Root canal treatment is used to save teeth which would otherwise need to be removed.

A root canal can be considered when the nerve and blood supply inside the tooth (also known as the pulp) is infected through decay or injury. When the pulp tissue in a tooth gets infected, it is damaged irreversibly and the infection can spread down the canals into the bone around the tooth roots. At this point, the infection has become an abscess.

Your body cannot heal an irreversible pulp infection or abscess because the blood supply inside the tooth is destroyed, so there is no way to get the immune cells needed to kill off the bacteria into the infected tissue. This leaves two options to get rid of the infection. The tooth can be removed with an extraction, which would leave a gap in the dental arch that could be filled with an implant or a bridge. Alternatively, the tooth can be kept in place and just the infected pulp tissue can be removed from inside the tooth with a procedure called a root canal.

It is important to evaluate the risks of remnant chronic infection in lateral and webbed canals vs the benefits of an attempt to preserve the tooth and its root with surrounding vital ligament cells with root canal treatment. The complexity of the pulpal canal system is variable in each person, in each tooth. The Root Canal Anatomy Project, a 5 year academic study of 3D imaging the pulpal systems of multiple teeth, shows the variable and complex webbed pulpal tissue systems of examples of each tooth in the mouth. There are many considerations to take in determining if an attempt to preserve the tooth is right for your specific situation, such as the need for bone remodeling cells that reside in the ligament that surrounds tooth roots to be present for bone growth and remodeling with proper orthodontic bone development in tooth movement. As with everything in health care, this is a case specific and patient specific evaluation. Never one size fits all.

Image Credit: “Human tooth diagram-en.svg from Wikimedia Commons by K. D. Schroeder, CC-BY-SA 4.0“

Our doctors will thoroughly examine your tooth to determine if the nerve is infected. The exam includes x-rays and checking the health of the tooth with a pulp tester. Additionally, your doctor may also apply cold and heat, or tap on the tooth to see if it is sensitive or press gently on gums around the tooth to check for pain.

At Apex Dental, we have Cone Beam CBCT technology right in our office, so that we can take a 3D image of the tooth and visualize the pulpal canal system inside the roots in all dimensions. This is an invaluable tool to identify all canals for disinfection, as well as to evaluate the presence and extent of abscess or cavitation in the bone surrounding the roots.

Following the thorough examination of your tooth, our doctors will discuss their findings and diagnosis with you, as well as the prognosis of treatment options. Root canal treatment is an advisable option if the anatomy of the pulpal canal system allows for adequate disinfection and the bone around the root is sound. In cases that the pulpal canal system is more complex with accessory canals, that the root is fractured, or that cavitations in the bone are too extensive, extraction of the tooth followed by tooth replacement may be advised.

With all of the information available from this evaluation, you will be able to make the decision that is right for you. Our doctors are always happy to answer any questions you may have to help you in this decision.

We use local anesthesia to eliminate discomfort. Additionally, we can provide nitrous oxide analgesia or IV Sedation if requested. Utilizing the advanced imaging and findings from your evaluation, our doctors will use specialized instruments and irrigants to thoroughly clean and disinfect the pulpal canal system of your tooth. The disinfected canals will then be filled and sealed with a material called gutta percha, and the tooth will be restored with a crown for strength and durability.

The procedure will typically take about an hour. Most of our patients are able to drive home after treatment and comfortably return to normal activity right away.