Endodontic Services and Post Treatment

Introduction

Here at the Endodontic practice of Grassi & Grassi, PC, we focus on heartfelt gentleness and professional excellence. We pride ourselves on the level of care we offer our patients as well as our ability to make every patient as comfortable and pain-free as possible. In the sections below, you'll find information about the different procedures we perform. Some sections include short, animated videos to help you better understand the procedure. All videos are closed-captioned for the deaf and hard-of-hearing.

When you come to Grassi and Grassi, we want you to be as comfortable as possible for your procedure. If you have any questions at all, please ask any member of our staff for help or additional information.

Root Canal Therapy

A tooth has two general parts: the crown and the root. The crown of the tooth is made of dentin covered with enamel. This is the exposed portion of the tooth. The root of the tooth (also made of dentin) is the portion of the tooth that extends into the jaw, anchoring the tooth in place. Inside the tooth is the pulp which extends from inside the crown into the root. The pulp contains blood vessels and nerves, and is critical to the tooth's initial growth and development. Once the tooth is fully developed, it no longer requires the pulp for continued health.

Root canal treatment is needed when the pulp becomes inflamed or infected as a result of injury, deep decay, repeated dental procedures, or if the tooth is cracked or chipped.

In root canal treatment, we first administer local anesthesia to completely numb the tooth and surrounding tissue. We then remove the inflamed or infected pulp from the tooth and carefully clean and shape the inside of the canal. Once cleaned, we fill and seal the space.

After the root canal treatment is completed, you will return to your general dentist for a crown or other restorative procedures. Once this step is completed, the tooth will function like any other tooth.

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Instructions For Care After Your Root Canal Therapy

  • Make an appointment with your general dentist as soon as possible to have the tooth restored.
  • Do not bite down on the affected tooth until the tooth restoration is completed.
  • Initially, there will be some soreness, especially when biting. This is normal.
  • If you have any problems regarding your treatment, extreme discomfort, or swelling in the area of the procedure, contact us immediately. Your comfort and the success of your therapy are our primary concerns.

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Endodontic Surgery

Surgery can help save your tooth in a variety of situations. Common symptoms that may indicate a need for surgery include:

  • Symptoms that are caused by problems that cannot be seen on an x-ray. Your tooth might have a tiny fracture that can't be found using non-surgical procedures.
  • Sometimes, calcium deposits may make a tooth canal too narrow to be cleaned using a traditional, root canal therapy approach. In this case, we may need to perform a surgical procedure to completely remove the infection.
  • Normally, root canal therapy is a final treatment and will last for years. In a few cases, however, the tooth may not heal as expected. Pain and disease may appear months (or years!) after the root canal therapy is performed. Endodontic surgery may be necessary to save the tooth.
  • There may be damaged root surfaces or surrounding bone that require surgery.

Apicoectomy

The most common Endodontic surgical procedure is called an apicoectomy (or "root end resection"). This procedure is performed when there is persistent inflamation or infection in the bony area around the end of your tooth after a root canal procedure.

In this procedure, we may place a small filling in to seal the end of the root canal, combined with a few sutures (stitches) to help with healing.

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Other Forms Of Endodontic Surgery

While the apicoectomy is the most common form of endodontic surgery, there are others. These include dividing a tooth in half, repairing an injured root, or removing roots. We will discuss the specifics of your surgery with you if any of these are required.

Instructions For Care After Your Endodontic Surgery

  • After surgery, return home and curtail physical activity for the day.
  • Continue the application of an ice pack to the surgical area until bedtime. Apply the ice pack for twenty minutes at a time, with ten minute breaks between each application. Note: Some swelling and brusing may appear for several days — this is normal.
  • Your surgery most likely required sutures. To avoid dislodging or tearing your sutures, avoid exaggerated lip movement. Do not use a toothbrush in the area of the sutures. Instead, use a Q-tip to gently clean the affected area.
  • Do not use mouthwashes or salt water rinses/soaks until you receive our approval. Do not "swish" fluids in the surgical area.
  • Some localized bleeding is normal. If the bleeding persists, dampen a tea bag with warm water and gently place it in the surgical area. If the bleeding is excessive, contact us immediately.
  • Continue taking all prescribed medications (antibiotics) until the bottle is empty. You will not need to refill the prescription unless directed to do so by our office.
  • You may use over-the-counter medication to manage any pain. We recommend 600mg (three 200mg tablets) of Ibuprofen (Advil, etc.) taken 3-4 times per day. Do not exceed the recommended dosage. Do not continue the use of Ibuprofin for more than three to four days. If necessary, our office can prescribe a stronger pain medication. This normally is not necessary.
  • If you experience continued excessive swelling or you develop an elevated temperature, contact us immediately.
  • After four to seven days, you will need to return to the office to have your sutures removed.

