The phrase "root canal treatment" carries a great deal of emotional baggage, that is sure. But the reality is that big changes have been afoot in the past few years, and this procedure in dentistry has changed beyond recognition. In a good way. As a matter of fact, we should really re-name it. So if you happen to have a root canal treatment scheduled, before you get all nervous, read along with me and be reassured. You're going to be fine.
First of all, there's the issue of being numb enough. Modern local anesthetics and methods of using them have evolved to the point that you should not feel pain during the procedure. Once in a great while a tooth is so incredibly painfil going in that we have a hard time numbing our patient. The best defense against this is to contact your dentist before the pain gets that severe! But rest assured--this is exceedingly rare. In our practice, difficulty getting numb enough now happens less than once a year.
You may also want to have nitrous oxide. You're still awake, yet nitrous oxide reduces pain and reduces anxiety.
The important thing to remember is that you can have root canal procedures done without pain. Now let's look at what's new.
In recent years I have adopted four remarkable new technologies in the field of endodontics (root canal treatment). Allow me to review them for you and provide my assessments of what they do for the quality of care that we can provide.
The Operating Microscope:
Treating patients with the surgical operating Microscope (I love using it so much, I always capitalize it) is the most powerful of all the tools available to us now.
The illumination from the LED lights is intense. And when we can see, we can treat accurately and safely.
The 6 levels of magnification allow us to: rapidly and safely identify canals; avoid perforations through the sides of the tooth; find more of the tiny MB2 canals (which all maxillary first molars have); and just generally work more safely and efficiently in this highly demanding area of dental treatment.
Rotary files are the standard of care for endodontics in 2013, and for some years now. Stainless steel hand files transport canals, which means such files change their shape and take them off center. This is not a good thing. With rotary Nickel-Titanium files, we stay centered! Rotary files are made of a nickel-titanium alloy that flexes like a piece of plastic even though it's metal. Bend them and they don't stay bent--they snap back to being straight. This means they can follow along in curvy canals and clean just the canal without transporting or perforating.
In root canal treatment we fill the canals with an inert material, because we cannot yet re-grow a live pulp in a tooth. We have to keep the germs out, and no matter how well we clean a tooth's canals, germs are always trying to get back in.
For decades the most common filling material for root canals was gutta percha. Well, many of us have retired it. For quite some time now I have used Resilon, a composite resin based material.
We could go on for hours about this but consider the most compelling reason to use Resilon:
It leaks less.
Gutta percha is a latex-like material. You cannot bond anything to it. And it's put in place with a dissimilar sealer. The gap between the gutta percha and the sealer is significant, and bacteria can leak all along the interface as easy as pie.
Resilon is put in place with a flowable version of Resilon as the sealer. It’s also bonded to all the dentin, as we remove the debris of the "smear layer" and prime the canals, just like we treat the dentin when we do a composite resin filling. There’s no gap, and there's nothing dissimilar. Resilon can still leak and be attacked by bacteria. But so much less than gutta percha. It's a great material.
Irrigation with sodium hypochlorite (NaOCl) has been proven time and time again to be the only way to thoroughly cleanse the root canal system of a tooth. It's so important that we can say that the point of all that cleaning and shaping with files is to allow the irrigation to actually work! We recently started using the EndoVac irrigation system. It’s astonishing.
This is a combined suction and syringe that does a much better job than blunt needles at flushing the canals with NaOCl. And then there is a tiny suction tip that you actually put in the canals. This draws the NaOCl down by negative pressure, getting much more irrigant to the apex and agitating it there. And then there’s a tiny metal canula that you put all the way to working length. Same effect.
Looking in the Microscope, I cannot believe the amount of debris that comes out of the canals when I use the EndoVac.
And we never really irrigated the apex very well before. Think of a running stream, and then think of a backwater, say, where the stream rounds a bend. There’s always quiet water that doesn’t flow much. It might even have algae in it. That’s what we have at the apex with regular irrigation—minimal flow. With the EndoVac, even the apex is like a white water rapids.
I also notice that the rotary files are working with half the effort when I use the EndoVac. Which means faster treatment and less chance of file breakage.
Studies have even shown that patients have less post-operative pain when the EndoVac is used for root canal irrigation. I find this too. Patients just don't have much pain after treatment anymore.
In fact, the combination of Microscope, rotary files, Resilon and EndoVac has reduced post-op pain from root canal treatments to a tiny minimum in my practice. Maybe it is time we re-named it.
T.A.F.T.-- Tooth Aqueduct Foundation Therapy?
Carnassial Bedrock Enhancements?
Someone stop me...