Our Treatments | Lake Michigan Endo

Endodontic Diagnosis and Treatment

What is Endodontic Treatment?

Endodontic treatment, commonly known as a root canal, is a dental procedure designed to save a tooth that has become infected or inflamed. It focuses on the dental pulp, the soft tissue inside the tooth that contains nerves, blood vessels, and connective tissue. Here's a breakdown:

What is Endodontic Treatment?

Essentially, endodontic treatment involves removing the infected or inflamed pulp, cleaning and shaping the inside of the root canals, and then filling and sealing the space. This process prevents further infection and allows the tooth to remain functional.

Factors Leading to the Need for Endodontic Treatment:

Several factors can lead to damage or infection of the dental pulp, necessitating endodontic treatment:

Deep Tooth Decay:
- When decay progresses deep into the tooth, it can reach the pulp, allowing bacteria to invade and cause infection.
Cracked or Fractured Teeth:
- Trauma or injury to a tooth can cause cracks or fractures, creating pathways for bacteria to enter the pulp.
Repeated Dental Procedures:
- Multiple dental procedures on a tooth, such as fillings or crowns, can sometimes irritate the pulp and lead to inflammation or infection.
Trauma to the Tooth:
- A blow to the tooth, even without visible cracks, can damage the pulp and disrupt its blood supply, leading to pulp death.
Leaky Fillings:
- If a filling becomes leaky, bacteria can enter the tooth and infect the pulp.

In summary, endodontic treatment aims to preserve a natural tooth that would otherwise require extraction. By addressing the infection or inflammation within the pulp, this procedure allows patients to maintain their oral health and function.

The Root Canal Procedure: A Step-by-Step Guide

We understand that the thought of a root canal can be daunting. However, modern endodontic techniques have made the procedure virtually painless. Here's what you can expect:

Anesthesia: Local anesthesia is administered to numb the affected tooth and surrounding area.
Rubber Dam: A thin flexible sheet of latex or non-latex material is used to isolate the affected tooth to prevent contamination during the procedure.
Access Opening: A small opening is created in the crown of the tooth to access the pulp chamber.
Pulp Removal: The infected or damaged pulp is carefully removed from the pulp chamber and root canals.
Cleaning and Shaping: The root canals are cleaned, shaped, and disinfected using specialized instruments and solutions.
Filling and Sealing: The cleaned root canals are filled with a biocompatible material, typically gutta-percha, and sealed to prevent future infection.
Restoration: A temporary or permanent restoration, such as a crown, is placed to protect the tooth and restore its function.

Steps of a Root Canal

Endodontic Retreatment: Giving Your Tooth a Second Chance

Endodontic retreatment becomes necessary when a previously treated root canal fails to heal properly or develops new problems. Here are the primary reasons:

Missed Canals:
- Complex root canal anatomy can sometimes lead to missed canals during the initial treatment.
- These untreated canals can harbor bacteria, leading to persistent infection.
Inadequate Cleaning or Shaping:
- Insufficient removal of infected tissue or debris during the initial procedure can contribute to treatment failure.
- This can be due to complex anatomy, calcified canals, or limitations of the initial technique.
Inadequate Obturation (Filling):
- If the root canal filling material doesn't completely seal the canal system, bacteria can re-enter and cause infection.
- Voids or gaps in the filling can provide pathways for bacterial contamination.
New Decay or Fracture:
- New decay can develop, allowing bacteria to penetrate the previously treated tooth.
- A fracture in the tooth can also create a pathway for bacteria to enter the root canal.
Delayed Crown Placement:
- If a crown is not placed in a timely manner after a root canal, the tooth can become susceptible to fracture or leakage.
Complex or Changed Anatomy:
- Over time, changes to the teeth can occur. Calcifications, or other changes can occur that were not present during the initial procedure.
Periapical Lesion Persistence or Development:
- Sometimes the periapical lesion, which is an area of infection at the tip of the root, can persist after the initial treatment or develop later.

Steps Involved in Endodontic Retreatment

Access Preparation:
- Dr. Dzingle will access the interior of the tooth by removing the existing crown (if present) and filling material.
Removal of Existing Filling Material:
- The existing gutta-percha and sealer are carefully removed from the root canals using specialized instruments and techniques, often including ultrasonic instruments.
Canal Cleaning and Shaping:
- The root canals are thoroughly cleaned and reshaped to remove any remaining bacteria, debris, or infected tissue.
- This step may involve the use of rotary instruments and copious irrigation.
Identification and Treatment of Missed Canals:
- The dentist or endodontist will carefully examine the root canal system to identify and treat any missed canals.
Placement of Medication:
- In some cases, an antimicrobial medication may be placed inside the root canals to eliminate any remaining bacteria.
Obturation (Filling):
- Once the canals are thoroughly cleaned and disinfected, they are filled with gutta-percha and sealer to create a tight seal, preventing bacterial re-entry.
Final Restoration:
- A final restoration, such as a crown, is placed to protect the treated tooth and restore its function.
- Post placement may be necessary prior to crown placement.
Follow-up:
- Follow up appointments are very important to ensure proper healing.