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Common Questions about Endodontic Surgery

Will it hurt?

Local anesthetics are used to make the procedure comfortable. You may feel some discomfort or have slight swelling while your incision heals. This is normal. We will recommend appropriate pain medication. You will be provided with post-operative instructions similar to those listed above. If you experience pain that does not respond to medication, contact us immediately.

Will my insurance cover endodontic surgery?

You will need to contact your employer or insurance company. Each company has different plans and levels of coverage. We will provide information for pre-authorization upon request.

Are there alternatives to surgery?

You may find that the only alternative to surgery is extraction. If extraction is necessary, the extracted tooth must be replaced with an implant, bridge, or removable partial denture. In most cases, endodontic surgery is the most cost-effect option for maintaining oral health.

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Endodontic Retreatment

In some cases, a tooth may not heal as expected after initial treatment. For example:

  • Narrow or curved canals were not treated during the initial procedure.
  • During the first procedure, complicated canal anatomy was undetected.
  • A crown or other restoration was not placed soon enough after treatment.
  • During restoration, saliva contaminated the inside of the tooth.

Retreatment may also be necessary after successful treatment. For example:

  • New decay has developed exposing the root canal filling material to bacteria, causing a new infection in the tooth.
  • A loose, cracked, or broken crown or filling exposes the tooth to a new infection.

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Common Questions about Retreatment

What will happen during retreatment?

We will meet with you to discuss your treatment options. If you choose retreatment, we will reopen your tooth to access the root canal filling.

After the canal filling is removed, the canals will be cleaned. We will also carefully examine the inside of your tooth for any additional canals or unusual anatomy that require treatment.

After cleaning the canal(s), we will fill and seal the canal(s) and place a temporary filling in the tooth. In some cases, unusally narrow or blocked canals may require surgery. If so, an incision will be made near the end of the root to allow the tip of the root to be sealed. We will discuss this process with you if we believe it is necessary.

Upon completion, you MUST return to your personal dentist as soon as possible to obtain a new crown or restoration. This will protect the tooth and allow it to regain full function.

Is retreatment the best choice for me?

We are proud to say that retreated teeth can function well for many years. Our goal is to save your tooth.

New technologies often allow us to change the way root canal treatment is performed. At Grassi and Grassi, we continually study and train to keep our skills current with each new development in endodontic treatment.

As with any dental or medical procedure, there are no guarantees. What we can guarantee is that everyone at Grassi and Grassi will provide you with the individual attention and consideration necessary to ensure your treatment is as successful as possible.

How much will it cost?

The cost of retreatment procedures varies. Depending on the complexity involved and the specifics of your dental anatomy, the cost may be more than the initial endodontic treatment. Your dental insurance may cover a portion of this cost. Many insurance policies limit coverage to a single procedure on a tooth in a given period of time. Check with your employer or insurance carrier to be sure of your individual coverage. For your benefit, we always discuss this with you before treatment.

What are the alternatives to retreatment?

Endodontic surgery is one option. We will give you the best recommendation for your specific case. Surgery can sometimes be advised in conjunction with retreatment, or as an alternative.

The only other option is removing the tooth (extraction). If this happens, the tooth must then be replaced with an implant, bridge, or removable partial denture. This is done to restore chewing function and to prevent the shifting of adjacent teeth. These options require extensive surgery or dental procedures on adjacent healthy teeth, making them far more costly and time-consuming than retreatment.

Your natural tooth is always better than a tooth replacement, no matter how effective the replacement may be. We want to save your tooth whenever possible. Choosing retreatment can give you a healthy, functioning, natural tooth for many years to come.

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