The Endodontist and a Successful Root Canal Treatment
Many international scientific studies demonstrate that root canal treatment is generally successful and provides an excellent long-term prognosis when the dental surgery is properly performed utilizing sound biological and mechanical concepts. As with any clinical situation, there are factors that must be considered when discussing root canal procedure outcomes with your dentist or endodontist:
- Root canal treatment has not always been as successful as it is today. Fortunately, the guiding principles of modern endodontics can now be utilized to deliver very predictable results over a patient's lifetime. Some of these principles were unknown or misunderstood in the past and, consequently, many teeth have had endodontics treatment based on concepts, techniques, and materials that are not considered optimal by today's standards. Even so, some of these teeth have given, and will continue to give, additional years of good service. In other instances, previously treated teeth exhibit bacterial leakage that may or may not be accompanied by clinical symptoms. Failing endodontically treated teeth can generally be successfully retreated by an endodontist using modern biological concepts, technologies, and techniques.
- Root canal treatment can be successful even if a tooth is severely damaged by decay, trauma, or other destructive events. In cases such as this, it may be necessary to reinforce the tooth by placing a post into the root before a crown can be placed. In these situations, the root canal dentist must weigh risks versus benefits during the treatment planning process.
- The success of root canal treatment is greatly enhanced when the tooth receives a protective restoration after completion of the treatment. When a protective crown is not placed, the root canal filling may leak or the tooth may develop additional decay or even fracture. Once a root fracture has occurred, there is generally no predictable treatment or dental surgery to save the tooth.
- For an endodontic treatment to be successful, the periodontal supporting structures of the tooth must be healthy or capable of being returned to a state of health with periodontal treatment. Other specialty consultations may also be necessary depending on the findings in a particular situation.
- To insure that root canal treatment is working, the particular tooth should be evaluated over time. Teeth are subject to enormous shifts in temperature (such as hot coffee vs. ice cream), tremendous mechanical loads (in pounds per square inch), and constant exposure to the bacteria in saliva. Periodic re-evaluation allows the dentist to examine the results of past treatments and to intervene early if new damage or breakdown is occurring.
As with any human endeavor, there are certain clinical situations in which dental surgery does not work even with the best efforts that modern dentistry can offer. Fortunately, these cases are infrequent and, if they occur, many of the teeth can be successfully retreated by an endodontist. A root canal procedure, when appropriately planned and well-performed by your dentist or endodontist, is the most cost-effective and predictable treatment alternative in most clinical situations.
Causes And Treatment Of Root Canal Disease
Why Does My Tooth Need Root Canal Treatment?
A tooth generally needs a root canal procedure because the pulpal tissue inside the tooth has become irreversibly injured because of root canal disease. The tooth pulp is composed of elements similar to any other tissue in the body and is susceptible to injury from bacterial decay, repeated or extensive dental procedures, traumatic accidents, or advanced periodontal disease. Pulpal disease occurs in an anatomically complex space termed the root canal system. When appropriate, root canal treatment is directed towards removing inflamed or abscessed tissue, disinfecting, and preparing this space to receive a biocompatible filling material. Once the root canal system has been sealed and a protective crown placed by an endodontist, the tooth can be retained as a healthy and functional member of the dental arch.
What Are the Usual Events That Trigger Root Canal Disease?
Events that may trigger root canal disease include:
- Decay: Dental decay contains bacteria that can infect the tooth pulp. Decay can progress through the outer enamel surface of the tooth into the underlying dentin, which is a hard, yet porous, structure. Ultimately, decay can invade the dental pulp and cause pulpal injury, which leads to an inflammatory condition that can potentially become an abscess. As dental decay and its associated bacteria invade the pulpal tissue, a patient may experience no discomfort or, in other instances, the pain may be acute.
- Traumatic events: The tooth pulp is vulnerable to trauma. A blow to the mouth may lead to a variety of dental injuries. A traumatized tooth may appear whole but exhibit root canal disease at a later date. A tooth may be only slightly chipped or it may be fractured to the extent that its clinical crown is broken off and the pulpal tissue is exposed. In severe situations, the root can be fractured within the bone or the tooth completely knocked out of the mouth, which is called an "avulsion." Frequently, these traumatic events will irreversibly damage the tooth pulp by causing bacterial contamination or by interfering with the tooth's blood supply and its ability to repair. Some teeth are traumatized to the extent that they are not treatable and must be removed.
- Repetitive or extensive dental procedures: The tooth pulp is also vulnerable to injury from repetitive or extensive dental procedures. Subjecting a previously injured pulp to the additional trauma of even the best planned and performed dental surgery may be enough to cause the pulpal tissue to become irreversibly inflamed and the tooth to require root canal treatment. The dentist may or may not be able to predict this outcome in advance. At times, based on the examination and treatment plan, the dentist may recommend the removal of the dental pulp before performing other planned dental procedures. In these situations, the tooth pulp is removed so that it will not become problematic at a later date under a new, and possibly complex, restoration. At times, initiating a root canal procedure through an existing restoration may compromise its integrity.
- Periodontal disease: Infection in the gum and bone around the tooth is referred to as periodontal or gum disease. Advanced periodontal disease may compromise the blood supply to the dental pulp and ultimately, bacteria may enter and infect the pulpal tissue in the root canal space.
By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS