ENDODONTIC RETREATMENT
Endodontic retreatment is a procedure used to re-clean the root canals of an endodontically treated tooth that either is symptomatic, or appears radiographically to have a periradicular abscess. This process is much more difficult than the initial endodontic treatment, mainly because, very often, the endontist has to face the results of various mishaps that have taken place inside the canals during the initial treatment (root perforations, broken endodontic microinstruments, etc). In addition, the bacterial population in these root canals is much more complex, and therefore, extra attention and special knowledge is needed to remove all bacteria from the root canal system. For these reasons, endodontic retreatments should be performed only by endondondists with the use of special equipment (dental microscope and special endodontic tools).
The endodontic treatment is a procedure with which a tooth’s root canal system is cleaned by its content and then filled with a material called gutta-percha. Root canals may contain vital pulp (vessels and nerves), or necrotic pulp and bacteria. The whole procedure is also called ‘root canal treatment’.
Caries is the most common cause of pulp irritation that leads to endodontic treatment. When tooth decay progresses deeply into dentin, tooth pulp gradually gets irritated, then inflammed, and in the end it produces toothache. This type of toothache can be sharp, that worsens with cold and hot stimuli, and may become really severe at night during bedtime. Often, the patient cannot figure out which tooth causes the pain, since it is reffered to the other jaw, or to a different spot at the same jaw. It can also be reffered outside of the mouth and take the form of migraine or earache.
In other cases, caries may progress without any initial symptoms and lead to pulp necrosis. Pulp becomes necrotic and root canal system is invaded by oral bacteria. This causes inflammation at the tip of the root, which often is described as an ‘abscess‘. The abscess is located outside of the tooth, around its root, but is caused by the bacteria that reside inside the root. An abscess may be asymptomatic for a long period, but can periodically become acute and cause severe pain, often described by the patient as throbbing pain(following the rhythm of the heart). If the condition is left untreated, it may progress to a localized or diffuse swelling, usually after 1-2 days. In this case antibiotics help with the symptoms, but cannot treat the inflammation. If the abscess is still left untreated, the inflammation gradually grows in size and may lead to the creation of a fistula in the gum of the responsible tooth, which is described by the patient as a pimple with pus discharge.
In all of the above cases, endodontic therapy will treat all the symptoms.
Apicoectomy is a minor microsurgical operation at the tip of the root/roots of endodontically treated teeth that are symptomatic. The inflammation located at the tip of the root is cleaned surgically, 3 mm of the root tip is resected and, in the end, a retro filling with a biocompatible material is placed at the new tip of the root.
1. I have toothache, what can I do?
In case of sudden toothache, we advise you to take strong pain killers and contact us as soon as possible. Avoid taking antibiotics, because they don’t help in all cases of dental pain.
2. I am swollen, what can I do?
In case of intraoral or extraoral swelling, antibiotics may be necessary for your relief until definitive treatment. However, you should not take antibiotics on your own, because not all antibiotic regimens are appropriate and drastic. Contact us as soon as possible so as to examine and advise you properly.
3. Will I be in pain during or after the endodontic therapy?
No. During treatment the tooth is very effectively anesthetized and you will not feel any pain. After the endodontic treatment, and depending on the initial condition of the pulp, you may feel pain, discomfort when chewing, or even swelling. All of the above are normal reactions and, of their possible presence and medication needed, you will be fully informed by us.
4. Will my endodontically treated tooth feel the same as the rest?
Yes. With the exception of the first days posttreatment, endodontically treated teeth are completely asymptomatic and feel like the rest of the teeth.
5. Will the tooth be more fragile after the endodontic treatment?
Yes. We know that endodontically treated teeth are weaker and thus prone to fractures, but not because of dehydration after pulp removal. The cause of postendodontic tooth weakness is strictly mechanic (due to the removal of the roof of the pulp chamber, that holds the tooth walls together). Since the cause is mechanic, we can face it machanically, by holding the tooth walls together with an onlay or a crown. In this way we avoid fractures.
6. Do endodontically treated teeth change color?
No. In the past years, most endodontically treated teeth showed a distinct change in color. In our days, endodontically treated teeth do not change color, and this is firstly because modern root canal filling materials are resin-based and do not stain, and secondly because using rubber dam means that we can clean the root canals with very strong chlorine-based liquids, that also have a strong whitening effect on dentin.
7. Is it possible for endodontically treated teeth to decay?
Yes. Decay can affect endodontically treated teeth as easily as it affects intact teeth. The difference is that endodontically treated teeth are missing the nerve that usually warns about the existence of caries i.e., with a sensitivity to something cold or sweet. As a result, caries may progress without any symptoms. For this reason, good oral hygiene, even of endodontically treated teeth, is absolutely necessary.
8. Why is it better for the endodontic treatment to be performed by a specialist?
Endodontists are dentists specialized in endodontic treatment. They have a far better knowledge of root canal system’s anatomy and its deviations, and are more familiar with the use of modern techniques and equipment. Instead of standard hand endodontic instruments, they use machine-driven micro-instruments for root canal cleaning, special apparatuses for root measuring and filling, and finally the dental microscope. The use of the dental microscope helps the endodontist perform the treatment under magnification and sometimes allows him to have visual contact even with the tip of the root. With all this special equipment and knowledge, the endodontist can work fast and precisely, and even complete the endodontic treatment in a single visit.
9. Can the endodontic treatment be completed in a single visit?
Yes. Today we believe that the endodontic treatment not only can, but should be completed in a one visit. With a single visit, we minimize the risk of root canal recontamination and tooth fracture between visits, because the tooth will not stay with the temporary filling for long. In addition to that, one visit means that the patient will have possible posttreatment symptoms once, which is very convenient. Completing the endodontic treatment in one visit requires experience and time, so as to perform the process efficiently. If this is impossible, treatment can be completed in 2 or 3 visits.