Restoring the Tooth After Root Canal

Restoring the Tooth After Root Canal

After the root canal procedure your tooth may need to be restored. This gives your tooth natural shape and appearance. In the front teeth a composite filling material is used to restore the tooth. The molars and premolars need a crown. Before the crown is made your dentist will make a base or foundation to reinforce the tooth and support the crown. The base to reinforce the tooth is called a core. A post may be needed to hold the core in place. The post is a rod made of metal. Your dentist may take out a little root filling material from the root canals to make space for the post. The crown is prepared in a dental laboratory. Material used to make crown are porcelain, metal, or a combination of the two. The crown is cemented onto the base or foundation. 

Possible Retreatment or Surgery

 Root canal procedure can fail. Reasons for failure of root canal include

• All the infection from a canal was not removed
• All  the canals were not cleaned or
• Tooth gets infected again if there is a leakage around an old filling or crown from which the bacteria can enter the tooth.

The procedure to do a repeat root canal treatment is the same but it is more complicated and time consuming than the first one because the restorative material has to be removed before the second root canal.Most of the failed root canal treatments have infection that are difficult to eliminate

You may need endodontic surgery, either in place of or after retreatment. If a second root canal is not possible endodontic surgery apicoectomy may be needed. During apicoectomy, the root tip, or apex, and the infected tissue are removed. Then filling is done to seal the end of the root. An apicoectomy is performed using an operating microscope. That's why apicoectomy is also called endodontic microsurgery. Apicoectomy may be needed if the tooth remains infected after retreatment. The success rate for apicoectomy is approximately 80% to 90%. If the tooth remains infected after apicoectomy also it will have to be extracted.

Bone Augmentation and its Procedure.

Bone Augmentation and its Procedure.

Dental implants are successful, only if there is enough bone to support it in the jawbone. There may not be enough bone in the jawDue to tooth loss from periodontal (gum) disease,After injury or trauma,In developmental defects orIn people with jaw which is too short (up and down), too narrow (side to side) or bothBone augmentation is a procedure in which the jaw bone is built up by bone grafting (with bone or bonelike materials) so that dental implants can be placed. The grafted material fuses with the jaw bone in a few months. Your dentist after examining you will decide the procedure that can be used for bone augmentation based on the type, location and number of implants to be used. Implant is usually placed 6 to 12 months after the bone-augmentation procedure. 

Where Does the Bone Come From

 In most bone-augmentation procedures bone grafts are used and your own bone is considered as the best material for augmentation. Bone is mostly taken from the chin or ramus (the back part of your lower jaw). Bone from hip or shin bone (tibia) may be used if needed. Bone material made from bone of human cadavers or cows can be used if required. Your dentist will discuss the options available for you before the procedure.

A Typical Bone-Augmentation Procedure

 Bone augmentation procedure for a tooth can be done in your dentist’s office. Before the surgery you may be given antibiotics and pain relieving medication. The surgery is usually done under local anesthesia, but you may be given sedation if required. Local anesthesia is given both at the area where the bone augmentation is needed (recipient site) and the area from where bone will be taken (donor site). Bone is taken for the donor area and placed in the area that needs bone augmentation. After the surgery you will be prescribed antibiotics, pain medication and an antibacterial mouthwash. Follow the instructions give by your dentist regarding medications, food (such as avoid certain foods), oral hygiene and how to avoid pressure on the area while it heals. You will have to avoid wearing denture till the area heals. Bone graft takes about 6 to 12 months to heal. The implant is usually placed 6 to 12 months after the bone-augmentation procedure. 

Building Up Bone for Several Implants

 If you need several implants then the bone is usually taken from hip, shin or another site as more bone-graft material is needed than if a single implant is being placed. This procedure is usually done in a hospital under general anesthesia, and requires an overnight stay. Time needed for surgery will depend on the number of area where you need bone grafting. 

Success of Bone Grafting

 Success rate of bone grafts done for dental implants is very good. But like any other surgical procedure there is always a chance of failure after bone grafting. Cause of bone grafting failure include infection, smoking, certain medications or if the grafted bone wasn't stabilized properly. However bone grafts are not rejected like other organ transplants. 

Other Types of Bone-Augmentation Procedures

 Besides bone grafting, other types of procedures that are done to build bone so that implants can be placed areSinus lift: In this bone-augmentation procedure the height of your upper jaw is increased by filling part of your maxillary sinus for placing implants in the upper jaw.Ridge expansion: This done if your jaw is not wide enough to support implants.

