Endodontics is a specialty of Dentistry that deals with diseases of the dental pulp and its supporting structures. Endodontic Treatment is an effective way to preserve tooth function, especially compared to the cost of tooth loss and replacement.

Endodontists are Dentists with specialist training in this field and are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose. Although General Dentists can perform Endodontic treatment, patients are often referred to an Endodontist when the case is complicated or more difficult than usual. Anna Bates has been working as a specialist Endodontist in practice since 1997 and also taught endodontics in Guy's Dental School in London.

Root Canal Treatment Process Explained Step By Step

In order to understand what Endodontic Treatment or Root Canal Treatment is, it helps to know something about the anatomy of a tooth.

Teeth have several layers.

  • The outside layer of the tooth is composed of a hard layer called Enamel.
  • The Dentine layer which is protected by the Enamel layer has at its centre a soft tissue known as the Pulp.
  • The Pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding Dentine and Enamel during tooth development. The Pulp receives its nourishment supply from vessels which enter the end of the root.

Although the Pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

Endodontic Treatment or Root Canal Treatment is necessary when the Pulp becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities (caries), repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth.

If Pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess. The inflamed or infected pulp can be removed, carefully cleaned and shaped and then sealed. Often treatment is performed in a single appointment, normally ranging from 60 - 120 minutes (depending on the number of canals). Once treatment is completed, you will be returned to your regular dentist for a permanent restoration. The restoration of the tooth is an important part of treatment because it seals the cleaned and filled canals from the oral environment, protects the tooth and restores it to function.

In addition to conventional endodontic treatment your dentist may have referred you for Endodontic Retreatment, Endodontic Surgery, Cracked Tooth or Traumatic Injury:

What is Endodontic Retreatment?

Teeth that have had endodontic (root canal) treatment can last as long as natural teeth, however, in some cases the treatment can fail or symptoms can persist. This may happen shortly after the treatment has been completed or even years following the treatment. In these cases it may be possible to carry out the treatment again, a procedure called endodontic retreatment. Endodontic treatment can fail for a number of reasons: It was not possible to treat narrow or curved canals well enough or the canals were not fully cleaned during the initial procedure. The tooth may have additional complicated anatomy that was not found on the initial treatment. The final restoration was not placed quickly enough or the final restoration leaked due to a poor fit, fracture or recurrent decay around it.

Retreatment is usually more complicated than initial root canal treatment as the tooth is normally fully restored with a permanent restoration. This can range from a simple restoration to a full coverage restoration such as a crown or as part of a bridge. In addition to this a post may have been placed inside the root prior to a final restoration being placed. This creates difficulty as access to the root canals is more difficult. Additionally the canals will have been filled with root filling material and hence this has to be removed before they can be instrumented and cleaned again. All of these obstructions make the process more complicated.

All dentists can carry out endodontic treatment but many prefer not to carry out retreatment procedures as this can be more challenging and may require additional equipment that may not be readily available. Your dentist may opt to refer you to another practitioner who either has greater experience and training in the procedure or to a dedicated specialist endodontist for the procedure. A specialist endodontist is a practitioner who is registered and approved by the General Dental Council to carry out all forms of endodontic treatment. The endodontist will have more additional dental equipment that may facilitate the procedure. The endodontist will discuss with you the treatment options for your tooth. The endodontic procedure will be explained to you as well as the costs for the treatment.

If you decide on retreatment the endodontist will gain access to the root canals of the tooth to remove the root filling and clean the canals again prior to refilling the canals. In many cases the restoration on the tooth will have to be removed, including complex restorations such as crowns and posts to allow the procedure to be carried out. Retreated teeth can function for many years if the reasons for the initial failure can be overcome. Advances in technology have allowed retreatment to be carried out on complicate problems but like most medical and dental procedures difficulties can prevent some teeth from responding to the treatment. The endodontist can advise on the likely success of the procedure and difficulties prior to the procedure.

The cost of the retreatment is usually dependant on how complex the procedure might be but would normally cost more than the original root canal treatment. Usually the alternatives would be removal of the tooth or endodontic surgery. Removal of the tooth would then leave a space that may or may not be acceptable functionally or aesthetically and perhaps would require a prosthetic replacement tooth in the form of a denture, bridge or implant.

Endodontic surgery involves lifting the gum (or gingival tissue) after a small incision to allow access to the root tip that is the cause of the persistent problem. This root tip can then be treated and sealed. Endodontic surgery would allow the existing restoration to be retained, however retreating the canals is usually the first and best option. Your endodontist can advise on the particular options for your problem.

Traumatic injury from split tooth:

split tooth split tooth
fixed split tooth

To fully restored function