, covering the roots and restoring the gum line to its original, healthy location. This procedure can also be performed for cosmetic reasons.

Scaling and root planing is one of the most effective, non-surgical ways to treat gum disease before it becomes severe. Scaling and root planing cleans between the gums and the teeth down to the roots.

Scaling is basically the process of removing dental tartar from the surfaces of the teeth. Root planing is the process of smoothing out the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gum line. A careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and smoothing the tooth root to remove bacterial toxins will help ensure that your gum disease is controlled.

HELPFUL HINTS TO KEEP IN MIND

• Scaling and root planing does not usually cause much discomfort, but you might experience some soreness afterwards, since deeper regions under the gums have been cleaned.
• Your teeth themselves may become a bit more sensitive to temperature, and bleeding might occur for a little while after your procedure.
• Over-the-counter painkillers, such as ibuprofen, work very well to alleviate discomfort, as do ice packs applied to the outside of the face around the treated area.
• Brushing and flossing will have to be done more gently to avoid aggravating any bruised or tender gum areas. We’ll show you the best methods for keeping your teeth clean during this time.

Scaling and root planing is a simple procedure that can work very well to stop gum disease. If you maintain good dental care after the procedure, the progression of your gum disease should stop, and your gums will heal and become firm and pink again in no time!

Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment, your periodontist can help you identify the factors contributing to the problem. Gum grafting will cover the exposed roots to protect them from decay, help reduce tooth sensitivity, and improve the aesthetics of your smile. Whether you have a gum graft to improve function or aesthetics, you’ll probably receive the benefits of a beautiful new smile and improved periodontal health: your keys to smiling, eating, and speaking with comfort and confidence.

GUM RECESSION

Gum recession is caused by advanced gum disease. When gingivitis goes untreated, gum disease (also called periodontitis) will cause gums to pull away from the teeth, leaving deep pockets where bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back from the teeth, making the teeth look longer. Teeth may then become loose, fall out, or have to be pulled out by a dentist.

DO YOU HAVE GUM RECESSION?

Gum recession does not happen overnight. You may not even notice that your gums have receded, as it is a very slow, gradual process. However, without a gum tissue graft, recession can have a detrimental effect on the health and function of your teeth. If your dentist has diagnosed you with gingivitis or periodontal disease, it is important to notice if:

• You have sensitivity to hot or cold temperatures, or even to sweet, spicy, or sour foods
• Your teeth appear longer than normal
• Spaces between your teeth seem to grow
• The roots of your teeth begin to show

GUM TISSUE GRAFTING

When you come to our office for your grafting procedure, a local anesthetic will be given to numb the areas involved. You may also receive medicine to help you relax. We want your experience in our office to be as comfortable as possible, so let us know if there is anything you need during your procedure.

Depending on your specific needs, your periodontist will perform one of three different types of gum tissue grafts.

• Connective tissue grafts: The most common method to treat root exposure, connective tissue grafting involves your periodontist cutting a flap of skin on the roof of your mouth (or palate) and removing tissue from under the flap, called sub-epithelial connective tissue. This tissue is then stitched to the gum tissue surrounding the exposed root. After the connective tissue, or graft, has been removed from under the flap, the flap is then stitched back down.
• Free gingival grafts: Similar to a connective tissue grafting, a free gingival graft involves the use of tissue from the roof of the mouth. But instead of making a flap and removing tissue under the top layer of flesh, a small amount of tissue is removed directly from the roof of the mouth and then attached to the gum area being treated. This method is used most often in people who have thin gums to begin with and need additional tissue to enlarge the gums.
• Pedicle grafts: In this procedure, instead of taking tissue from the palate, it is grafted from gum around or near the tooth needing repair. The flap, called a pedicle, is only partially cut away so that one edge remains attached. The gum is then pulled over or down to cover the exposed root and sewn into place. This procedure can only be done if you have plenty of gum tissue near the tooth.

Many factors will contribute to your chosen grafting technique. Your periodontist can tell you which method will work best for you, your health, and your smile.

Osseous surgery, also known as pocket depth reduction, is a surgical procedure intended to restore your gums to a healthier, more natural state. If your periodontist has recommended osseous surgery, it is because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine. Your bone and gum tissue should fit snugly around your teeth, creating a protective cover from bacteria. If you have periodontal disease, the supporting tissue and bone are destroyed, and this forms pockets around the teeth. Over time, these pockets become deeper and provide a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. To reduce the need for extractions, osseous surgery may be recommended.

Reducing pocket depth and eliminating existing bacteria are important in preventing damage caused by the progression of periodontal disease and in helping you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it’s important to make them as small as possible. Small pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth as well as decrease the chance of serious health problems associated with periodontal disease.

HOW IS OSSEOUS SURGERY PERFORMED?

During this procedure, your periodontist will fold back the gum tissue and remove the disease-causing bacteria before securing the tissue back into place. If the underlying bone has been damaged, the irregular surface will be smoothed out to limit areas where disease-causing bacteria can hide. This will also allow your gum tissue to reattach to healthy bone more effectively.

You may experience some swelling after the surgery, so applying an ice pack to the outside of your face over the treated area can help with any discomfort. In some cases, antibiotics are given before, during, and after the treatment in order to prevent any infections. After a week or two, you’ll come back to our office so that your periodontist can check the surgical area and ensure your mouth is healing properly.