Paul Kobernick, D.D.S., F.R.C.D. (C)


Root Canal Therapy


Why do I need root canal therapy?

How is root canal performed?

How long will the procedure take?

What happens after the treatment?

How painful is the root canal treatment?

I don’t have pain, so why do I need a root canal treatment?

Why should I go to an Endodontist vs. a general dentist?

What is a retreatment?

What is endodontic surgery?


Why do I need root canal therapy?

The whole purpose of a root canal is to save your tooth. The only alternative is to remove the tooth and then replace it with an artificial one (bridge or implant).  This is not advised for two reasons. Firstly, although modern restorative techniques are very effective, dentists believe that your best teeth are your own. If properly performed and under normal circumstances, a root canal treated tooth can last you your lifetime.

The second reason not to remove your tooth, is that to replace this missing tooth with a bridge or implant, can be far more costly and time-consuming.

To help you understand why you might need a root canal, we need to first explain about the anatomy of a tooth. Inside a tooth, under the white enamel and another hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue. The pulp is important during a tooth's growth and development.

However, once a tooth is fully mature it can survive without the pulp, because the tooth is continuously nourished by the blood supply surrounding it. It is important to know that there are two main blood supplies to a tooth. The first is the central blood supply contained in the pulpal tissue. The second is the surrounding blood supply which nourishes the root of the tooth.

healthy tooth - root canal therapy
decayed tooth - root canal therapy

Root Canal treatment (endodontic therapy) is necessary when the pulp becomes inflamed or infected. There are several reasons why the pulp can become inflamed or infectioned; namely: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, any physical trauma to the tooth such as a fall or blow, may cause pulpal damage even if the tooth has no visible chips or cracks.

If pulp inflammation or infection is left untreated, it can cause pain and eventually lead to an abscess. An abscess, besides being very painful, can cause damage to the bone around the tooth.

Symptoms of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, pain while chewing or biting, and swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.


How is root canal performed?

Root Canal therapy involves removing the diseased or dead pulp and replacing it with a substance that will help prevent any reinfection. Although each case is different, the steps outlined below are ones generally followed in our office.

Step 1: Examination and diagnosis

First, Dr. Kobernick will go through your medical history and ask you questions about your tooth and any symptoms you are experiencing. Next, he performs a complete oral exam including oral cancer screening and then subsequently examines the tooth that may be causing you problems. He will test the tooth in various ways to determine whether or not the pulp tissue is diseased. Radiographs (x-rays) of the tooth will be taken. If a root canal procedure is required, Dr. Kobernick will discuss with you what he intends to do and answer any questions you might have.

Step 2. Preparing you for the procedure

Dr. Kobernick administers local anestethic to the area. You will wait several minutes until the tooth is totally numb. Many times a second injection will be given to further desensitize the area. Next Dr. Kobernick places a small protective sheet called a ``rubber dam" over the area to isolate your tooth and keep it clean and free of saliva during the procedure.

Step 3. Your tooth is opened.

Dr. Kobernick gently makes an opening in the crown of the tooth. Any tooth decay and broken fillings are removed. This procedure is called ``making of the access cavity".

Step 4. Cleaning and Shaping of the Root Canal system:

This procedure is the most difficult and time consuming. It involves complete removal of the infected pulpal tissue. It is by far the most important phase of root canal therapy. If performed accurately, it will definitely increase the success of the case. To perform this phase of therapy, Dr. Kobernick uses a series of very delicate, sterilized flexible finger-held instruments, called endodontic files, to clean and shape the canals. Other instruments called ”rotary files" are also used for this procedure. A total of 15 different sized micro-surgical instruments may be used to prepare the canals. Additional x-rays are taken to insure the instruments go exactly to the end of the root and not beyond.

Step 5. Filling the Canal

After the space is cleaned and shaped, Dr. Kobernick fills the root canals with a biocompatible material, called “gutta-percha." The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canal system. This procedure helps to prevent any reinfection of the root canal by occupying the space where bacteria might otherwise grow.

Step 6. Preparation of a Post Space

If the tooth lacks sufficient structure to hold the restoration in place, Dr. Kobernick may prepare a space for a post (small screw) inside the canal. When you return to your general dentist, he or she will use this space in the canal to place the post.

Step 7. Finishing the Root Canal

Lastly, Dr. Kobernick will fill your tooth (access cavity) with a temporary filling material. In most cases, this temporary restoration will be removed by your dentist before the tooth is restored with a permanent filling or crown.


How long will the procedure take?

Most often, Dr. Kobernick will complete a root canal in one or two visits. The length of each visit, will depend on the nature of the work to be performed. When you make your appointment, our receptionist can give you more information.


What happens after the treatment?

After each visit, you will be given special instructions to follow. Our staff and/or Dr. Kobernick will go over the instructions and give you a copy to take home with you. If you have any questions or if you would like to talk to Dr. Kobernick after your appointment, please feel free to call our office.

After your treatment, Dr. Kobernick will send a report of the details of your root canal treatment to your general dentist. The report will include 2 radiographs (x-rays) of your tooth; one picture of your tooth before it was treated (preoperative film), and another picture of your tooth after the root canal treatment (postoperative film).

