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What Is Non-Surgical Root Canal Treatment (NSRCT)?

Non-surgical root canal treatment is a procedure directed towards saving an endodontically failing tooth. At times, the patient's existing artificial crown must be removed. In other instances, access through the crown may be possible. The access opening is created in order to give the dentist non-surgical access into the root canal space through the biting surface of the tooth. Once this has been accomplished, a non-surgical retreatment procedure oftentimes requires:

  • Locating and treating previously missed canals.
  • Removing old filling materials from the root canal space.
  • Removing posts and broken instruments.
  • Enhancing existing root canal treatment.
  • Negotiating blocked canals and bypassing canal ledges.
  • Repairing mechanical and pathological perforations in the root.

Once these objectives have been accomplished, the root canal system is re-cleaned, re-shaped, disinfected, and three-dimensionally sealed. A protective restoration can then be placed and the tooth restored to a state of health and function.

 

What Is Surgical Root Canal Treatment (SRCT)?

Surgical root canal treatment is a procedural effort in which it is necessary to elevate a small flap of tissue adjacent to the involved tooth in order to gain access to and treat root canal disease. Surgical root canal treatments are usually minor, in-office procedures performed under local anaesthesia. Once the pathological area is exposed, the doctor performs a "curettage" to remove the diseased tissue from around the root. This is usually followed by an "apicoectomy," a procedure in which the diseased portion of the root is removed. A small filling is then usually placed to seal the remaining portion of the root. Surgical root canal treatment will oftentimes result in a good long-term prognosis for the tooth if the cause of pathology can be effectively eliminated.
Unfortunately, on occasion, retreatment efforts may not be possible or cost-effective and extraction may be the only alternative. However, saving a tooth that has been previously treated endodontically and is failing is usually possible, can be very predictable, and is typically the most conservative option for the patient.

Today, well-trained general dentists and specialists alike can oftentimes perform non-surgical endodontic retreatment in a very predictable, cost-effective, and time saving manner when compared to other treatment alternatives. At times, however, retreatment cannot be managed with non-surgical efforts alone. In these situations, and as an alternative to extraction, a surgical approach may be necessary.

 

Alternatives to Root Canal Treatment - The only alternative to root canal treatment is the extraction of the problematic tooth. It is wise to consider all of the implications of losing a tooth before having it removed. The decision should not be made hastily or because the tooth is painful. If pain is present and the dentist thinks that the tooth can be saved, the discomfort can first be relieved and then the alternatives explored.

The discussion about tooth replacement alternatives after extraction can be complex because each individual situation is unique and, at times, various specialists may need to be consulted. When considering the alternatives for replacing a missing tooth, a few of the major factors to consider are the long-term predictabilities of the various alternatives, the overall chair time involved in treatment, the esthetic results, the effects on the adjacent and opposing teeth, and the costs. The usual alternatives that a patient has after tooth extraction are:

  • A restored dental implant. This restoration involves a surgical procedure to insert the dental implant into the bone, a healing phase of several months, and a final restorative phase, which is similar to having a single tooth crown. Significant time and laboratory costs are involved.
  • A fixed bridge. Fabricating a fixed bridge requires cutting down ("preparing") the teeth next to the missing tooth so that they can receive the artificial crowns that support the replacement tooth. These teeth must be strong and healthy if they are to be effective bridge supports. Preparing the teeth for crowns could have a detrimental effect on their pulp health, depending on a variety of factors. This possibility needs to be discussed and factored into your decision. Fixed bridges may take multiple appointments to complete and have significant associated costs.
  • A removable partial denture. These appliances restore function and esthetics and can be inserted into the mouth and removed at will. Although many teeth are successfully replaced with removable prosthetic appliances, patients may initially find them cumbersome. Removable partial dentures may also temporarily alter phonetics as well as place unfavourable forces on the supporting teeth and soft tissues. There may be significant costs associated with this restoration.
  • Not replacing the extracted tooth. This is a poor choice in most situations. Leaving a space after extraction can lead to long-term problems with teeth shifting and tipping, destabilization of the biting system, and esthetic changes in the profile of the face. Financially and psychologically, this could turn out to be the most costly choice over the lifetime of the patient.

After considering and weighing all of the consequences of extraction and all of the alternatives for tooth replacement, in most situations it becomes obvious that well-performed root canal treatment with a protective restoration is the treatment of choice. Root canal treatment is usually the least time-consuming, the least invasive, and Ortho.

Inlays / Onlays
These are restorations that can replace missing or broken tooth structure when a filling just won't be strong enough. These restorations can be made of tooth colored ceramics (porcelains), composites or polyglass materials (plastics with fillers such as quartz, fiber, or glasses).
Porcelain Crowns
Porcelain crowns are another restorative dentistry procedure that can be used for correcting teeth defect. Sometimes teeth become too unstable for repairing. This is when porcelain crowns can be used for correcting the condition. Here the entire outside portion of the teeth is covered up with porcelain veneers to help you in getting back the perfect teeth.
Implants
Implants are a restorative dentistry procedure that can be used for replacing missing teeth. In this procedure titanium roots are placed in the jawbone of missing teeth. The jawbone must be strong enough to support new growth of teeth. The roots can be used for building a single tooth or a set of teeth as may be needed for filling up the gap in a person’s mouth.
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