Root Canal Therapy.
No longer the daunting experience it once was.
An implant is a often the best way to replace a missing tooth. The process involves placing a titanium screw into the bone and then placing a fabricated tooth right on top of it. They look amazing and feel incredibly real. No one will ever know the difference.
Implants are significant because once you lose teeth, the bone in that region gradually reduces. 42% in the first year, actually. An implant is the only way you can preserve the bone in the region. The other obvious advantage is that you don't have to cut two perfectly good teeth, as you may do with a bridge. They can be flossed and cleaned like normal teeth, so are more hygienic and less prone to other complications.
The Process.
Treatment involves 3 stages.
Its all performed under Local Anaesthetic, so you won't feel a thing.
First visit: An opening is made in the top of the tooth, the pulp is removed and the 'pimple' is drained. An antibiotic paste mixed with a pain killer is then placed within the tooth and a temporary cap is placed on top.
This will provide pain relief.
2 weeks later....
Second Visit: The canals are all located and cleaned with metallic brushes. These shape the canals of the root so that that can accept a rubber filling.
3 days later....
Third Visit: The roots are filled using a rubber based material known as Gutta-percha. This seals off the roots for good, so that they stay free from infection.
All root canal treated teeth need a Crown.
This is because the tooth is significantly weakened and is VERY prone to fracture. Its not uncommon for root canal treated teeth to just crumble while eating even soft foods, like bread. Think of it like a dead tree. It looks fine on the outside, but do you know where the roots are? They're dead. It only takes a small storm to tip it over.
After the roots have been filled, the tooth can now be prepared for a crown. Treatment is not complete without a crown and chances of tooth loss are high.
Lets get detailed.
Teeth are not all one layer. They have 3 layers. A bit like an egg. Eggs have the shell, the white and the yolk. In teeth these are called the enamel, dentine and the pulp. Just as the yolk supplies all the nutrients to the egg, the PULP supplies the nutrients to the tooth. The pulp contains Blood vessels and a nerve supply. You can see in the photo (right) how this comes from the main branch, which runs deep within the jaw.
However, when the decay extends deep into layer 3 (the pulp/yolk) a small pimple like structure develops at the base of the tooth, within the jaw bone. This causes the tooth to become very painful, difficult to chew on and may even keep you up at night. These infections are known as periapical periodontitis. The pimple structure is called an apical granuloma.
Just as a pimple found on the face wants to be popped to alleviate pain. These pimples also need to be popped to alleviate pain and is the first part of root canal therapy.
Left untreated these can turn into a life threatening abscess; the condition known as Ludwig's angina.
When the decay is in layers 1 and 2 (as in left image), we place a filling.
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The Risks.
Root canals cary one of the highest success rates of any procedure in medicine and dentistry; as high as 96% in most cases.
However, as with all things, there are some risks.
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Upon treating the tooth, a canal may not be visible to the naked eye and can be missed in the treatment.
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A file may separate within the canals
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A communication between the inner and outer layers of the tooth may result, known as a perforation
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Despite all efforts, the root canal may be unsuccessful and need to be redone. In some cases the tooth may need to be removed.
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A specialist may often be involved to assist in managing these complications.