General Information

Endodontists are dentists who specialize in maintaining teeth through endodontic therapy -- procedures, involving the soft inner tissue of the teeth, called the pulp. The word "endodontic" comes from "endo" meaning inside and "odont" meaning tooth. Like many medical terms, it's Greek. All dentists are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat. That’s why you may have been referred to an endodontic specialist.

In addition to dental school, endodontists receive two or more years of advanced education in this kind of treatment. They study root canal biology and procedures in greater depth, which aid in the diagnosis and treatment of more difficult cases. For this reason, many dentists choose to refer their patients to endodontists.

A local anesthetic will be given. A sheet of latex called the "rubber dam" (we have non-latex ones too) will be placed around the tooth to isolate it, hence keeping it clean and dry during treatment. The treatment consists of three or four basic steps, but the number of visits will depend on your particular case. Most treatments can be completed in 1-2 visits, however, occasionally 3 or more appointments are needed.

The number of visits depends on the degree of infection/inflammation and degree of treatment difficulty. I believe it is more important to perform treatment at the highest level possible than to try to meet a specific time criteria.

Let's look at the basic steps for non-surgical endodontic therapy:

1. Locate the canals that are within the root.

2. Clean and instrument the canals to their fullest extent within the root.

3. Fill the canals. The standard filling material is a natural rubber called gutta percha.

4. Seal the tooth to ensure that bacteria cannot readily leak into the root canal system and Maintain the structural integrity of the tooth.

Root canal or endodontic therapy has a high degree of success when the ideal goals of treatment are achieved. We will discuss with you the chances of success during the consultation to help you make an informed decision. There are, of course, no guarantees. However, if endodontic therapy is unsuccessful you still have options.

Here is an example case that I performed. I treated tooth #31 (the lower right second molar). Another endodontist had treated tooth #30 in front.

I was able to locate, clean, instrument and fill the major canal anatomy in a conservative manner. The front root had two separate canals that joined at the tip of the root while the back root had one main canal that split at the tip of the root and exited from two separate exit points (red arrow).

I sealed/restored the tooth with a silver-mercury amalgam restoration. At the 6-month follow-up appointment, the periodontal pocket had healed and the radiograph suggests complete healing of the bone. At the 4-year follow-up, the patient is still asymptomatic and the radiograph appears normal.

When comparing the two endodontically-treated teeth, what stands out in my mind is that while both procedures achieved the same short-term result, by performing treatment with the conservative removal of healthy, natural tooth structure I expect a higher likelihood of good long-term success. Over time, a tooth that is instrumented more aggressively will be more likely to fracture, and thus lost prematurely, even under normal biting forces.

Conservative preparation of the tooth during root canal treatment in this manner is made possible by the use of the surgical operating microscope.

One of the key determinants of the survivability of a tooth is how much natural tooth structure a given tooth has remaining. Once you cut away tooth structure, you can never regain it.

Oral pain such as toothaches or cracked/fractured teeth can often be difficult to pinpoint. Because of the vast network of nerves in the mouth, the pain of a damaged or diseased tooth often is felt in another tooth and/or in the head, neck, or ear. An endodontist is a specialist in diagnosing and treating this type of pain.

Pulp damage is sometimes caused by a blow to the mouth, and the endodontist specializes in treating these traumatic injuries. For example, a blow to a child's permanent tooth that is not fully developed can cause the root to stop growing. A procedure called apexification stimulates bone to be deposited at the end of the root which makes it possible to then save the tooth through a root canal procedure. An endodontist is specially trained in procedures for replanting teeth that have been knocked out of their sockets.

Occasionally a tooth that has undergone endodontic treatment does not heal or pain continues despite therapy. Sometimes a tooth initially responds to root canal therapy but becomes painful or diseased months or years later. When either of these situations occur, the tooth often can be maintained with a second endodontic treatment or retreatment.

In the example case, I performed endodontic retreatment of tooth #31 over a 3-month period, medicating the tooth in between treatment visits to help promote healing. Nine months following completion of treatment, the bone loss around the root tips that was initially present appears to be healing. The patient is scheduled for further recall appointments to evaluate long-term healing.

I typically reserve root canal surgery (apicoectomy, root amputation, resorption repair) as a treatment of last resort. If we are unable to achieve healing through non-surgical endodontic therapy, surgical intervention may be necessary. Endodontic surgery involves cleaning the root tips directly (in the bone) and requires sutures (stitches) in the gum tissue that will need to be removed a few days following the surgical procedure. That being said, I find that when I am able to achieve the ideal goals of non-surgical endodontic therapy, surgery is typically not needed.

Once endodontic therapy is completed, your tooth should be examined periodically, usually at 6 - 12 month intervals. This allows us to make sure the tooth has healed or is healing properly. We will schedule a tentative follow-up appointment upon completion of endodontic therapy and we will contact you to remind you of the follow-up appointment. We do not charge an additional fee for the follow-up appointments as we consider them to be an essential component of the endodontic therapy performed. Since our goal is the long-term, disease-free survivability of your tooth, our office is committed to re-evaluate the cases we perform for 10+ years.