Taken from the Greek words "endo" meaning "inside" and "odont" meaning "tooth", endodontic treatment treats the inside of the tooth. Inside the tooth, under the white enamel is a hard layer called the dentin. Under this layer is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue. The pulp is what can become inflamed and infected. This can be caused by caries (decay), trauma to the tooth, cracks, or repeated dental procedures. This damaged pulp is what needs to be removed during treatment.

How successful is root canal treatment?

Success for this treatment is very high - approximately 95+% - if done by properly trained and skilled professionals. The success is also dependent on the patient, to have the tooth permanently restored within 30 days of the completion of the root canal treatment. If your tooth is not amenable to endodontic treatment, or the chance of success is unfavorable, you will be informed of this as soon as it becomes evident.
 

What is a root canal procedure?

After the tooth is numbed with a local anesthetic, a protective shield called a "dental dam" is put over the tooth to isolate it and keep it clean and free of saliva during the procedure. The endodontist will then make an opening in the crown of the tooth. Using very small instruments, the diseased or injured pulp is removed from the pulp chamber and the root canals. After a thorough cleansing, disinfecting and shaping, the root canals are then filled with biocompatible material called "gutta-percha". This rubber-like material is placed into the canals with an adhesive cement to ensure complete sealing of the root canals, so that bacteria cannot enter and re-infect the tooth. In most cases, a temporary filling is placed to close the opening, and you will be referred back to your general dentist for a permanent restoration.

Will I feel pain during or after the procedure?

Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With the modern techniques and anesthetics used, most patients report that they are very comfortable during the procedure. After treatment, it is normal to experience sensitivity and tenderness to chewing and touch, for as little as one day to as much as one week. Try to avoid chewing on the treated side. Usually any discomfort can be managed with over-the-counter medications. If necessary, a prescription will be given for a stronger pain medication. You will be able to drive home after your treatment and will probably be comfortable returning to your normal routine.

What is "re-treatment" of a previous root canal?

In some cases, a tooth that has had a root canal fails to heal or becomes diseased. This can happen months or years after successful root canal treatment. Some possible reasons a tooth may need to be re-treated are:

• Narrow or curved canals were not treated during the initial procedure.

• Complicated canal anatomy went undetected during the initial procedure.

• The placement of a crown or other restoration was delayed following the endodontic treatment.

• The crown or other restoration did not prevent salivary contamination to the inside of the tooth.

• New decay exposed the root canal filling material to bacteria, causing new infection in the tooth.

• A loose, cracked or broken crown or filling exposed the tooth to new infection.

• The tooth sustained a fracture.

The good news is you have a second chance. Re-treatment may be able to save your tooth.

What is a re-treatment procedure?

The endodontist will re-open the tooth to gain access to the root canal filling material. In most cases, complex restorative materials (a crown, post and/or core) need to be disassembled and removed in order to permit access into the canals. The canals are then cleansed and disinfected and are carefully examined under a microscope, searching for any additional canals or unusual anatomy. As in initial root canal treatment, the canals are then filled and sealed with a biocompatible  material called "gutta-percha". You will then be referred back to your general dentist for a permanent restoration.

What is an apicoectomy?

This is the most common type of endodontic surgery. When infection or inflammation persists in the bony area around the end of the tooth after a root canal procedure, an apicoectomy may be needed. This is a micro-surgical procedure where the endodontist will open the gum tissue near the tooth to see the underlying bone and remove any inflamed or infected tissue. The root tip is also removed during this procedure. A small filling may be placed at the end of the root to seal the canal and a few sutures placed in the gum to help the tissue heal properly.

Other types of endodontic surgeries

These include dividing a tooth in half, repairing an injured root or sometimes removing one or more roots. In some cases, a procedure called intentional re-plantation may be performed. This procedure involves extracting the tooth, treating it with an endodontic procedure while it is out of the mouth and then "replanting" it back into the tooth socket.

What is a cracked tooth?

There are many different types of cracks. Treatment and outcome for your tooth depends on the type, location and severity of the crack. Early diagnosis is essential. Even with high magnification and special lighting used by endodontic specialists, it is sometimes difficult to determine the extent of a crack. A cracked tooth that goes untreated will gradually worsen, resulting in the loss of the tooth.

	Craze Lines: These are tiny cracks that affect only the outer enamel. They are extremely common in adult teeth. No treatment is needed.
	Fractured Cusp: When a cusp (the pointed part of the chewing surface) weakens, a fracture sometimes results. This cusp may break off on its own, or be removed by your dentist. A fractured cusp rarely damages the pulp and endodontic treatment is seldom needed.
	Cracked Tooth: This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Damage to the pulp is common and root canal treatment is frequently needed.
	Split Tooth: This is often the result of the long-term progression of a cracked tooth, but is now distinct segments that can be separated. The position and extent of the crack will determine whether a portion of the tooth can be saved. A split tooth can never be saved intact.
	Vertical Root Fracture: These are cracks that begin in the root and extend towards the chewing surface. They often go undetected because signs and symptoms are minimal. Vertical root fractures are often discovered when the surrounding bone and tissue become infected. Treatment frequently involves extraction of the tooth. However, in some cases endodontic surgery is appropriate if a portion of the tooth can be saved by removing the fractured root.