American Association of Endodontists Link:
Diplomate, American Board of Endodontics

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Root Canal Treatment:

Root Canal Treatment Video: American Association of Endodontists

Has your dentist or endodontist told you that you need root canal treatment? If so, you're not alone. Millions of teeth are treated and saved each year with root canal, or endodontic treatment. Root canal treatment is a common dental procedure performed by dental specialists known as endodontists. Endodontists have advanced training in root canal treatment, specialized instruments, and state-of-the-art imaging technology to provide the patient with the highest level of dental care. Learn how root canal treatment can relieve your tooth pain and save your smile.

To understand a root canal procedure, it helps to know about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and cells that help the root of your tooth to grow during development. A fully developed tooth is able to survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.

  Tooth anatomy

 Root canal infection due to decay

Root canal (endodontic) therapy treats the inside of the tooth and is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, faulty crowns, or a crack in the tooth structure. Trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess. 

Symptoms of the infection can be identified as visible injury or swelling from the tooth, sensitivity to temperature or pain in the tooth and gums. If any of these symptoms are experienced, the Endodontist will  likely recommend root canal treatment to eliminate the diseased pulp. The injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy involves local anesthesia and may be completed in one or more visits, depending on the treatment required. Success for this type of treatment occurs in about 90% of cases
. If the tooth is not amenable to Endodontic Treatment or the chance of success is unfavorable, the patient will be informed at the time of consultation or when a complication becomes evident during or after treatment.

 Root canal cleaned

Root canal treatment completed

Final core build-up and crown

If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth.

Prior to crown fabrication: Post and Core placement

For more detailed information concerning root canal treatment visit the American Association of Endodontists website page:

Root Canal Retreatment

Endodontic Retreatment Video: American Association of Endodontists

       With proper care, teeth that have had root canal treatment can last a lifetime. But sometimes, a tooth that has been treated with root canal doesn't heal properly and can become painful or diseased years after treatment. If your tooth failed to heal or develops new problems, you have a second chance. An additional procedure called root canal retreatment can promote healing and save your tooth. If you have pain or discomfort in a previously treated tooth, talk to an endodontist about retreatment.

       As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

  • Narrow or curved canals were not treated during the initial procedure. 
  • Complicated canal anatomy went undetected during the initial treatment.
  • The crown or other restoration was not placed within the appropriate amount of time following the root canal procedure.
  • The restoration did not prevent salivary contamination to the inside of the tooth.

 Untreated canal

          New problems can also affect a tooth that was successfully root canal treated. Two common problems are: (1) new decay that exposes the underlying root canal filling material. This will result in bacterial contamination and infection. (2) A cracked filling or crown that exposes the tooth to bacteria.

New decay present

     When Endodontic Retreatment has been selected as a solution to the problem, the Endodontist will reopen the tooth to access the root canal filling material. The Endodontist will then clean the root canals and carefully examine the inside of the problematic tooth. When the canals are cleaned the Endodontist will then fill and seal the canals. This procedure is usually performed over two visits, with the placement of medicine in the root canals for 7-14 days to achieve complete cleaning of the canals. Following the root canal treatment, a temporary filling is placed in the tooth and the patient will return to the general dentist for a new crown or restoration to restore the tooth to full functionality.

      Root canals cleaned


Completed retreatment: new root canal filling

Completed bone healing with a new crown

What are the alternatives to retreatment?

For some patients considering retreatment, endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be sealed. Endodontic surgery may be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.

The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.

No matter how effective modern tooth replacements are - and they can be very effective - nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for many years to come.


      For more detailed information concerning root canal retreatment, please visit the American Association of Endodontists website page:

Cracked Teeth:

Cracked Teeth Video: American Association of Endodontists

How do I know if my tooth is cracked?

    Cracked teeth display many types of symptoms. These symptoms may include pain when chewing, temperature sensitivity, and even discomfort to release of biting pressure. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.

    Chewing can cause movement of the cracked pieces of the tooth, and the pulp within the tooth becomes irritated.  When biting pressure is released, this may cause the crack to close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and the tooth will consistently hurt, even while not chewing. It is a good possibility that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.  Below are some examples of Cracked Teeth.

1. Cracked Tooth:

     A cracked tooth means a crack extends from the chewing surface of your tooth vertically toward the root. The tooth is not yet separated into pieces, though the crack may gradually spread. Early diagnosis is important in order to save the tooth. If the crack has extended into the pulp, the tooth can be treated with a
root canal procedure.

     However, if the crack extends below the gum line, it is no longer treatable, and the tooth cannot be saved and will need to be
extracted. That’s why early treatment is so important. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.

     Cracked teeth

2. Split tooth:

     A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In some cases,
endodontic treatment may be performed to save a portion of the tooth.

  Split tooth

3. Vertical Root Fracture:

     Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However,
endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.

 Vertical root fracture


After treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your endodontist about your particular diagnosis and treatment recommendations.

What can I do to prevent my teeth from cracking?

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

  • Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.
  • Don't clench or grind your teeth.
  • If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.
  • Wear a mouthguard or protective mask when playing contact sports.

Endodontic Surgery (Apicoectomy):



Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and your
endodontist will recommend surgery. Endodontic surgery can be used to locate small fractures or hidden canals that weren't detected on x-rays or during previous treatment. Surgery may also be needed to remove calcium deposits in root canals, or to treat damaged root surfaces or the surrounding bone of the tooth. To learn more about endodontic surgery, talk to your endodontist.

     There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which is occasionally needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure. In this microsurgical procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed to seal the end of the root canal and few stitches or sutures are placed to help the tissue heal. Over a period of months, the bone heals around the end of the root. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day. Postsurgical discomfort is generally mild

 Removing infected tissue

A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly.

 Root-end filling placed

Over a period of months, the bone heals around the end of the root.

 Healed bone

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