OHSU Graduate Endodontics

Patient Information
 

What is a root Canal	Non-healing after a root canal
After completion of a root canal	Apicoectomies

Root Canal Treatment
Simply put, when the nerves inside the tooth (the "pulp") become irreversibly inflamed or infected, you need a root canal. Below is an explanation of the procedure:
 
 

This is a picture of your tooth. The pulp is the soft tissue inside the tooth. It provides the tooth its ability to feel hot and cold and allows the tooth the essential blood supply and nutrients necessary during the tooth's development.

 

When decay gets very close to or into the pulp, the tissue becomes inflamed and sometimes infected. This inflammation and infection inside the tooth can be very painful.

 

The inflammation and infection  can also spread to the surrounding  bone and sometimes cause pain and swelling.

 

To treat this, first the decay is removed,  an entry is made into the pulp  and the pulp is removed..

 

Finally, the canal spaces are filled,  usually with an inert material called  Gutta Percha, and a crown  is placed. After about three-six months,  the bone reforms.

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After Completion of Endodontic Treatment

Endodontic treatment for this tooth has been completed. The canals inside the roots have been cleaned and permanently sealed. However, there is a temporary filling in the outer surface of the tooth. PLEASE CALL YOUR DENTIST FOR AN APPOINTMENT IN ABOUT TWO WEEKS FOR A PERMANENT FILLING OR CROWN. This is very important for the protection of the tooth against fracture or reinfection of the root canal. Although the nerves inside the tooth have been removed, there are still many nerves outside the roots. These nerves have been inflamed and may continue to be sensitive for a short time after the root canal treatment. Avoid chewing with this tooth. Two to four tablets of Ibuprofen (Advil, Motrin, etc.) taken four times a day for the next three-four days usually helps control the sensitivity. Frequent rinsing with hot salt water for the next two days will also help. If the doctor has prescribed other medications, be sure to take as directed. We will contact you by mail in six months for a follow-up appointment. We will take an x-ray to ensure that the tooth and surrounding tissues are healed. If you ever have any questions concerning your treatment, please feel free to call us. Our doctors are available after hours through our answering service.
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Non-Healing After Endodontic Treatment

Fortunately for everyone, most root canals heal with about a 95 percent success rate. When they don't heal, we would prefer to call this "non-healing" rather than "failing". Be aware that this is not mere carpentry -- it is a medical procedure and all medical procedures do not heal 100 percent of the time, including root canals. Generally speaking, the non-healing takes on one of two avenues:
1. Pain (mild to severe) with or without swelling, or
2. No symptoms at all, but changes on the x-ray suggestive of non-healing (i.e. bone dissolving around the root tips).

Typically, the non-healing is caused by one two things:
1. Inflammation, or
2. Infection .

The inflammation may be from the tooth being inflamed prior to treatment, or the treatment itself may elicit more inflammation. Usually time, non-steroidal medication (e.g. Advil), or steroids (e.g. dexamethazone) can resolve this. Infection can be from three main causes:
1. The original infection persists, or
2. There is a crack in the tooth, or
3. There is leakage through the top of the tooth (i.e. the filling) that re-infected the root canal filling.

If the non-healing is due to infection, usually time and antibiotics will resolve this. If signs or symptoms persist, there are three options:
1. Retreat the root canal, or
2. Surgically clean the bone that surrounds the root tip and seal the tip of the root (apicoectomy), or
3. Extract the tooth.

Obviously, every case is different and careful evaluation is paramount to resolving any conditions of non-healing.
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Apicoectomy                                               

When there is non-healing of a root canal, many times it is because of a persistent infection, located typically at the tip of the root of the offending tooth. When a root canal is done, usually the source of this infection is removed by cleaning out the inside of the root and sealing it up. However, sometimes this infection persists outside the tip of the root, possibly because of irregularities in the root system. This necessitates surgically cleaning out the infection around the outside of the root and then trimming off the tip of the root to reveal a clean surface, then the tip of the root is sealed.
 
 

Here is a picture of a tooth that has had a root canal  (pink filling inside of canal space)  and a crown. There is good bone around the roots

 

On a rare occasion, the root canal treatment may not heal, either just after the procedure or years later. As described above, this infection can be taken care of by antibiotics, or if necessary, retreatment of the root canal or an apicoectomy.

 

When an apicoectomy is performed, the area of recurrent infection is surgically cleaned out by making a small opening through the gums and using a surgical microscope. Then, a filling is placed into the tip of the roots associated with this infection.

 

When healing occurs, the bone fills in  where is was previously infected.

This page is presented with the permission of Dr. Louis H. Berman Thank You Very Much!!

201 West Street

Annapolis, Maryland 21401

canals@erols.com

(410) 268-4770