Endodontic Retreatment

Endodontic Microsurgery: Precision and Expertise

An Apicoectomy is a surgical endodontic procedure performed when a root canal treatment has failed or is not feasible, and a persistent infection remains at the apex (tip) of the tooth root. Here's a breakdown of the reasons and steps involved:

Reasons for an Apicoectomy:

Persistent Periapical Infection:
- When a root canal treatment fails to eliminate an infection at the root tip, an apicoectomy is needed to remove the infected tissue and seal the root end.
Complex Root Anatomy:
- Sometimes, complex or inaccessible root canal anatomy, such as blocked canals or curved roots, prevents complete cleaning and sealing during a standard root canal.
Fractured Root Tip:
- A fractured root tip can harbor bacteria and prevent proper healing, requiring surgical removal.
Calcium Deposits or Canal Obstructions:
- Calcium deposits or other obstructions can block access to the root tip during a root canal, necessitating an apicoectomy.
Failed Previous Root Canal:
- If a previous root canal has failed, and a retreatment is not possible, or also fails, an apicoectomy is the next step.
Perforation repair:
- Sometimes during a root canal procedure, a perforation of the root occurs, and an apicoectomy can be used to seal that perforation.

Steps Involved in an Apicoectomy

Local Anesthesia:
- The area around the affected tooth is numbed with local anesthesia to ensure patient comfort during the procedure.
Gum Tissue Flap:
- A small incision is made in the gum tissue to expose the underlying bone and root tip.
Bone Removal:
- A small amount of bone is removed to access the infected area and the root apex.
Root Tip Resection:
- The infected root tip is removed, and the remaining root surface is smoothed.
Retrograde Filling:
- A small filling is placed at the cut end of the root to seal the canal and prevent further infection. This is called a retrograde filling.
Cleaning and Inspection:
- The area is cleaned, and inspected, to ensure all infected tissue is removed.
Gum Tissue Closure:
- The gum tissue flap is repositioned and sutured back into place.
Post-Operative Care:
- Patients are given post-operative instructions, including pain management, oral hygiene, and follow-up appointments.

Post-Operative Care:

Patients may experience some swelling and discomfort after the procedure, which can be managed with pain medication.
Cold compresses can help reduce swelling.
Patients should avoid strenuous activity for a few days.
Proper oral hygiene is essential for healing.
Follow-up appointments are necessary to monitor healing and ensure the success of the procedure.

Endodontic Microsurgery

Diagnosing a Cracked Tooth

A cracked tooth can present with a variety of symptoms, and its diagnosis and treatment depend on the severity and location of the crack. Here's a breakdown:

Symptoms of a Cracked Tooth:

Sharp Pain When Chewing: This is often the most common symptom, especially when releasing biting pressure.
Intermittent Pain: The pain may come and go, making it difficult to pinpoint the exact tooth.
Sensitivity to Temperature: Increased sensitivity to hot or cold foods and drinks.
Discomfort or Pain When Releasing Bite Pressure: As mentioned before, pain when releasing bite pressure can be very telling.
Gum Inflammation: The gum tissue around the cracked tooth may become inflamed or tender.
Difficulty Locating the Pain: Sometimes, the pain can be vague and hard to locate, especially in the early stages.

Diagnosis of a Cracked Tooth:

Visual Examination: The dentist will carefully examine the tooth for visible cracks, often using magnification and bright light.
Bite Test: A common diagnostic tool involves having the patient bite down on a cotton roll or a specialized instrument. Pain when biting or releasing pressure can indicate a crack.
Probing: The dentist may use a dental explorer to gently probe the tooth surface, checking for any irregularities or cracks.
Transillumination: Shining a bright light through the tooth can sometimes reveal cracks that are otherwise difficult to see.
Radiographs (X-rays): While X-rays may not always show cracks, they can help identify other problems, such as periapical lesions or bone loss, that may be associated with a cracked tooth.
Periodontal Examination: checking the gums and surrounding tissue for inflammation, or pocketing.

Treatment of a Cracked Tooth:

Bonding: If the crack is small and superficial, dental bonding may be used to repair the tooth.
Crown: A dental crown is often recommended for more extensive cracks, as it provides support and protection to the damaged tooth.
Root Canal Treatment: If the crack extends into the pulp, a root canal may be necessary to remove the infected tissue and prevent further complications.
Extraction: In severe cases where the crack extends below the gum line or the tooth is irreparably damaged, extraction may be the only option.
Splinting: If the cracked tooth has some mobility, splinting it to adjacent teeth can provide some support and stability.

Treatment of a Cracked Tooth