Root Canal Treatment in New York

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Procedures and instructions for patients are listed and explained here:

Root Canal Treatment

Explanation of Endodontics

Endo is the Greek word for “inside” and odontis Greek for “tooth”. Endodontic treatment covers the inside of the tooth. To understand endodontic treatment, it helps to know something 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 connective tissue and creates the surrounding hard tissues of the tooth during development. The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root.

The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature, it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it. Endodontists specializes in procedures that work with the pulp and root of the tooth, especially, root canals.

Why would I need an endodontic procedure?

Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, an injury 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, and potentially, you could lose the tooth.

What are the signs of needing endodontic treatment?

Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes, as well as nearby bone and gingival tissues. In rare cases, however, there are no symptoms.

What causes an endodontically treated tooth to need additional treatment?

New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover additional, very narrow or curved canals that could not be treated during the initial procedure, and so a second procedure is necessary.

Can all teeth be treated endodontically?

Most teeth can be treated and saved. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth. Your dentist will discuss this with you.

Root Canal Re-Treatment

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 final restoration or crown was delayed following endodontic treatment
untreated calcified canal

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 down filling can expose the tooth to bacterial contamination
  • The tooth sustains a fracture
root canal decay

What will happen 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—crown, post and core material—must be disassembled and removed to permit access to the root canals.

blocked root canal

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.

root canal retreatment

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 other end of the root to be sealed.

temporary filling

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 its full function.

root canal filling

Are there any other options?

Occasionally, retreatment is not possible. In that case, endodontic microsurgery may be needed.

The only other alternative is extracting 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 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.

Endodontics Microsurgery

Why would I need endodontic surgery?

  • Surgery can help save your tooth in a variety of situations.
  • Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.
  • Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this “calcification,” your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
  • Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
  • Surgery may also be performed to treat damaged root surfaces or surrounding bone.
  • Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, we may have to perform an apical microsurgery (apicoectomy).

What is Microsurgery (Apicoectomy)?

Although the apicoectomy procedure has been around for many years, the name can be deceiving. Other than the concept, it has little in common with the way it is performed today. When done by an endodontist or a dentist specifically trained in modern surgical endodontic techniques, apicoectomy is a very precise and successful procedure. It requires the use of a surgical operating microscope, special micro-instruments, most advanced materials along with a special set of skills.

In this 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 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.

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

Are there other types of endodontic surgery?

Other surgeries we might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. We will be happy to discuss the specific type of surgery your tooth requires.

In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.
These procedures are designed to help you save your tooth.

Will the procedure hurt?

Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. We will recommend appropriate pain medication to alleviate your discomfort.
We also will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call us

Can I drive myself home

Often you can, but you should ask before your appointment so that you can make transportation arrangements if necessary.

How do I know the surgery will be successful?

We are suggesting endodontic surgery because we believe it is the best option for saving your own natural tooth. Of course, there are no guarantees with any surgical procedure. We will discuss your chances for success so that you can make an informed decision.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery 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, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.
No matter how effective modern artificial 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 the rest of your life.
respond to medication, call us?

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. We will be happy to discuss your expected recovery time with you.

Saving a Knocked Out Tooth

If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently. Avoid touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into its socket as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it. Call a dentist immediately!

If you cannot put the tooth back in its socket, it needs to be kept moist in special solutions that are available at many local drugstores (such as Save-A-Tooth). If those solutions are unavailable, you should put the tooth in milk. Doing this will keep the root cells in your tooth moist and alive for a few hours. Another option is to simply put the tooth in your mouth between your gum and cheek. Do not place the tooth in regular tap water because the root surface cells do not tolerate it.

Once the tooth has been put back in its socket, your dentist will evaluate it and will check for any other dental and facial injuries. If the tooth has not been placed back into its socket, your dentist will clean it carefully and replace it. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.

The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist will affect the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.

Postoperative Care

If you have had endodontic surgery, your post-surgery care will help ensure a faster and more comfortable healing period. You can expect to experience any of the following:

Moderate swelling
Mild to moderate discomfort
Facial discoloration (especially for fair skinned patients, who bruise easily)

What can you do for pain relief? Here is what we recommend:

Take Motrin tablets (600mg) every 4 to 6 hours for 3 days.
If you can not take NSAIDS(Advil/Ibuprofen/Motrin, etc) or if you are allergic to Aspirin, take Tylenol (500-1000 mg) every 4-6 hours for 3 days.
If you cannot take any of these, please consult with us.

Antibiotics – Take as instructed. If you have questions, please contact us.

For swelling, it is essential that you use a cold pack, 10 minutes on and 10 minutes off, on the first day.

For oozing – Take a moist gauze pad or tea bag on the oozing area and hold with light pressure for 20 minutes.

Important Notes:

Oral Hygiene

It is essential that you keep the surgical area clean, to promote healing. Please rinse with salt water or antiseptic rinses as often as possible throughout the week. Do not brush your teeth near the incisions for the first week; instead, use a gauze pad moistened with salt water to clean your teeth. Continue normal dental hygiene in other areas of your mouth.

Restricted Activities

DO NOT jog, swim, do aerobics, bicycle, or perform any activities that include heavy movement or jarring of your head. Do not bend down with your head below your waist. We recommend avoiding alcoholic beverages, smoking and spicy foods for 4-7 days.

Root Canal Post Treatment Care

The following are important notes for dental patients who have had any work done on their teeth.

  • Do not eat anything, and do not drink anything hot, until numbness wears off. This will prevent you from biting your cheek or tongue or burning your mouth.
  • Avoid chewing at that tooth until it is completely restored by your dentist.
  • Be sure to floss and brush normally.
  • If the opening in your tooth was restored with a temporary filling material, it is not unusual for a thin layer to wear off in-between appointments. However, if you think the entire filling has come out, contact us.

Contact us right away if you develop any of the following:

  • A visible swelling inside or outside of your mouth
  • An allergic reaction to medication, including rash, hives or itching (nausea is not an allergic reaction)
  • A return of original symptoms
  • Your bite feels uneven.

Endodontic Procedures

Fifth Avenue Endodontics provides a variety of dental services and procedures with the utmost skill and care. Located in Manhattan, New York, we maintain the highest standard of cleanliness and sanitation in our practice, and follow the strict disinfection guidelines of both OSHA* and the American Dental Association. *Occupational Safety and Health Association Our office uses only digital X-rays, which significantly reduce radiation exposure. They also provide an instant image for our doctors, on a flat screen monitor. We are using the latest digital dental CT Scan technology (Cone Beam Computed Tomography or CBCT) to make diagnosis that is elusive even with the best digital X-rays. This state-of-the-art scanner gives one of the best quality 3-D images available on the market today, while using a fraction of the radiation delivered by a medical CT and most of the dental CBCT machines. Procedures and instructions for patients are listed and explained here:

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