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The pulp of your tooth, which contains the nerve and tiny blood vessels, can become infected. The pulp has a limited ability to heal itself. This infection can be caused by a deep cavity that reaches the center of the tooth causing the pulp to die, a traumatic injury to the tooth, or an extensive preparation (drilling) of the tooth. The extensive preparation may have been done to prepare the tooth for a crown (cap) or other large preparation for a restoration. The pulp may or may not abscess immediately in these cases. It may take years for a problem to develop. The infected pulp tissue may or may not be painful. It may or may not be visible on a dental radiograph. A tooth with this type of an abscess is not usually extracted because the infection can be treated with endodontic therapy on the tooth. This routine procedure can save the tooth and enable you to avoid the harmful effects of tooth loss. It is successful in more than 90% of the teeth in which the treatment is completed.
Endodontic treatment can take from one to three appointments to complete. Teeth can have one to four canals that need to be treated. An opening is created to access the nerve, and the abscessed nerve is removed from the root or roots. The canals where the nerves had been located are then cleaned and shaped and a medication may be placed in the canal to promote better healing.
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When it has been determined that the canals are free of infection, they are filled with a special rubber-like material and sealed with a cementing medium. The abscessed area associated with the tooth will then begin to heal. It may take several months before healing is completed and for the tooth to become asymptomatic, that is, for any soreness in the area to disappear.
Once the endodontic therapy has been completed, the tooth is usually restored with a cast crown or onlay. This is done to protect the tooth and prevent it from fracturing. Failure to follow through with mandatory restorative procedures after endodontic therapy on a previously uncrowned tooth can result in a vertical fracture. If there is very little tooth structure remaining, we may also advise the use of a post and core to further help the tooth retain its final restoration. We will discuss with you the exact type of restoration that you will need.
Please note that this infection may cause discomfort between root canal appointments. This is normal and usually not a cause for any concern. Contact the office if there is pain and/or swelling. Remember to avoid biting down on the tooth until the root canal is completed and the final restoration has been placed. You may have had no discomfort from the tooth prior to the root canal treatment or have been unaware that you even had an abscess. However, you may experience pain or swelling after the root canal treatment has begun.
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| If we have prescribed antibiotics for the abscess, be sure to fill the prescription and take it until it is finished. It is important that you do this in order to quickly control the infection. If you do not take the prescribed medication, the resolution of the abscess may be delayed and problems with the postoperative pain are more likely. |
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Indications
Although endodontic treatment has an extremely high rate of success, it is not 100% effective. Some teeth may not respond as expected to the root canal therapy. Sometimes, it is clear from the beginning that the root canal is not working as planned. Other times, it may be years later that the need for other treatment arises. The first and most desirable method of solving the problem is to re-treat the root canal at one or more roots. In other words, the root canal treatment is redone in a method similar to the original therapy. If it is possible to re-treat the root canal with this non surgical approach, this is best. If not, a different form of treatment, an apicoectomy, must be considered.
Teeth that have narrow, curved roots, “blockages” of the canal, root resorption, persistent infection, fractures, a wide open apex, and associated cysts are some of the problems that can be corrected with an “apico.” There may be reasons not to perform the apico, such as surgical inaccessibility, poor or lack of bone support, short roots, or vertical fracture of the root.
The Procedure
The root or roots that are to receive the apicoectomy are measured with radiographs, and the approximate location of the root tip is estimated. The area to be treated is anesthetized with a
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local anesthetic. An incision of the gum is made over the root tip area and the gum is moved to the side. Access is made through the bone, and the tip or apex of the root can then usually be seen through this “window” in the bone. The infection is visualized and cleaned out. The tip of the root is usually removed, and a sealing filling is placed in the remaining tip opening. The tissue is then sutured back into place. The tooth does not lose significant stability from this procedure.
There is no pain during the surgery. Postoperative discomfort will be eliminated with anti-inflammatory and analgesic medication. There is usually some slight swelling of the surgical site. The swelling is temporary and will disappear after a few days.
When the “apico” is begun and the tooth can actually be seen, another type of problem may be noted. A fractured root may be the problem, and an apico would not work and the tooth would have to be removed.
This procedure can be completed by a general dentist, but it is sometimes referred to an endodontist (root canal specialist) for evaluation and treatment when unusual conditions exist. |
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