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The Endodontic practice of Grassi & Grassi P.C. is an office of heartfelt gentleness and excellence. We pride ourselves on caring for our patients by putting patient care first in our goals. Your needs come first at Grassi & Grassi and here is a list of frequently asked questions and their answers.

WHAT IS ENDODONTIC (ROOT CANAL) TREATMENT?

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First, let us discuss the anatomy of a tooth. The soft tissue called the pulp is inside the tooth (see diagram) under the white enamel and a hard thick layer called the dentin. The pulp contains blood vessels and nerves, and creates the surrounding hard tissues of the tooth during development. It extends from the crown (chewing portion) of the tooth to the tip of the roots where it connects to the surrounding tissues. The pulp is very important during a tooth’s growth and development. Once a tooth is fully mature, it can survive without the pulp because it continues to be nourished by the surrounding periodontal membrane.

Root canal treatment is needed when the pulp (the soft tissue inside the tooth) becomes inflamed or infected as a result of injury, deep decay, repeated dental procedures on the tooth, or a cracked or chipped tooth.

• Most patients who have had a root canal performed by an endodontist describe the procedure as virtually painless.

• Eighty-five percent of patients who have had a root canal performed by an endodontist would return to an endodontist for future work.

• Between 1990 and 1999, the number of root canals performed in the United States increased by 13 percent to nearly 16 million.

• Root canals performed by endodontists are a better and common alternative to tooth extraction.

• When performing a root canal, an endodontist removes inflamed or infected pulp, carefully cleans and shapes the inside of the canal (a channel inside the root), and fills and seals the space.

• After performing the procedure, the endodontist returns the patient to a general dentist to have a crown placed or other restorative work performed.

• After restoration, the tooth continues to function like any other tooth.

Who performs endodontic treatment?

While all dentists receive training in endodontics, general dentists often refer patients to dentists with specialized endodontic training. Endodontics perform only endodontic procedures and are specialists in their field. They perform routine and complex treatment and are experienced at discovering the cause of oral or facial pain that has been difficult to diagnose.

When nonsurgical endodontic treatment cannot save the tooth, your Endodontist may recommend surgery.

• Persistent symptoms that do not indicate problems from x-rays. Your tooth may have a tiny fracture not detected in a non-surgical treatment. The Endodontist will perform surgery to find the problem and determine treatment.

• Occasionally, calcium deposits narrow a canal making it too small for cleaning and shaping instruments to reach all the way to the root. In cases of calcification, your Endodontist will perform a surgical procedure to clean, remove infection and seal that tooth.

• Although most root canals are the final treatment and last the rest of your life, occasionally a tooth may not heal as expected. Pain and disease may show up months, or even years, later. In this case, endodontic surgery may save the tooth.

• Damaged root surfaces and surrounding bone may also require surgery.

The most common Endodontic surgical procedure is called an apicoectomy, or ‘root-end resection’. This is performed when the inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.

In this procedure, the endodontist may place a small filling in to seal the end of the root canal, combined with a few stitches or sutures to help healing.

OTHER TYPES OF ENDODONTIC SURGERY

Some other surgeries include dividing a tooth in half, repairing an injured root, or removing roots. Discuss your surgery specifics with your endodontist.

Complex cases may require a procedure called ‘intentional replantation’. The requires the extraction of a tooth that is treated with an endodontic procedure while it is out of your mouth, after which it is replaced in its socket.

Local anesthetics are used to make the procedure comfortable. You may feel some discomfort or have slight swelling while your incision heals. This is normal. Your endodontist will recommend appropriate pain medication. This will be included in the post-operative instructions your endodontist gives you. If you experience pain that does not respond to medication, call your endodontist immediately.

Ask your endodontist before your appointment if travel arrangements will be required.

Most patients return to routine activities the next day. Discuss this with your endodontist.

Check with your employer or insurance company. Each company has different plans.

You may find that the only alternative to surgery is extraction. In the event this is necessary, the extracted tooth needs to be replaced with an implant, bridge, or removable partial denture. Endodontic surgery is usually the most cost-effective option for maintaining your oral health.

There are a number of reasons a tooth may not heal as expected after initial treatment. For example:

• Narrow or curved canals were not treated during the initial procedure.

• In the first procedure, complicated canal anatomy was undetected.

• Crown or other restoration was not placed soon enough.

• During restoration, saliva contaminated the inside of the tooth.

Additionally, new problems can jeopardize a tooth that was successfully treated. For example:

• New decay exposing the root canal filling material to bacteria will cause a new infection in the tooth.

• Any loose, cracked, or broken crown or filling may expose the tooth to a new infection.

The endodontist will meet with you to discuss treatment options. If you choose retreatment, the endodontist will reopen your tooth to access the root canal filling. Some cases may require taking apart the crown, post, and core material.

After removal of the canal filling, the canals will be cleaned and the endodontist will carefully examine the inside of your tooth for any additional canals or unusual anatomy that requires treatment.

Following cleaning, the canal (s), the endodontist will fill and seal the canal (s) and place a temporary filling in the tooth. Unusually narrow or blocked canals may require surgery involving an incision near the end of the root to allow the tip of the root to be sealed. Your endodontist will discuss this with you, if necessary.

After, it is necessary that you return to your personal dentist as soon as possible to have a new crown or other restoration restored in order to protect the tooth and restore it to have it regain full function.

We are proud to say that retreated teeth can function well for years---many do so for a lifetime. Our goal is to save your tooth.

New technology often allows us to change the way root canal treatment is performed. Grassi and Grassi, P.C. maintains a forward thinking outlook—we continually study and train to keep our skills current with each new development in root canal treatment.

As with any dental or medical procedure, there are no guarantees. But at Grassi and Grassi, P.C. we guarantee individual attention and consideration to make sure your treatment is as successful as possible.

Cost varies. Depending on the complications involved, and the specifics of your dental anatomy, the cost may be more than the initial endodontic treatment. Your dental insurance may cover a portion of this cost. Many policies limit coverage to a single procedure on a tooth in a given period of time. Check with your employer or insurance carrier to be sure of your individual coverage. For your benefit we always discuss this before treatment.

Endodontic surgery is also an option. Your endodontist will give you the best recommendation. Surgery can sometimes be advised in conjunction with retreatment, or as an alternative.

The only other option is losing the tooth through extraction. If this happens, the tooth must then be replaced with an implant, bridge, or removable partial denture. This is done to restore chewing function and to prevent shifting of adjacent teeth. These options require extensive surgery or dental procedures on adjacent healthy teeth, making them far more costly and time consuming than retreatment.

Your natural tooth is always better than a tooth replacement, no matter how effective the replacements can be. We want to save your tooth, when at all possible. Choosing retreatment could give you a healthy, functioning natural tooth for many years to come.