Dr Key DMD
Tooth Diagram


Non Surgical (Conventional)
Root Canal Therapy

What is root canal therapy?

With over 14 million procedures performed every year Root Canals are one of the most common and simple dental treatments available. It can save your natural teeth and prevent the need for dental implants or bridges.

A Simple Overview

Symptoms can be identified as visible swelling, sensitivity to temperature or pain in the tooth and gums. These are symptoms of the diseased pulp, which is the leading indicator which leads to Endodontic care. Your teeth have layers, which surround the pulp. The pulp is a collection of blood vessels that helps to build the surrounding tooth. Irreversible inflammation and infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures.

The only alternative to endodontic treatment when the tooth's pulp is damaged, is extraction of the tooth. To restore chewing function and to prevent adjacent teeth from shifting, the extracted tooth must be replaced with an implant or bridge. This requires surgery or dental procedures on adjacent healthy teeth and can be far more costly and time consuming than endodontic treatment and restoration of the natural tooth.

How is a root canal performed?

More often, if you experience symptoms associated with a degenerating, diseased, or infected pulp, your dentist will recommend non-surgical endodontic treatment. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or more visits depending on the treatment required. You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine that same day.

Root Canal Diagram

What happens after treatment?

When your root canal therapy has been completed, a record and radiograph of your treatment will be sent to your regular dentist. You should contact their office for a follow-up restoration within two weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, we are available at all times to respond. To prevent further decay, continue to practice good dental hygiene and keep scheduled appointments with your dentist.

Non-surgical re-treatments of endodontic therapy is most commonly completed when non-surgical root canal therapy is unsuccessful. Some of the more common reasons are:

Leakage. Leakage is typically due to decay or loss of the restoration on the part of the tooth above the level of bone. Leakage allows bacteria and irritants into the tooth, which can get to the end of the tooth in as little as 7 days even with the roots filled. Some older filling materials may corrode or not fill canals completely and need to be replaced by newer superior filling materials.

Incomplete Cleaning and Sealing. For root canal therapy usually to be successful, the canals must be thoroughly cleaned and sealed. Occasionally, the initial endodontic therapy was unable to remove enough irritants inside your tooth that it fails to heal or pain continues. More often, the canals are so narrow, hardened, or curved that the tiny instruments used to clean and shape them cannot completely pass through easily and requires specialized techniques. Other canals are so small they are extremely difficult to find and went undetected during the first procedure. A Surgical Operating Microscope can often help find these small canals.

If a temporary is placed after completion of treatment, it is imperative to return to your restorative dentist for treatment. Because a temporary filling is designed to last only a short time (about four weeks), failing to return to your dentist as directed to have the tooth sealed permanently with a crown can lead to the deterioration of the seal, resulting in decay, infection, gum disease and/or the premature loss of the tooth with additonal treatment required like another re-treatment or extraction. If your temporary comes out, it needs to be replaced right away. You've invested in maintaining the tooth, so return to your restorative dentist as soon as possible (within a month).

Apicoectomy (An overview of endodontic surgery)

Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to induce healing, and surgical therapy may be indicated. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on radiographs but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure; as well as removal of infected tissue and pathological lesions. The most common surgery used to save damaged teeth is an apicoectomy (a-pico-éct-omy) or root-end resection.

What is an apicoectomy?

Apicoectomy Diagram

The above diagrams illustrate this procedure. A cut or incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The root end filling material employed by Dr. Key has shown to be extremely biocompatible while providing a superior apical seal. The bone naturally heals around the root over a period of months restoring full function.

Traumatic Injuries

Dislodged teeth

Injuries to the mouth can cause teeth to be pushed back into their sockets. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth. Eventually, a permanent root canal filling will be replaced.

Sometimes a tooth may be pushed partially out of the socket. Again, your endodontist or general dentist may reposition and stabilize your tooth. If the pulp remains healthy, then often no other treatment is necessary. Yet, if the pulp becomes damaged or infected, root canal treatment will be required.

Dislodged Teeth

Avulsed teeth

If an injury causes a tooth to be completely knocked out of your mouth, it is important that you are treated immediately! If this happens to you, keep the tooth moist. If possible, put it back into the socket. A tooth can be saved if it remains moist. You can even put the tooth in milk. Your endodontist may start root canal treatment based upon the stage of root development. The length of time the tooth was out of your mouth and the way the tooth was stored, may influence the type of treatment you receive.

Avulsed Teeth

In Case you wanted to know about our Technology

What new technologies are being used?

Operating microscopes: Magnification and fiber optic illumination are helpful in aiding the doctor to see tiny details inside your tooth.

The advent of the microscope as part of the doctor's regimen has revolutionized the field of endodontics. Historically, many of the failures associated with root canal therapy had been the result of inadequate visualization by the practitioner. With the use of the microscope, extra canals are more readily located fractures and perforations identified, and canals more thoroughly cleaned. In short, the microscope has paved the way for more predictable and more successful endodontic results!

Digital Radiography: All radiographs in our office are taken with digital sensors. The acquired image is then sent to a computer and can be instantly viewed on monitors in each treatment room. These images require up to 90% less radiation than conventional low dose x-ray films. All images are stored in your "digital chart" for easy access and communication with your restorative dentist.

Apex Locators: We utilize advanced electronic root-length measuring technology to ensure accuracy of instrumentation. These devices work by calculating resistance of tooth structure to provide a visual and audible signal indicating root length.

Ultrasonics: These advanced devices vibrate small instruments to help remove posts and other canal obstructions, as well as aid in the search for calcified canals.

Nickel-Titanium Instrumentation: The cleaning and shaping of the root canal is aided by the use of metal instruments made of a unique alloy of nickel-titanium. We use both hand and rotary instruments along with a liquid antimicrobial agent to help remove bacteria and tissue.

©2008 Dr. Jennifer E. Key, DMD, 201 East Chestnut St. Asheville, NC 28801