Dr. Raed Kamal D.M.D

Dental Care For The Whole Family

Winnipeg Family Dentist | Dr. Raed Kamal

If a tooth is repeatedly traumatized, or gets infected too deeply by bacteria, the nerve tissue and blood supply start to die off within the tooth. When this happens the infected and dying tissue can cause significant pain and an abscess (body can not fix the dying tissue inside the tooth, so tries to reject the tooth). To correct this, either an extraction or a root canal treatment is performed. This treatment involves removal of the dead and infected tissue and sealing of this space, usually with a rubber material and special cement or sealer. Although root canal treatments are rather successful, like all things, there is a failure rate. The anatomy of teeth is so complex that in some cases diseased tissue is missed either due to difficulty in finding it, or its inaccessibility, despite the skill of the dentist. When these treatments do fail, re-treatment can often be done to find what was missed, or even surgical treatment done to seal the root tips. And in other cases, the tooth is just extracted. To minimize the risk of a failed root canal treatment, treatment should be performed prior to the formation of any abscess. Once an abscess is present, the environment around the root tip is a lot more complex and less predictable for complete healing.

For many the thought of a root canal brings about images of intense pain. Fortunately, this is not always the case. The sooner a tooth is treated, the more comfortable it is, and more successful. Once an abscess sets in, it can be harder to freeze the area and maintain comfort during the procedure. In general, most root canal treatments performed at My Family Dentist have a similar comfort level to that of having a filling done. And in cases where the tooth was dying and causing a lot of pain, root canal treatment can bring about very quick relief.

Initial Root Canal Treatments

To understand root canal treatments more, lets look at a straight forward example. This patient had a dying tooth that was starting to cause some pain. Fortunately, root canal treatment was able to be performed before a full blown abscess kicked in. To do the root canal treatment a hole is drilled through the top of the tooth to gain access to where the nerve tissue and blood supply is. This space is called the pulp chamber. The first picture on the right shows the hole drilled in the top of the tooth to access the pulp chamber and the 4 channels of nerve tissue this tooth has.

Once the channels of nerve tissue are found, various files and cleaning solutions are used to clean out the dead and dying tissue and disinfect the area. Once thoroughly cleaned, the empty channels are filled with a heated rubber material and special cement or sealer. In the x-rays to the right, note how the darker lines inside the tooth (nerve channels) are filled in with white in the after shot (radiopaque rubber material).

endodontic winnipeg
Winnipeg before-after-endo-x-ray

endo-retreat-missed-canalAlthough root canal treatments are often very successful, in some cases problems can occur. The anatomy is very complex and there can be channels of tissue missed, or insufficiently cleaned enough to allow for complete healing. When this happens, the tooth can sometimes be retreated to find the offending tissue and complete the cleaning process. In other cases, a surgical approach or extraction are the options.

In the case to the right, the patient had root canal treatment done by an Endodontist (root canal specialist) about 10 years prior. Although the work that was done was good, and looked good on the x-ray, this treatment ultimately failed which was evidenced by an abscess around one of the root tips. This particular root usually has 2 channels of nerve tissue, of which one is commonly missed or very difficult to treat. Assuming this was the cause of the failure Dr. Schau performed a re-treatment. Upon opening the tooth, and with a bit of digging he found the untreated channel of nerve tissue and was able to clean it and seal it. The first picture shows the original work done with a dark spot around the root tip on the right (the abscess). The middle picture shows the final re-treatment which looks much the same as the original x-ray. The picture on the right shows the 4th channel of nerve tissue filled. The two channels in the one root are often so close together they overlap on the x-rays and appear as one unless an appropriate shift is taken with the x-ray to make them visible.

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