ROOT CANAL TREATMENT
PICTURE OF TOOTH: CROWN AND ROOTS
This drawing shows the complexities of a root canal system in a molar tooth. The objective of root canal treatment is to remove all the pulp (nerve, blood vessels, & other tissues) from within the root canals. Following removal of the pulp, a root canal filling is placed. The material most commonly used to fill canals is called gutta percha. In the cases below, the gutta percha appears white on radiographs (x-rays).
Incisor teeth usually have one root and one canal per root. However, there are some incisor teeth which have two or more canals. Bicuspid teeth may have one, two, three canals or more. Two canals are most common in these teeth. Molars usually have three or four canals. However, they can have anywhere from one canal (uncommon) to six canals.
Incisor teeth usually have one root and one canal per root. However, there are some incisor teeth which have two or more canals. Bicuspid teeth may have one, two, three canals or more. Two canals are most common in these teeth. Molars usually have three or four canals. However, they can have anywhere from one canal (uncommon) to six canals.
ROOT CANAL RETREATMENT
Although endodontic treatment has a high success rate (90%), there are occasions in which the treatment outcome is less than ideal. This occurs when bacteria or bacterial byproducts from within the root canal system leak out into the bone. Endodontic retreatment often resolves the infective process. See the x-rays below.
#1 - Before Retreatment #3 - After Retreatment
Dark area (Lesion) is due to abscess Dark area no longer present due to healing
Retreatment Required - DENS INVAGINATUS or DENS EN DENTE
This term is reserved for teeth which are formed with an invaginated part of the clinical crown of the tooth which is enamel lined. This leads to food entrapment which in combination with bacteria from the saliva, allows for decalcification of the enamel in the defect. Ultimately the pulp (nerve) of the tooth becomes exposed. This results in pulpal degradation which usually leads to symptoms. Often times this anomaly is referred to as a "tooth within a tooth".
This anomalous tooth formation is commonly found in Asian people, North American Natives, and Eskimos.
In the radiograph adjacent, the irregular white line extending the length of the tooth is the root filling material placed within a part of the root canal system. The blackish area around the root end is the image seen on radiographs when bone loss has occurred. This is due to the fact that the root canal system was not debrided completely. Retreatment of this tooth is appropriate and the infection can be eliminated.
BEFORE RETREATMENT Radiograph (x-ray)
This anomalous tooth formation is commonly found in Asian people, North American Natives, and Eskimos.
In the radiograph adjacent, the irregular white line extending the length of the tooth is the root filling material placed within a part of the root canal system. The blackish area around the root end is the image seen on radiographs when bone loss has occurred. This is due to the fact that the root canal system was not debrided completely. Retreatment of this tooth is appropriate and the infection can be eliminated.
BEFORE RETREATMENT Radiograph (x-ray)
Healing following retreatment of the tooth in the photo above.
Following endodontic retreatment of the case above, the bone healed. Note that this tooth had more than one root canal as seen by the white lines (gutta percha filling) within the root. The bone around the root is no longer dark in appearance. This radiographic image reveals new bone has regrown around the root. The x-ray above was taken prior to endodontic retreatment being performed. This x-ray was taken one year following completion of treatment to confirm that healing of the bone has occurred.
AFTER RETREATMENT Radiograph (x-ray)
AFTER RETREATMENT Radiograph (x-ray)
FRACTURED or CRACKED TEETH.
Some teeth are sensitive to cold, heat and sweets as well as biting pressures. The cause of these reactions could be related to cracked cusps of teeth, or an incomplete fracture of a tooth, or a vertical fracture of the tooth root(s) which were intact teeth. Endodontic treatment is necessary to alleviate discomfort is some instances whereas, in other cases, endodontic treatment is contraindicated.
CUSPAL FRACTURE
This tooth has 4 cusps. One is fractured or cracked. This allows for leakage and stimulation of the nerve fibers of the pulp of the tooth. Removal and replacement of the cusp can eliminate patient discomfort.
This tooth has 4 cusps. One is fractured or cracked. This allows for leakage and stimulation of the nerve fibers of the pulp of the tooth. Removal and replacement of the cusp can eliminate patient discomfort.
CRACKED TOOTH
A vertical crack or fracture of the tooth can result in discomfort which is usually more uncomfortable than that experienced with a cracked cusp. This is related to continual irritation of the nerve within the root canal spaces. Endodontic treatment can alleviate discomfort. However, the tooth is a weaker structure and depending upon the restoration which is placed, the chewing forces of the individual, and the gingival attachment apparatus, the tooth may not be retained for more than a few years.
A vertical crack or fracture of the tooth can result in discomfort which is usually more uncomfortable than that experienced with a cracked cusp. This is related to continual irritation of the nerve within the root canal spaces. Endodontic treatment can alleviate discomfort. However, the tooth is a weaker structure and depending upon the restoration which is placed, the chewing forces of the individual, and the gingival attachment apparatus, the tooth may not be retained for more than a few years.
VERTICAL ROOT FRACTURE or SPLIT TOOTH
Some teeth suffer vertical root fractures. These teeth have a poor prognosis and usually cannot be retained. Endodontic treatment for these teeth is contraindicated.
Some teeth suffer vertical root fractures. These teeth have a poor prognosis and usually cannot be retained. Endodontic treatment for these teeth is contraindicated.
