Root canal treatment
Carried out under local anesthetic, a root canal treatment consists in locating all the canals of the tooth, cleaning them out and disinfecting them. After they are disinfected, they are packed with a natural, inert polymer called gutta-percha. This packing is warmed so that it fills and seals the canals. During treatment, a rubber dam is placed around the tooth to isolate the patient's mouth and protect the patient from dental debris and disinfectants. It also isolates the tooth from saliva and the many bacteria it contains. The entire procedure is done using a surgical microscope. This instrument magnifies the area being treated by up to 20 times and provides lighting to ensure perfect visibility.
Root canal retreatment
Root canal retreatment is done when the initial root canal treatment was not successful or the root canal system has become contaminated by bacteria. The treatment is done in two visits, under local anesthetic and using a rubber dam. During the first visit, all the canals are retreated by removing the existing packing material, disinfecting the area again, shaping the canals and locating the canals that were overlooked or have calcified. Medication is then placed in the tooth to dry the canals and eliminate all sources of bacteria. During the second visit, the canals are thoroughly cleaned again and the tooth is prepared for the gutta-percha that will fill and seal the canals.
Non-surgical exploration and repair of cracks or fissures
Despite all the technologies available, non-surgical exploration may be the only way to determine if a tooth needs an endodontic treatment. Such treatments are performed when a diagnosis leads the endodontist to suspect a fissure or crack in the tooth. It is then a matter of removing the filling and using a microscope to check if fissures or cracks extend into the canals. Repairing these cracks may be an alternative to a root canal treatment if the tooth reacts well to subsequent endodontic tests at a follow-up appointment after treatment.
Complementary treatments
In complementary treatments, the endodontist can also remove separated instruments in the canals or bypass them, and ensure that the treatment is properly sealed. The endodontist can also repair holes made while looking for very calcified canals, thereby ensuring that the root canal treatment is successful.
Apicoectomy
Apical surgery is another option for treating an apical lesion. It is used when retreatment is not possible because of obstacles or to avoid compromising crowns or fixed bridges. This surgery, called an apicoectomy, is also done under local anesthetic. A small incision is made in the gum, and the tissue is retracted to give access to the tip of the root in order to treat the lesion, disinfect the site and perform a root-end filling with a biocompatible dental material designed specifically for this treatment.
In some cases, the endodontist may perform an apicoectomy by extracting the tooth from the socket, doing a root-end filling on the problematic canal and then reinserting the tooth in its socket. This procedure is called an intentional replantation of the tooth.
Surgical exploration or curettage
The purpose of surgical exploration is to determine whether a tooth has fissures or cracks, using microsurgery.
Root resorption repair
Root resorption (damaged dental pulp) can often only be seen in x-rays. Resorption can result from dental trauma at a young age, among other things. Internal or external root resorption can also be treated by an endodontist in order to preserve the natural tooth. Different treatments are possible depending on the situation and can be performed from inside the canals of a tooth or by surgery. A preliminary assessment using 3D scanning is of paramount importance to see the extent of the resorption and to determine the treatment.
Intentional replantation
In some cases, the endodontist may perform an apicoectomy by extracting the tooth from the socket, doing a root-end filling on the problematic canal and then reinserting the tooth in its socket. This procedure is called an intentional replantation of the tooth.
Emergency opening of a tooth
If the pulp is very inflamed and the pain is intolerable, the endodontist will perform an emergency opening to remove the pulp from the tooth and allow the infection to drain. The tooth is then disinfected and a medication is used to eliminate any sources of bacteria. At the next visit, the endodontist performs a root canal.
Surgical drainage
When a dental infection causes severe swelling, it is sometimes necessary to make an incision in the gum and to place a drainage device to allow the infection to drain quickly and relieve the swelling.
Dental trauma in children and adults
While children are growing, they may experience dental trauma that leads to cracked baby teeth or the loss of tooth vitality. The endodontist must then treat the pulp of the tooth, performing an apexogenesis if the pulp is vital or an apexification if the pulp is necrotic, to avoid loss of the tooth. The endodontist can also be called upon to treat adult teeth that have become necrotic after an accident, getting hit or undergoing other trauma.
Internal bleaching
After a trauma or root canal treatment, a tooth may lose its natural colour. The endodontist will then whiten the tooth by placing a bleaching agent in the tooth.