Inferior Alveolar Nerve Repositioning

Inferior Alveolar Nerve Repositioning

Nerve repositioning may be needed for inferior alveolar nerve runs through the lower jaw before placing dental implant. This nerve gives sensation to the lower lip and chin. If there is significant bone loss in the lower jaw placing there is high risk of damage to this nerve while placing dental implant. 

Your dentist may consider nerve repositioning if he or she considers there is a risk of damage to the nerve while placing dental implant. 

Reasons to replace missing teeth are:

• For self confidence as missing teeth especially the front teeth can make you conscious about it.
• To prevent loss of bone from where the teeth are missing.
• Tooth loss can affect chewing and the foods that you are able to eat.
• Your bite (the way your teeth come together) can get affected by tooth loss and it can lead to problems in temporomandibular joint.
• Tooth/teeth loss can affect your speech and self-confidence.

 Types of implants

Currently several types of implants are used. Some commonly used types of implants are

•  root form,
•  blade form, 
• Ramus frame and 
• subperiosteal implants. 

For a dental implant to be successful it should fuse with the jaw bone (a process called osseointegration). The metal titanium is accepted well as part of the body and it gets well bonded with bone.

Root-form implants: It is most commonly used type of implant and is made of titanium. It is looks like a small cylinder or screw. The implant is inserted in the jawbone and after it fuses with the bone a metal collar called an abutment is attached to it. The crown, denture or bridge is eventually attached to the abutment. Success Success rate of dental implants is very good. According to studies root-form implants are successful in more than 90% of patients. Problem with these implants usually occur within the first year after insertion. However dental implant cost much more than standard dental restoration procedures.

Advantages of implants include

• They feel more natural than crowns, bridges or dentures as they are imbedded in your bone.
• They are more convenient as compared to other dental restorations such as the standard crowns, bridges or dentures.
• They make chewing and eating more comfortable as compared to dentures.
• As they look like your natural teeth, you feel more comfortable with them especially if they are on the front teeth.
• They do not affect speech but at times regular dentures can affect your speech 

Who Is an Implant Candidate

Dental implants are becoming a more popular option to replace missing tooth/teeth. However implants can not be placed in everyone who wants it. Your dentist after examining you will tell if you are suitable to get an implant. 

Some considerations before an implant are:

• You should be in good healthYou should have healthy gums
• There should be enough bone in the jaw to allow an implant to be placed in.
• You should be ready to take good care of the implanted teeth and surrounding gums. 
• You will have to maintain good oral hygiene by daily brushing and flossing and regular visits to the dentist for cleaning.
• Regular follow-up with your dentist is important. 

People who are not good candidates for implants include:

• Children whose jawbones are still growing
• Pregnant women
• Heavy smokers as smoking interfere with healing and can decrease the chance of implant success.
• Excessive use of alcohol or substance abusers
• Patients who have been administered high-dose irradiation to the head or neck
• People with chronic diseases such as hypertension (high blood pressure), diabetes, connective-tissue diseases, hemophilia and certain immune deficiencies
• Patients on medications that suppress the immune system such as steroids, immunosuppressant
• People with severe bruxism (who severely grind or clench their teeth) 

Your dentist after examining you will decide whether you can receive implants.Being Evaluated If you want an implant your dentist after examining you will decide whether you can receive implants.

Implant therapy involves more than one dental professional in your treatment. An oral surgeon or a periodontist will place the implant in your jaw bone. A prosthodontist or general dentist will make crowns, bridges or dentures to be placed on the implant. The oral surgeon and the prosthodontist or general dentist after examining you will coordinate the treatment and decide how many implants are needed and when and where they should be placed. 

Initial evaluation before placing an implant includes

• Examination of mouth and teeth
• Detailed review of your medical and dental histories
• X-ray of the teeth and jawsComputed tomography (CT) scan if needed 

After examining you your dentist will discuss the treatment options for you and the cost of treatment.

Information on Dental Implants

Dental implants are metal posts or frames which are placed in the jaw bone under the gums by surgery. After it is implanted surgically your dentist can put replacement teeth onto them. 