Once the root canal is finished you will need to see your general dentist in approximately 2-4 weeks -- for placement of a permanent restoration to prevent the tooth from fracture and decay.

It is important to evaluate the healing process after root canal treatment. This is normally done at 6-9 months after completion of your root canal. We ask you to return to the office for this follow-up examination. During this appointment, Dr. Kobernick will examine the tooth and take an x-ray to evaluate the healing process. A report of his findings will be forwarded to your general dentist.


How painful is the root canal treatment?

Most of the pain associated with a root canal is felt before the treatment, when your tooth is super sensitive. The actual treatment itself should not be any more painful than having a tooth filled. Many of our patients are very surprised and tell us that they didn't feel anything after the initial injection to numb the area.

Dr. Kobernick allows extra time to ensure you are properly numb before he begins. He asks you several times during the treatment if you feel any discomfort. If you do, he will stop and give you more anesthesia before he continues.

For the first few days after the treatment, the tooth may feel sensitive. This is especially true if you had a lot of pain or infection prior to the treatment. You may be told to take over-the-counter medication or we will give you prescription medications to take to control the pain. It is important that you follow the instructions we give you so that any additional discomfort will be avoided. You may call our office at any time, if you have any questions.


I don’t have pain, so why do I need a root canal treatment?

There can be a prior history of damage to the pulpal tissue as a result of a deep filling, or other trauma, which may go undetected for months or even years, e.g., you have no pain. Many times you have had prior pain in the area of concern, but because the pain episode was brief you may have forgotten.

Absence of pain does not necessarily mean that a problem doesn't exist. During a dental exam, your dentist may see a particular tooth that is discolored in comparison to the others. This is not a normal situation and indicates an unhealthy pulp. In this instance it would be advisable to have root canal therapy. However, the approach to treatment may involve both surgical and non-surgical therapies.

In another situation, all your teeth may look or give the appearance of being healthy. However a radiograph (x-ray) might show otherwise. Your dentist may see an abscess at the end of the root, damages to the root structure itself, and/or changes in the pulpal tissue space that are abnormal. Any or all of these signs may present themselves without pain, however they would indicate the necessity for root canal therapy or possibly even extraction.

A tooth, although currently pain free, that is damaged and left untreated, will eventually flare up and cause you severe pain. If your dentist advises you that a root canal is required, it is in your best interest to follow her instructions and have the tooth treated before further damage occurs.


Why should I go to an Endodontist vs. a general dentist?

Endodontists, like Dr. Kobernick, are dentists who specialize in treating the inside of the teeth. Endodontists have 2 or more years of additional, intensive specialty training in root canal procedures after completing 4 years of dental school. They limit their practices to endodontics, concentrating in surgical and non-surgical root canal therapy.

Root canals are complex. Often there is more than one canal in each root, especially in the back teeth (molars). Canals are extremely difficult to see, even with the use of sophisticated instruments. Another intricacy arises when the roots are curved or very narrow. Because endodontists limit their practice to root canals and have the additional training, they are better suited to handle complex cases and have a higher degree of success than general dentists. Also you should note that the most qualified endodontist is a Board Certified Endodontist.  Most general or family dentists prefer that you go to a specialist for root canal treatment. By referring you to a specialist who performs only endodontic procedures, your family dentist is demonstrating a personal concern that you receive the best quality dental care.


What is a retreatment?

A small percentage of root canals will fail. The original dentist who did the root canal may not have completely cleaned or sealed the canals. Or perhaps, because some canals are so hard to see, the original dentist may have missed a canal altogether. Another reason for having to retreat the tooth is that you have new decay in the area. A loose or broken filling can cause new decay and expose the root canal filling to bacteria and saliva, thus causing the tooth to be reinfected.

For retreatment of a root canal the tooth is reopened and the canals are cleaned again and refilled. Some cases will require a surgical procedure which may include, but is not limited to, the surgical removal of the root tip.


What is endodontic surgery?

A standard root canal treatment as described above, is called ``Non-Surgical Root Canal Therapy" (NSRCT). This is a root canal which is performed through the crown of the tooth. The other type of root canal treatment is called ``Surgical Root Canal Therapy" (SRCT). This procedure involves accessing the root through the gum and bone tissues directly, thus performing a ``surgery".

There are different types of endodontic surgeries. One of the most common procedures is called apicoectomy. In this treatment, an opening is made in the gum tissue in the region of the problem tooth. Next, the infected tissue is removed sometimes including part of the root. The end of the remaining root in certain cases is sealed with a very small filling. Several sutures are then placed in the gum tissues and healing generally proceeds uneventfully.

Other types of endodontic surgeries include:

1) the curettage (removing inflamed tissue);

2) root amputation (selected removal of roots);

3) Hemisection (dividing the tooth in half); and

4) Intentional Replantation (removing and reinserting the tooth).


Dr. Paul Kobernick

5530 Wisconsin Ave., NW  Suite 814

Chevy Chase, MD 20815

Office Hours:

Monday through Friday

8:30 AM until 5:00 PM

Telephone:

Office:  301-913-0600

Fax:     301-913-9812

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