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Root canals can be performed on all the teeth. The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
The endodontist makes a small opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.
After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.
In apexification, the unhealthy pulp tissue is removed. The dentist will place medication into the root canal to create a hard tissue formation near the root tip. This hardened tissue creates a calcific barrier at the root end, allowing the root canal to be sealed.
The endodontist numbs the gums around the affected tooth, and then creates a small hole to gain access to the pulp. The infected pulp is removed from the root canal and the canals are cleaned. Medication is placed into the canal and the tooth is temporarily sealed. The medication is surgically replaced every two to four months, though this can vary among individuals.
After the root end has formed, treatment is finished, which means you can return to your regular dentist to have the tooth restored.
An apicoectomy may be needed when an infection develops or won't go away after root canal treatment or retreatment. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. To complete the apicoectomy, the endodontist will clean and seal the end of the tooth's canal.
This procedure, also called “open and medicate,” encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close, in turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.
A therapeutic pulpotomy, better known as a “baby root canal,” removes part of a tooth's pulp, the center of the tooth that contains nerves and blood vessels. The part that is removed is inside the crown.
This procedure can be done in children's baby teeth or in young permanent teeth. In primary teeth, the procedure is done to keep the primary tooth from being removed. Extracting a primary tooth before it is ready to fall out can alter the way permanent teeth come in.
If the pulp of a permanent tooth becomes injured or decayed soon after it emerges, the tooth may require root canal treatment. However, root canal treatment is not done until the tooth's roots are finished growing. In this case, a pulpotomy can be done instead. Root canal treatment can be done after the roots finish developing.