How do Dental Implants Work

 The implants after placement get fused with your jawbone. This then give a stable support for the artificial teeth or dentures and bridges. Dentures and bridges that do not slip or shift in your mouth is big advantage while eating and speaking. Another advantage of implants is that the healthy teeth adjacent to the implant don’t need to be prepared. Where as standard bridges and dentures may not be as comfortable, and need to be fixed to teeth on either side of the missing tooth/teeth. 

Prerequisite for an implant

Your gums should be healthy and there should be adequate bone to support the implant.After implant you have to maintain good oral hygiene to keep these structures healthy.Regular dental visits and cleaning as required will be needed for long-term success of dental implants.But remember that implants cost a lot more than the standard bridges and dentures. The two types of implants that are considered to be safe are endosteal implants and subperiosteal implants. When you consult your dentist for an implant he or she will advise regarding the appropriate implant for you. 

Deciding if implants are right for you

 Implants can not be placed in everyone who wants it. Your dentist after examining you will tell if you are suitable to get an implant. Some considerations before you get an implant areYou should have healthy gums and enough bone in the jaw to allow an implant to be placed in.If you have periodontal (gum) disease, infection or injury you may need antibiotics or other treatment for it before the implant is placed.If there is a severe infection in your tooth root then after extraction the area will need time to heal before the implant can be placed.At times uour jaw bone may need bone grafting or augmentation. In this procedure, before the implant is placed, your jaw bone is built up by bone grafting to increase the chance of implant success. Your dentist may do the bone grafting and place the implant at the same time. At times he or she may do the bone-graft procedure first and the place the implant after a few months (about 4 to 12 months). During this time you will be given dentures or bridge, so that you are not without teeth.You should be ready to take good care of the implanted teeth and surrounding gums. You will have to maintain good oral hygiene by daily brushing and flossing and regular visits to the dentist for cleaning.People who are not good candidates for implants includeChildren whose jawbones are still growingPregnant womenHeavy smoker as smoking interferes with healing and can decrease the chance of implant success.Excessive use of alcohol or substance abusersPatients who have been administered high-dose irradiation to the head or neckPeople with chronic diseases such as hypertension (high blood pressure), diabetes, connective-tissue diseases, hemophilia and certain immune deficienciesPatients on medications that suppress the immune system such as steroids, immunosuppressantPeople with severe bruxism (who severely grind or clench their teeth)Your dentist after examining you will decide whether you can receive implants.

Myths About Root Canal Treatment

Root canal is usually painful Most people fear that a root canal treatment is usually associated with pain during treatment. Your dentist or endodontist will give a local anesthesia to numb the area around the tooth. If you are very apprehensive and tense you may need sedation, such as nitrous oxide. This eliminates the pain that is caused due to the procedure. If you have pain while the procedure is being done, tell your dentist about it. Your dentist will adjust the technique to avoid causing pain again or give more anesthesia if required. As my tooth's nerves are removed, I won't feel any pain Some people think that after the root canal treatment they won’t feel any pain in the treated tooth. However this is not true. Even though the pulp of the tooth is removed the nerves that surround your tooth can feel pressure and touch. These sensations are transmitted by the nerves in the surrounding tissue. In addition after the procedure you can have soreness in the concerned tooth for two to three days. You may be prescribed pain relievers such as acetaminophen or ibuprofen to ease the discomfort. Why should I get a root canal treatment if the tooth may have to be taken out eventually? A tooth after root canal treatment can last for the rest of your life with proper care. To increase the longevity of your teeth maintain good oral hygiene. To maintain healthy teeth and gums brush with fluoride toothpaste (twice a day) and floss everyday. Go for regular dental checkups and professional cleanings. Root canal treatment has helped to save several teeth that would or else need extraction. If I don’t have any pain, I don't really need a root canal It is very much possible that your tooth that needs root canal therapy may not have pain. But remember that absence of pain does not mean that your tooth is healthy. Like an infection of the pulp of the tooth may not cause pain initially. But without treatment it can cause pain and swelling. In some cases untreated infection can cause pus accumulation at the root tip in the jawbone, forming an abscess. Untreated abscess can extend and destroy the bone around the tooth and cause pain. After examination if your dentist recommends root canal treatment get it done even if there are no symptoms. In root canal therapy the roots of my tooth are removed, or my whole tooth is removed A tooth has outer enamel, the dentin (main body of the tooth) and soft tooth pulp (in the center of the tooth and in canals also called root canals). Nerves and blood vessels enter the tooth through the end of the root (called the apex) and then pass through a canal inside the root to the pulp chamber. In root canal treatment, the tooth pulp which may be inflamed or infected is removed. After removing the diseased pulp tissue, the space is cleaned, shaped and filled. In root canal therapy the roots of the tooth or the whole tooth is not removed. After root canal, I don’t need to go back to the dentist for a while After root canal therapy, you might think that you don’t have to go the dentist for a sometime. But it is important to go for follow-up and have the permanent restoration placed. If the crown is not placed on the back teeth, the risk of fracturing the tooth when you bite down or chew is higher.

How Crowns and Bridges solve Dental Problems

Crowns and most of the bridges are fixed dental prosthetic devices that are cemented on the existing teeth or implants. These can be taken out by a dentist only.How do Crowns Work?                  A crown or "cap" covers the entire surface of a damaged tooth. It not only strengthens a damaged tooth, it improves its appearance, shape or alignment as well. It may be placed on an implant too to give a tooth-like shape and structure for function. Materials used to make a crown include—porcelain, ceramic, gold and metal alloys, and acrylic. Crowns made of porcelain or ceramic match the color of your natural teeth. As the alloys are stronger than porcelain they are preferred for back teeth.You may be recommended crown as a treatment option:As a replacement of a large filling if there isn't enough tooth leftPrevent fracture in a weak toothRepair a fractured toothConnect a bridgeCover up a dental implant, discolored or poorly shaped tooth, or tooth after root canal treatment How do Bridges Work?If you have one or more missing tooth a bridge may be advised. Missing teeth can cause: Remaining teeth to rotate or shift into the unfilled space of the tooth/teeth and cause bad bite.Imbalance as a result of the missing teeth can lead to gum disease and temporomandibular joint (TMJ) disorders. Bridges may be used to replace one or more missing teeth. They fill the space of the missing teeth. The bridge is attached or cemented to the existing natural teeth or implants around the unfilled space of the missing tooth/teeth. Several different material are used to make bridges. Your dentist may advice you the material based on the missing tooth (or teeth), its function, aesthetic considerations and cost. Bridges made of porcelain or ceramic match the color of your natural teeth.How Long do Crowns and Bridges Last?Crowns and bridges can last for the rest of your life. But they can become loose or fall out. To increase the longevity of your crown or bridge maintain good oral hygiene. The bridge can be damaged if the teeth or bone holding it in place are affected by dental disease. To maintain healthy teeth and gums brush with fluoride toothpaste (twice a day) and floss everyday and go for regular dental checkups and professional cleanings. Do not chew hard foods, ice or other hard objects to avoid damage to your new crown or bridge.What is a crown?Crown is a fixed dental prosthetic device that is cemented on the existing teeth or implants. A crown or "cap" covers the entire surface of a damaged tooth. It not only strengthens a damaged tooth, it improves its appearance, shape or alignment as well. It may be placed on an implant too to give a tooth-like shape and structure for function.A crown may be recommended as a treatment option:As a replacement of a large filling if there isn't enough tooth leftTo prevent fracture in a weak toothTo Repair a fractured toothTo cover up a dental implant, discolored or poorly shaped tooth, or tooth after root canal treatmentThere are two types of crown--- prefabricated or made in a laboratory.Prefabricated crowns: These can be prepared from plastic or stainless steel. They are mostly used as a temporary restoration until a permanent crown is made. Rarely prefabricated crowns are used for permanent restoration.Materials used to make crowns include metal [gold alloy, other alloys (palladium) or a base-metal alloy (nickel or chromium)], porcelain fused to metal (PFM), or ceramic. Crowns made of metals or PFM are tougher and p...

Oral Health Guidelines: Filling Basics

Determining If You Need a Filling

 Your dentist will examine and tell if you need a filling. A dentist uses a small mirror to inspect the surface of all the teeth. If needed your dentist may ask for X-ray of the teeth and jaw. The treatment for your decayed tooth will be decided by the dentist after examination. Filling is done not only for decay but for cracked or broken teeth, or teeth worn due to abnormal strain such as nail-biting, tooth grinding as well. 

