About Your Treatment

Endodontic Treatment for Patients in Etobicoke & Toronto

For almost 40 years, dentists in Etobicoke, Toronto and throughout Ontario have referred their patients to Endodontic Specialty Group for professional endodontic solutions. Our practice combines decades of training and education to deliver patient-focused endodontic therapy using state-of-the-art technologies. With our endodontic specialists, root canals are nothing to fear. We have clinics in Etobicoke and Toronto for your complete convenience.

When you and your dentist decide that canal therapy is right for you, be it initial treatment, retreatment or periapical surgery, Endodontic Specialty Group will provide complete service from beginning to end. Endodontists are dentists who limit their practices to root canal treatment and related procedures involving the tooth pulp, the soft inner tissue of the tooth. They are experienced in treating complicated cases, previous treatments, surgical procedures, and specialize in diagnosing and relieving oral pain and treating traumatic injuries to the teeth.

Understanding Root Canal Therapy

Endodontic treatment is most commonly referred to as root canal therapy. It is a preventative technique that enables dentists to save and subsequently restore teeth that might otherwise have to be removed. It is performed when the pulp of the tooth has been damaged, usually by decay or physical trauma. Treatment consists of removing the pulp and cleaning, sterilizing, filling and sealing the root canals. The tooth remains functional, nourished by adjacent tissues of the gums and jaw.

At Endodontic Specialty Group, no tooth will be treated unless our team feels there is an excellent chance for success. While there is no absolute certainty about healing anywhere in the body, studies indicate that treatment is successful in 80 to 90% of cases. It is possible that your chances of success may fall below this expectancy or that your tooth may not be amenable to surgical root canal therapy at all. You will be advised of this at the time of your consultation and informed of your treatment alternatives. It is our policy that no treatment will be rendered until our patients are completely comfortable with all aspects of their care.

Why Do I Need Root Canal Therapy?

To answer this, it’s important to understand the make-up of a tooth. A tooth consists of a crown and one or more roots. The roots help anchor the tooth in the jawbone. The bulk of the tooth consists of dentin. Inside the dentin is a space called the pulp chamber. This chamber houses the pulp, which consists of blood vessels and nerves. This soft tissue extends throughout the root system in canals from an opening at the tip. If the pulp becomes injured or diseased, it may become infected. The germs causing the infection may spread throughout the entire pulp and eventually reach the jawbone, causing an abscess. If this happens, it is necessary to remove the pulp and to clean, sterilize and seal the root canal system of the tooth.

Other reasons for root canals include:

Deep decay reaching close to the pulp space
Failure of previous endodontic procedure
A need to institute drainage which cannot be achieved without removing the tooth
Repeated dental procedures on the tooth resulting in post procedural discomfort
Faulty crowns
Crack or chip in the tooth resulting in inflammation of the pulp
To reduce pain and swelling by disinfecting the root canal system

How Does the Pulp Become Infected?

There are several ways pulp can become infected. Possible ways include:

Bacteria from a deep cavity may infect the pulp
Nerves and blood vessels may be damaged by a sudden blow to your tooth
A fractured or broken tooth can expose the pulp to harmful bacteria in your mouth
Severe periodontal (gum) disease may affect the pulp, requiring endodontic as well as periodontal therapy.

Important Facts about Endodontics

Endodontic Specialty Group wants to make you aware of several important aspects of endodontic therapy.

Root canal therapy is about 95% successful. Your endodondist will discuss with you factors that could lower your individual success rate.
Your teeth may normally be sensitive following appointments and even remain tender for a time after treatment is completed. If sensitivity persists and does not seem to be getting better even several weeks after treatment has been completed, please call our office.
Fractures are one of the main reasons why root canals fail. Fractures are hard to detect. They can occur as a result of traumatic injury, biting on hard objects, habitual clenching or grinding or even just through normal wear and tear.
Since endodontically treated teeth may be more broken down and brittle than other teeth, the dentist will probably recommend a crown to prevent future damage. This is especially important with molar and bicuspid teeth.
Teeth treated with root canal therapy can still decay but since the nerve is gone, there will be no pain. As with other teeth, proper oral hygiene is important.
With some teeth, conventional root canal therapy alone may not be sufficient. For example, if the canals are severely bent or calcified, if there is a substantial or long-standing infection in the bone around the roots or if the canals are obstructed for any reason, the infection may not resolve and the tooth may remain sensitive. A surgical procedure may be necessary to resolve the problem.
The alternative to endodontic treatment is tooth extraction.

What Does Endodontic Treatment Involve?

Endodontic treatment in most cases can be performed in a single visit. However, some cases require more than one visit.. A small opening is made through the crown into the pulp chamber. In your front teeth, the opening will be on the tongue side of the tooth; in your back teeth, it will be on the chewing surface.

After the opening has been made, the inside of the tooth is carefully cleaned of all infected material. Next, the root canal system is medicated and the opening in the crown is temporarily sealed.

When the endodontist is satisfied that the root is free from infection, he will fill and seal the root canals and pulp chamber with a material which will prevent bacteria from re-entering the tooth. The next stage involves the restoration of the tooth structure by your dentist. This can be achieved in a variety of ways. The choice as to the most appropriate method will be added when you return to your dentist after the endodontic treatment has been completed.

