Our Treatment Services
Among our patients, usually, canal therapy is considered as the most complex and scary dental procedure. By summarizing the endodontic treatment procedure conducted in our clinic, we aim to resolve those unnecessary concerns and fear of our patients on canal therapy.
If we want to understand the mechanism of root canal therapy, first we should comprehend the basic tooth anatomy.
The visible part of the tooth is called as “crown” while the invisible portion within the mouth and bone are called as “root”. A tooth is composed of several layers. The outermost layer, above the most coronal line of gingiva, is named as “enamel”. Enamel is the hardest and most highly mineralized material in our body. Below the gingival line, a material called as “cement” covers the root surface. Beneath the enamel and cement layers, there lies the structure named as “dentin”. While dentin is almost as hard as bone, unlike enamel, houses nerve ends.
“Pulpa” is the name of the layer below dentin. It is composed of small and large blood vessels, connective tissue, nerve fibers, and various cells. Feeds the tooth during growth and development. In a tooth that ended its growth and development, the sole purpose of pulpa is to conduct pain and inform any damage or infection.
Sometimes, pulpa may show inflammation. In such cases, pulpa should be removed with root canal therapy. Root canal therapy is the only way to keep such a tooth in the mouth. A completely developed tooth can continue its functions without pulpa, as well.
How is Pulp Infected?
The most commonly encountered mechanism of pulpal infection is untreated caries. Every human has bacteria in one’s mouth and normally, those bacteria do not cause any harm. However, some produce acids by metabolizing carbohydrate containing foods and drinks. These acids, damage enamel and dentin. Caries formed through this mechanism, if left untreated, extend to the pulp (nerve tissue) and cause infection there by exposing it. Also, pulp can be infected as a result of a severe trauma to the tooth. Such a severe trauma may inhibit the blood flow transferred through jaw bone which leads to death of the pulp tissue. It is interesting that, a tooth fracture at enamel or dentin level might reduce the necessity of root canal therapy. Because it may absorb (compensative) traumatic effects by accelerating the blood flow towards broken tooth.
Another mechanism that pulp can get infected is presence of long-term periodontal disease around the tooth. Bacteria reach pulp via inflamed gingiva through the tiny secondary canals opening into the root surface, and cause an inflammation that we call “retrograde infection”.
*If the canal infecting the tooth is left untreated, in time, it may cause a painful abscess in the jaw bone around the tooth.
How can we understand an infected tooth?
Sensitivity against hot and cold food and drinks as well as pain on biting, should arise infection suspicion.
Also, serious discoloration of the tooth without any pain or swelling in the adjacent gums is signs of dental infection too.
In some instances, it may be clinically asymptomatic and the need for a root canal therapy can only be understood via dental and radiographic examinations.
What is the importance of antibiotic use in treatment of a dental infection?
The treatment of a tooth inflammation is either root canal therapy or extraction of that tooth. With the death of pulp, the entire structure of the tooth constitutes an ideal environment for the bacteria. In cases where required to, your doctor may prescribe antibiotics in order to boost immune system of the body and fight against infection.
*Normally, antibiotic use is not necessary in a canal therapy.
Do I feel pain during and after the root canal therapy?
Root canal therapy is a treatment method that requires some level of devotion both from the patient and the doctor. The duty of the doctor is to make his/her patient feel as comfortable as possible and prevent any pain. Therefore, in instances where the doctor deems necessary, anesthesia is applied preoperatively on the tooth and surrounding tissues. As a result of the established numbness, patient feels no pain and treatment is completed successfully.
Do each tooth has a different number of roots?
Anterior incisor and canine teeth generally have 1 root including 1 or 2 canals. Most of the lateral premolars have 2 roots and 2 or 1 canal. Usually the molar in the upper jaw have 3 roots and 3-4 canals, whereas molars of the lower jaw have 2 roots and 3-4 canals.
*All those numbers are generalizations. Sometimes, there might be additional roots or canals.
What are the stages of root canal therapy?
1-Local anesthesia: numbing the tooth and the surrounding tissues.
2-Cleaning the caries and opening the root canals.
3-Measurement of the canal length by radiography.
4-Removal and cleaning of the content (pulp tissue) of the root canals
5-Reshaping of the root canals with various instruments.
6-Disinfection of the root canals: purification from microorganisms
7-Filling of the root canals
*Filling the root canals is performed in order to close off the canal space that originally houses pulpa and thus build a barrier against microorganisms and tissue fluids. In that way, the dead tooth can continue to exist in the mouth successfully.
Do I feel pain after the canal therapy?
Following therapy, mild pain and sensitivity may be experienced in the tooth; however, this is only temporary. The best solution for this is not using the related tooth for a few days and uses an anti-inflammatory drug. The tenderness will resolve after short period of time.
How can I understand an unsuccessful root canal therapy?
Success rate of correctly performed therapies is 90-95%. Root canal therapy may be unsuccessful in cases where residual pulp tissue is left in the roots (might occur due to an untreated root canal), root canal is inadequately filled which renders the canal susceptible to microorganisms, tooth is damaged due to perforation during the procedure, or areas between the roots are broken. Following an unsuccessful canal therapy, usually spontaneous pain or swelling occurs.
What can be done in cases of unsuccessful root canal therapies?
Often, the problem is solved by the retreatment of the root canal and if present, resolution of the mistake. Previous canal filling is removed; canal is reshaped, cleaned, medicated, and filled. If that procedure does not help as well, a surgical method called as “root end resection” (apical resection) is applied. During this procedure, tooth root is reached and it is surgically cleaned along with the surrounding tissues and closed. In teeth with more than one root, infected root is removed. If surgery does not help, that tooth may be extracted.
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