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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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

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Dental Visits - The Endodontic Examination Appointment

On most occasions, the endodontic examination and the endodontic consultation take place at the same visit. Most dentists prefer this. This section will look at each process separately.

What Is the Purpose of the Endodontic Examination?

The purpose of the endodontic examination is to determine the state of health of the pulpal tissues of a tooth or group of teeth. The dentist hopes to collect specific information to assist in diagnosis and treatment planning. During the examination portion of the visit, the dentist will:

• Review the patient's medical history and evaluate the patient's current medical status and in order to determine how it might influence the dental diagnosis and/or treatment plan.
• Review the patient's dental history and, in particular, its relationship to the specific reason for the visit, also called the "chief complaint."
• Perform a thorough clinical examination.
• Perform certain endodontic tooth tests to help establish an accurate diagnosis of the condition of the pulpal tissue.
• Perform a radiographic examination. Two or three different radiographic angles of the same area are often required to adequately visualize the various teeth, the root canal spaces within each tooth, and the surrounding bone and structures. Since a single radiograph is a two-dimensional picture of a three-dimensional object, two or more radiographs with different angulations can provide important additional information. Radiographs reveal many things that the dentist is unable to see with the clinical examination alone.

What Is the Purpose of the Endodontic Consultation?

The purpose of the endodontic consultation is to present a root canal treatment plan to the patient. Once the dentist has collected and evaluated all of the diagnostic information, the goals of the consultation visit are to:

• Share the examination findings and the resultant diagnosis with the patient.
• Discuss the prognosis.
• Discuss the treatment recommendations and any perceived complications.
• Discuss the treatment alternatives and their respective ramifications.
• Discuss the number and length of appointments necessary to complete the recommended treatment.
• Review the cost of the recommended treatment and the various treatment options.
• Answer questions that the patient may have regarding the diagnosis and various treatment options.

On occasion, the dentist may need to consult with other professionals or obtain additional information before all of the goals listed above can be accomplished.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS