Working with you to keep your teeth
Nothing is as good as a natural tooth and with modern dentistry, losing teeth as you get older is not inevitable. With modern technology and modern techniques, endodontic (or Root Canal) treatment may be possible to avoid having teeth extracted and have a pain free alternative to dental implants or spaces in your mouth.
Pain free alternatives to tooth extraction
You may be told a tooth needs to be extracted if it has extensive decay, infection or gum disease. There are often ways of avoiding having a tooth extracted by investing in saving the tooth. After a consultation, we will assess your teeth to determine the underlying cause of disease in your mouth and work together to prevent new problems developing in the future.
Root Canal Treatment is performed under local anaesthetic allowing us to confidently provide comfortable treatment. A rubber sheet will also be placed over the tooth. This allows us to isolate the tooth and keep it clean throughout the procedure.
An opening is then made in the top of the tooth which allows access into the pulp space. Very small instruments are used to clean and shape the pulp complex within the tooth. The tooth is then disinfected to remove bacteria from within it and then sealed with a rubber material and biocompatible endodontic sealer.
Success is influenced by many factors such as your general health, the gum attachment and bone support around the tooth, the specific bacteria causing the infection, the shape, position and condition of the roots and nerve canals, quality of previous dental care and pre-existing root fractures, all of which can affect individual healing.
Treatment is all carried out to gold standard protocols with state of the art instruments and techniques which help give endodontics predictably high success rates (97% De Fabbro et. al. 2008, 90% Ng et. al. 2010 ) If the technical standard of the treatment drops by not employing contemporary techniques such as providing treatment with microscopic magnification, ensuring thorough disinfection of the root canal system with activated irrigants under a rubber dam and providing a three dimensional seal of the disinfected pulp space then success rates drop. Predictability of treatment can drop by half if technical standards are not maintained. (Saunders et. al. 1997)
All treatment is performed with the aid of magnification using an operating microscope. This magnifies the tooth up-to twenty times as well as illuminating the inside of the tooth to allow visualisation of the pulpal system within the tooth. This is critical as often, there are extra canals or nerve spaces inside a tooth which are easily missed without magnification and are often a cause of failing root canal treatments.
Cone Beam Computer Tomography (CBCT) allows us to take three dimensional x-rays of your teeth and supporting structures. Due to the increased volume of x-rays needed for 3D scans of teeth, this is not routinely required, however, it is invaluable in cases of failed root treatment where we can assess for extra canals in the tooth which have been missed. It is also a valuable tool in surgical planning where the supporting structures around the end of a tooth can be visualised in all dimensions.
Pain free local anaesthetic is given using ‘the wand’; a computer controlled system for slow painless numbing of your teeth and gums. Patients often report how they feel now discomfort as the tooth goes numb and little or no discomfort after the procedure.
During the procedure, ultrasonic technology is used for activation of disinfectants within the tooth, for removing calcified pulp tissue and washing the inside of the tooth. Thermoplastic gutta-percha techniques are employed for three dimensional sealing of the pulp space within the tooth.
The alternative to endodontic treatment is to leave and monitor the tooth (which can lead to further problems in the future) or extraction of the tooth. Following extraction, there will be a space which you may want restoring. A space can be filled with a denture, bridge or dental implant which is an artificial replacement of the tooth. These alternatives can be discussed at the consultation or with your normal dentist.
Fees for treatment depend on the complexity of the case. Some teeth can be treated in a single visit, whereas others may require multiple sessions. Typically, fees can be £450-£650, however, we will give you a treatment plan together with estimated treatment cost following your assessment appointment. The assessment appointment costs £95 and includes all necessary diagnostic tests and correspondence with your normal dentist.
If there is a crown on the tooth to be treated sometimes this crown (or bridge) may need to be removed. Sometimes we can get into the nerve space by accessing through the crown which can sometimes cause porcelain on the crown to fracture which may necessitate replacement.
It is possible for the small instruments used in endodontic treatment to fracture inside the tooth, particularly in curved or narrow canals. The files we use are used only once to try and prevent fracture and are made out of flexible Nickel Titanium. Despite all precautions, file fracture can still occur. If it does, we will try everything to retrieve the fragment, however, if it is not retrievable, we may need to seal the fragment inside your tooth. Should an instrument break, the likelihood of clinical success decreases.
Root canal treatment is an attempt to save a tooth which may otherwise require extraction. Although root canal treatment has a high degree of success, it can not be guaranteed. Occasionally, a tooth which has had root canal treatment may require further management such as; re- treatment, peri-apical surgery or extraction.
It is important to understand medical procedures carry risks which are outlined above. If you have any questions, please do not hesitate to ask; call us on 0191 286 3398.
After endodontic treatment.
After treatment, it is normal for the tooth to be tender for up-to a week following treatment and is part of the normal healing process. If discomfort persists, contact us.
After treatment, the tooth needs protection to prevent any fractures developing. It is often recommended that a root filled molar tooth is subsequently crowned as a fracture or crack in the tooth can not be fixed and will lead to the tooth becoming re-infected requiring extraction. For more information about how crowns can protect teeth, click here.
A root-filled tooth can still decay but because the nerve is gone you will not feel any pain so regular dental checks are advised.
Will it hurt?
No! Being patient and using a state of the art local anaesthetic delivery system at every stage of the procedure will ensure your comfort. Following treatment the tooth may feel a little tender for a few days, but this can normally be controlled by using the same medication you might use for a headache (ibuprofen and paracetamol taken together usually work well).
Dr Andrew Gemmell
BDS MFDS RCS(Ed) DipRestDent RCS(Eng) MPDC RCS(Ed) MSC(RestDent) FDS RCS(Ed)
Andrew is a certified member of the European Endodontic Society and has a lot of experience in managing complex endodontic cases and cases of failing root canal treatment. In addition to referral endodontic treatment at Kingston Park, Andrew is a member of staff in the department of Restorative Dentistry at Newcastle Dental Hospital and is a Honorary Clinical Lecturer with the University of Newcastle upon Tyne teaching clinical endodontic treatments. He also lectures to qualified dentists throughout the region about advances in endodontics.
He has a Postgraduate Diploma in Restorative Dentistry (DipRestDent) with the Royal College of Surgeons (England) with a specialist interest in Endodontics. He has been appointed as an examiner for the Diploma of Membership of the Faculty of Dental Surgery at the Royal College of Surgeons, Edinburgh and completed a Masters (MSc) degree in Clinical Restorative Dentistry with the University of Leeds, passing with distinction. In 2013 he was awarded the Diploma of Membership in Primary Care Dentistry (MPDC) from the Royal College of Surgeons in Edinburgh. This qualification recognises excellence in general dental surgery and Andrew is one of only an handful of dentists in the UK to have been successful in this examination.
In October 2017, he was elected as a Fellow of the Faculty of Dental Surgery, Royal College of Surgeons after assessment (FDS RCSEd). The fellowship internationally acknowledged as the highest College award in Dentistry. Andrew is now an examiner with the college for the Membership in Advanced General Dental Surgery examination.