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Archives for September 2020

Root canal treatment again?

Posted on September 30, 2020 by AllSmiles.

In 2014, my dentist did a root canal on an upper right molar. Two months ago, the tooth started hurting, and it’s getting worse. Will I need an extraction and dental implant, or if I see a specialist, can they try a root canal treatment again and prevent an extraction? – Thanks. Noble R. from CT

Noble,

Root canal treatment is one of the least predictable treatments in dentistry. Even if a dentist performs the procedure correctly, it has a 5-15% failure rate.

Can Root Canal Treatment Be Repeated?

Root canal treatment can be repeated multiple times. But it doesn’t always make sense to do it. Still, there is an option before extracting a tooth and replacing it with a dental implant.

Why Causes Root Canal Failure?

Sometimes root canal treatment fails because the dentist could not completely remove the infection from a tooth. Canals in a tooth can twist and turn and make it difficult or impossible for a dentist to clean out the infection and seal out bacteria fully.

The pulp in your tooth contains living tissue, nerves, and blood vessels. A pulp chamber is in the crown of a tooth, and a pulp canal conducts blood supply and nerve in the chamber. If tooth pulp is infected, a dentist will clean out the chamber and canal and seal them to prevent bacteria from entering the tooth.

Molar teeth usually have three canals for each tooth root. But sometimes a tooth has a fourth canal that’s difficult to find and clean. Some canals have branches at right angles. A dentist has tiny, highly flexible files to insert in the tooth and remove the infected tissue, but the files cannot enter a side branch with a right angle. Although a minority of teeth have fourth canals and challenging angles, sometimes fourth canals exist and retreatment is needed. Retreatment has a 50 to 75% success rate. But if retreatment is completed by a dentist who is skilled in root canal treatment and it fails, a third treatment is likely to fail.

Root Canal Surgery

Root canal surgery is a procedure that enters the tooth through the root instead of the crown. A root canal specialist, or endodontist, performs root canal surgery, or an apicoectomy. The treatment is 50 to 75% successful. The specialist will take the following steps:

  • Make an opening in the bone
  • Cut off the root tip of the infected tooth
  • Place a small filling at the end of the tooth to seal it

But even with an apicoectomy, a specialist sometimes can’t access tooth roots, or a root’s location—such as near a nerve in the lower jaw and lip—makes surgery risky.

Extraction Instead of Repeat Root Canal Treatment?

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Repeat root canal treatment is an option before extraction and a dental implant

An extraction is an alternative to repeat root canal treatment. Although it’s not the first choice, sometimes even a specialist can’t save a tooth, and you’ll need an extraction and dental implant.

Schedule a follow-up appointment with your dentist to discuss your options. You can compare your dentist’s recommendation with a second opinion from a root canal specialist.

Michael Szarek, DMD, a Lowell, MA, cosmetic dentist, sponsors this post.

Filed Under: Dental implants Tagged With: apicoectomy, dental implant, extraction and dental implant, how many times can a root canal be done, repeat root canal, root canal specialist, root canal surgery, tooth extractiond, what causes root canal failure, what happens during an apicoectomy, what happens during apicoectomy, what happens during root canal treatment

Straight teeth after Invisalign but jagged edges like a zipper

Posted on September 28, 2020 by AllSmiles.

I knew braces would straighten my teeth vertically, but I guess I didn’t think about their shape overall. The edges of my teeth are jagged like a zipper. After 18 months of Invisalign, I still need dental work on my teeth. I was negligent about wearing Invisalign, so my treatment is lasting longer than normal. I still have two months of Invisalign left, but now I’m concerned about having zipper-edged teeth. Will I need porcelain veneers to even out my teeth horizontally? – Thanks. Cliff

Cliff,
Although porcelain veneers create beautiful smile makeovers, they are too aggressive for evening your teeth in your case. There is an alternative for contouring your teeth without preparing—or lightly shaving—to the extent that porcelain veneers require.

What Is Enameloplasty or Cosmetic Contouring?

Enameloplasty or cosmetic contouring is the process of removing a small amount of tooth enamel to change the length, shape, or size of a tooth. Enameloplasty is limited to your tooth enamel. And after reshaping your teeth, your dentist polishes them to a natural gloss. Tooth enamel doesn’t contain nerves, so the procedure is painless. And it only lasts a few minutes. Other names for the procedure are odontoplasty or tooth shaving.

Who Completes the Procedure?

If your teeth require minor reshaping, your orthodontist might complete the procedure to finish your teeth. If more Is involved, it’s unlikely that a family dentist will achieve highly aesthetic results. We recommend that you visit a dentist with post-graduate training in cosmetic dentistry. An accredited cosmetic dentist will produce natural-looking results that enhance your smile.

Before enameloplasty, or tooth reshaping, upper teeth
BEFORE
After enameloplasty, or tooth contouring
AFTER

What About Cosmetic Bonding?

Before-and-after composite boning photos

Composite bonding

In some cases, a cosmetic dentist skillfully uses cosmetic bonding to fill in the sides of teeth. In the case to the right, edges of the teeth were evened and cosmetic bonding filled in the sides.

Best wishing for completing Invisalign treatment and giving your smile a gorgeous finish.

Micahel Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

Filed Under: Porcelain veneers Tagged With: enameloplasty, horizontal even teeth, Invisalign, jagged teeth, odontoplasty, porcelain veneers, porcelain veneers after braces, teeth edges, tooth contouring, tooth reshaping, tooth shaving, uneven teeth ater braces

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