Steps to a Filling

 Before filling your dentist will give you local anesthesia to numb the area if necessary. The decayed tooth part is removed and the concerned area is cleaned using hand instruments or a drill or air abrasion and lasers. After removing the decay material your dentist will drill and remove a part of the healthy tooth to shape the space to prepare it for the filling. The type of filling that is best for you will be decided by your dentist based onExtent of the repair that needs to be done,Your allergies to certain materialsWhich tooth needs fillingCost factorCommonly used materials for filling are gold, porcelain, a composite resin (tooth-colored fillings), and amalgam. Some filling materials release fluoride and aid to prevent further tooth decay. After the filling is done your dentist will make use of burs to finish and polish the tooth. 

After a Filling

 Following filling you may experience some sensitivity in the tooth. The tooth may become sensitive to pressure, air, sweet foods or temperature. Sensitivity is most often caused by composite filling but other types of filling material can also make the tooth sensitive. Sensitivity in your tooth will usually subside over one to two weeks. Avoid things that cause sensitivity. Tell your dentist about the sensitivity in your tooth following the filling. Depending on the extent of sensitivity the doctor will decide what should be done next. You may have some discomfort while biting. If the pain worsens over time tell your dentist about it. The filling placed in the tooth may need to be reshaped. If the discomfort is as a sharp shock when your teeth touch it is called galvanic shock. It is caused by the two metals used as filling in your tooth (one in the newly filled tooth and one in the tooth it's touching). When the metals touch they produce an electric current in your mouth and cause the discomfort. 

Temporary Fillings

 Some people may be given a temporary filling (usually white, off-white or gray) ifFilling needs more than one appointment.A short period of time is needed for the tooth to healIf the cavity is deep and the pulp (nerve and blood vessels)  are exposed during treatment.In case of emergency dental treatment.Temporary fillings provide a soothing effect on the tooth and you may feel better after it seals the tooth, and protects the pulp from bacteria and decreases the sensitivity. Eugenol is most often used for temporary fillings. You will need to get a permanent filling as recommended by your dentist. 

Why Replace a Filling

 Remember that fillings are not everlastingly. The filling can become discolored or wear out. Fillings can get damaged because of--chewing too hard on a large filling, or fracture in the filling or the tooth that has the filling. In these cases the filling may need to be replaced. Besides this a filling may need to be changed if it falls out, leaks or cracks. A crack or leak in the filling permits food debris and bacteria in your mouth to seep below the filling. As it is difficult to clean under a fill...

Oral Health Guidelines: Filling

Filling is done in a tooth damaged by decay. It helps to return a tooth to its usual function and form. Before doing a filling the dentist takes out the decayed tooth part, and cleans the concerned area. After the cavity is clean he or she fills it with a filling material. Filling closes the space where bacteria can get deposited and grow and prevents more decay. Commonly used materials for filling are gold, porcelain, a composite resin (tooth-colored fillings), and amalgam. Amalgam is an alloy that contains mercury, silver, copper, tin and sometimes zinc. 

Which Type of Filling is Best

 No one type of filling is considered as the best type of filling. The type of filling that is best for you depends onExtent of the repair that needs to be done,Your allergies to certain materialsWhich tooth needs fillingCost factorConcerns regarding different filling material are Gold filling: Is long lasting (may last more than 20 years) and is considered by some experts as the best filling material. But it is expensive. Amalgam (silver) filling: Relatively cheap and resistant to attrition. It is dark in color and thus often not preferred for visible areas, such as front teeth.Composite (plastic) resin: Have the same color as the teeth and thus preferred for visible areas, such as front teeth. Not a suitable material for large fillings. Life of the filling varies from three to 10 years. Porcelain filling: Have the same color as the teeth and thus preferred for visible areas, such as front teeth. In addition they are stain resistant, but it is expensive. If the tooth is damaged extensively due to decay or a fracture a crown or cap may be needed. If the tooth decay has reached the nerve treatment options includeRoot canal therapy--- In this procedure the damaged nerve is removedPulp capping--- In this procedure attempt to keep the nerve alive is made. 

What Happens When You get a Filling

 Before doing a filling the dentist takes out the decayed tooth part, and cleans the concerned area. After the cavity is clean he or she fills it with a filling material. Filling closes the space where bacteria can get deposited and grow and prevents more decay. The material used for filling include gold, porcelain, a composite resin (tooth-colored fillings), and amalgam. 

How Do I Know if I Need a Filling

 Your dentist will examine and tell if you need a filling. A dentist uses a small mirror to inspect the surface of all the teeth. If needed your dentist may ask for X-ray of the teeth and jaw. The treatment for your decayed tooth will be decided by the dentist after examination.