Root canal treatment is usually performed in one visit and generally involves the following steps.
Dr. Maguire will thoroughly examine your tooth and any relevant x-rays. After discussing the state of the tooth and the required course of treatment he will administer local anesthetic. With modern techniques, the administration of local anesthetic is virtually painless. He will then place a protective rubber sheet (“rubber dam”) over the tooth in order to keep saliva and the bacteria away from the tooth. Remember it is the bacteria in saliva that caused the damage in the first place. The rubber dam will also prevent any of the chemicals used during the root canal procedure from leaking into your mouth.
Dr. Maguire, using a microscope, will then make an opening in the tooth (the “access opening”) and remove any decay or broken tooth fragments. He will then clean out and sterilize the root canals and pulp chamber.
After the pulp chamber and all of the root canals have been cleaned and sterilized Dr. Maguire will fill all of the root canals with a biocompatible material called “Gutta Percha”. In some cases Dr. Maguire may put a permanent filling in the opening of the tooth but usually a temporary filling is placed. The temporary filling will be removed by your dentist before placing the permanent restoration (usually a crown) on your tooth.
If following the removal of decay and broken or cracked fragments, the tooth lacks sufficient structure to hold the crown in place Dr. Maguire or your dentist may place a post in one of the root canals and a core build-up to help hold the crown in place.
When Dr. Maguire has completed treatment you must return to your dentist as soon as possible (usually within 4-6 weeks) to have the crown or other permanent restoration placed. This will prevent leakage of saliva and the bacteria it contains from recontaminating the root canals and protect the remaining tooth structure.
Root Canal Retreatment – A second chance to save your tooth.
With proper care and occasional maintenance teeth that have undergone root canal treatment can last as long as other natural teeth. There are two situations where a tooth that has undergone root canal treatment needs to undergo a root canal retreatment.
In the first instance your general dentist has performed a routine root canal treatment and it has not taken care of your discomfort or the shadow visible on the dental x-ray has not healed within 2 years following the completion of the treatment. This generally occurs because the anatomy of your tooth was unusual and routine root canal treatment performed by you general dentist was unsuccessful in resolving the infection.
In the second instance the root canal treatment that had been performed was successful. Unfortunately due to a fracture or new decay (sometimes years after the root canal treatment was performed) saliva and the bacteria it contains were allowed to reinfect the root canal system leading to the return of symptoms or a shadow on the dental x-ray.
Successfully performing a root canal retreatment procedure is significantly more difficult than performing a routine root canal treatment. Many general dentists will refer you to Dr. Maguire for this specialized root canal procedure.
Following a thorough examination of your tooth and the relevant x-rays, Dr. Maguire will as always discuss all of your treatment options with you. Once the decision has been made to proceed with retreatment Dr. Maguire will gain access to the infected root canals in order to re-sterilize them. Usually complex restorative materials must be removed using very specialized techniques and equipment.
After removing the existing crown, post and core Dr. Maguire will use a surgical microscope to remove the old root canal filling as well as locate any areas that may not have been previously sterilized inside the root canal system. Dr. Maguire will then clean and sterilize the root canal system in its entirety using special micro-instruments and chemicals.
After cleaning and sterilizing the entire root canal system Dr. Maguire will fill all of the root canals with a biocompatible material called “Gutta Percha”. In some cases Dr. Maguire may put a permanent filling in the opening of the tooth but usually a temporary filling is placed. The temporary filling will be removed by your dentist before placing the permanent restoration (usually a crown) on your tooth.
When Dr. Maguire has completed treatment you must return to your dentist as soon as possible (usually within 4-6 weeks) to have the crown or other permanent restoration placed. This will prevent the leakage of saliva back into the root canals and protect the remaining tooth structure.
Root Canal Surgery
Root canal surgery can be used to help save your tooth in a number of situations.
Diagnosis – If you continue to have persistent symptoms but no signs of pathology that can be seen on an x-ray, your tooth may have a small crack or anatomic irregularity that could not be detected or treated during the root canal treatment or retreatment. In this situation exploratory root canal surgery allows Dr. Maguire to examine the root of your tooth to detect the problem and provide the appropriate treatment.
Inaccessible portions of the root canal – Occasionally natural or man-made blockages occur in the root canal and do not allow Dr. Maguire to sterilize the root canal system in its entirety. If these unsterilized areas continue to cause problems Dr. Maguire may need to remove that part of the root and seal the root canal from that end.
Dental plaque on the outer surface of the root – Bacteria have been shown to occasionally spread from the inside of the root canal onto the outer surface of the root. Occasionally these bacteria can form dental plaque just like the plaque a dental hygienist removes during a cleaning. If this occurs, the plaque must be removed for healing to occur. If Dr. Maguire determines that this has happened to your tooth surgery may be required to remove that portion of your root covered by plaque.
Apicoectomy and Retrofilling
Although there are many different types of root canal surgery that can be performed to save a tooth the most common is called an apicoectomy.
In performing this procedure, Dr. Maguire opens the gum tissue covering the root of the tooth to see the bone and root. He then removes any inflamed or infected tissue and any infected portions of the root.
A small biocompatible filling is then frequently placed to seal the end of the root canal and a few stitches are placed in the gum to help it heal.
Now that the surgery has been completed over the next few months the bone will heal and all signs of disease will disappear.
Will I feel pain during or after the procedure?
The procedures of root canal treatment are usually performed to relieve the pain caused by pulpal inflammation and/or infection. Using modern techniques Dr. Maguire will do his utmost to ensure you feel as little discomfort as possible both during and after all root canal procedures.
For a few days following root canal treatment, retreatment or surgery it is normal for the tooth to be a little sensitive, especially if there was pain or infection before the procedure. This discomfort is usually managed with pain medications such as Advil or Tylenol.
The tooth may feel a little different to chew on for some time after treatment has been completed but this generally subsides in a few weeks.
If you develop severe pain or swelling following root canal treatment call Dr. Maguire immediately at 604-531-3631 (24 hours a day 7 days a week).