Surgical Treatment

It is possible that a non-surgical root canal treatment might not be enough to save the tooth and a surgical treatment may be needed. The procedure involves making an incision in the gum tissue around your tooth. This tissue is then carefully lifted away so the bone overlying the area can be examined. The soft tissue infection is cleaned from inside of the bone and the end of the root is prepared to receive a root-end filling in order to arrest the infection. There are a number of filling materials that can be used. Please discuss your choice of filling material with us. Please note that silver amalgam is no longer used for this procedure.

The surgical procedure involves the use of microsurgical techniques. The area is examined under high-powered magnification for structural defects and fractures in the tooth and/or the root.

If the infection is severe, then it is often necessary to place a bone graft in the area to optimize the healing potential. If this applies to your specific care, you will be informed about this. Once the procedure has been completed, the gum tissue will be repositioned and stitches will be used to hold it in place.

The procedure is performed after the area is well anaesthetized with local antiseptic. In some instances, sedation is also recommended. If you would like to have sedation for your surgical procedure, please advise us so we can discuss your options in depth.

Schedule your surgery so that you do not have to resume any activity for the remainder of the day of the procedure. Depending on your individual situation, you should be able to resume normal activity the next day. Remember that you have stitches in your mouth. If they are not the dissolving type, these will be removed at your next appointment.

Some reasons for surgical treatment include:

A need to institute drainage which cannot be otherwise achieved through the tooth
An inability to seal the root end by non-surgical methods due to calcifications, obstructions, resorption or previous treatments
Persistent post endodontic infection that does not respond to non-surgical modalities
Failure of previous endodontic procedure

How Successful Is Endodontic Treatment?

Research shows that about 95% of cases are successful. In certain situations, root canal therapy is not feasible and the tooth may have to be removed. If this happens, a replacement tooth (either a bridge or an implant), should be put in its place. Your endodontist will discuss your specific chances of success with you personally.
Does Endodontic Treatment Hurt?

Endodontic treatment usually does not hurt. Local anesthetic solutions are used to eliminate any discomfort associated with the endodontic procedure. Occasionally, teeth will react to the treatment or an infection will take hold again, resulting in discomfort. Both cases can be taken under control quickly.
Can a Pulp Be Diseased if It Doesn’t Hurt?

Yes, pain and disease do not always go hand-in-hand. Deterioration of the pulp can be so gradual that it may be nearly painless. An x-ray examination of the teeth will often show evidence of disease before you experience any pain. Radiographs are an important part of periodontic dental check-ups.
Will My Tooth Discolour?

It may become less translucent and, therefore, appear to darken. If this happens, the tooth can be bleached to its original color. Bleaching is a relatively simple process which is done from the inside of the tooth. If the tooth darkens again, your dentist may put a crown on it to restore its original appearance.
What Are the Symptoms of a Diseased Pulp?

Often, a diseased pulp is painful. Your tooth may become very sensitive to hot or cold foods and beverages. It is also possible that the tooth may be uncomfortable during chewing, or in extreme cases, highly sensitive to touch.
How Long Will Endodontic Treatment Take?

This will depend on a number of factors, such as the degree of difficulty and the tooth’s accessibility. The treatment generally takes from one to four appointments.
Who Performs Endodontic Retreatments?

Endodontists are dentists with at least two additional years of advanced specialty education in diagnosis and root canal treatment. Because they limit their practice to endodontics, they treat these types of problems every day. Endodontists are experts in performing non-surgical and surgical retreatment. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals or unusual anatomy. Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging, to perform these special services.
How Much Will the Procedure Cost?

The cost varies depending on how complicated the procedure will be. The procedure will probably be more complex than your first root canal treatment because your restoration and filling material may need to be removed to accomplish the new procedure. In addition, your endodontist may need to spend extra time searching for unusual canal anatomy. Therefore, you can generally expect retreatment to cost more than the initial endodontic treatment. While dental insurance may cover part or all the cost for retreatment, some policies limit coverage to a single procedure on a tooth in a given period of time. Check with your employer or insurance company prior to retreatment to be sure of your coverage.
Is Retreatment the Best Choice for Me?

Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime. Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with retreatment. As with any dentist or medical procedure, there are no guarantees. Your endodontist will discuss your options and the chances of success before beginning retreatment.
What Are the Alternatives to Retreatment?

If non-surgical retreatment is not an option, then endodontic surgery should be considered. This surgery involves making an incision to allow access to the tip of the root. Endodontic surgery may also 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 a bridge, removable partial denture or implant to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive 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 tooth replacements are, nothing is as good as your natural tooth. You’ve already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.
Why Do I Need Another Endodontic Procedure?

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 in the first procedure The placement of the crown or restoration was delayed following the endodontic treatment The restoration did not prevent salivary contamination to the inside of the tooth In other cases, a new problem can jeopardize a tooth that was successfully treated. For example: New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth A loose, cracked or broken crown or filling can expose the tooth to a new infection A tooth sustains a fracture
What Happens During Retreatment

First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials (including the crown, post and core material) must be disassembled and removed to permit access to the root canals. After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment. After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the tip of the root to be sealed. After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to full function.