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Procedures

Dr. Harry G. Bobotis is a specialist and his practice is limited to the field of Endodontics.
The following is some basic information on Endodontics and a listing of the procedures that he performs along with their descriptions.

Root Canal Therapy
Apicoectomy
Internal Bleaching

You may also wish to visit the websites of the American Association of Endodontics and the American Dental Association. Both of these sites contain a wealth of information that you may find beneficial.

Basic Endodontic Information:
Endodontics
is a sub-specialty of dentistry that deals with the tooth pulp or nerve. Dentists specializing in this field are called Endodontics and complete an additional 2-3 years of training following dental school.

Root canals are the long passages full of soft tissue deep within the dentin of a tooth. In dentistry, endodontic treatment (root canal) is required to cure an infection of the root canal complex. A root canal, coupled with internal tooth bleaching, is also used to fix teeth that have blackened due to infiltration of decayed soft tissue into the dentin in the teeth, most often seen in frontal incisors that have been injured through a sudden impact.
At the center of a tooth is a hollow area that houses soft tissue, known as pulp. This hollow area contains a relatively wide space towards the chewing surface of the tooth called the pulp chamber. This pulp chamber is connected to the tip of the root of the tooth via thin hollow pipe-like canals—hence, the term "root canal". Human teeth normally have one to four canals; teeth toward the back have the most canals. These canals run through the center of the roots like pencil lead runs through the length of a pencil. The tooth receives nutrition through the blood vessels and nerves traversing these canals. Occasionally, a cavity on the outside of the tooth may allow this soft tissue to become infected. If left untreated a serious jaw infection can result. The infection and inflammation is very painful in most cases. Ideally treatment should take place before this happens.
To cure the infection and save the tooth, it is necessary for the dentist to open into the pulp chamber, and remove the infected pulp by filing it out of the root canals. Once that is done, the dentist fills the cavity with an inert material, usually Gutta-percha, and seals the opening. This procedure is known as root canal therapy. If enough of the tooth is damaged by the disease or removed as a result of the treatment, a crown is usually required.
For patients, root canal therapy is one of the most feared procedures in all of dentistry; contrary to popular belief, however, root canal treatment is usually painless due to effective pain control techniques used by the dentist while the treatment is being performed and the (optional) use of pain control medication after treatment.

 

Root Canal Therapy:
The most common procedure done in endodontics is root-canal therapy. The pulp (containing nerves, blood and lymph vessels) can become diseased or injured and thus is unable to repair itself. The pulp then dies and endodontic treatment is required. Endodontic treatment (Root-Canal Therapy) is the removal of diseased pulp tissue. The body's defense system can then repair the damage created by disease. The dentist will use a local anesthetic to make the procedure pain-free. A rubber dam isolates the tooth and provides a clean environment. An opening is made in the top of the tooth, then the pulp chamber and root canals are cleaned and shaped for filling and sealing. After completion of the procedure, the opening is filled with a temporary restoration, and the patient will then schedule an appointment with the general dentist for a permanent restoration. The aim of treatment is to remove infection (e.g. bacteria) from inside the tooth. If left, the infection would leak out of the tooth's root ends and make the surrounding bone ill and painful.

The way root canal therapy is performed today is vastly different than those done a few years ago, not to mention a decade ago. The potential level for quality care has dramatically increased. It is a thing of the past to do root canals in five to six appointments or by "touch or feel" because we could not see. Root canals can be done painlessly, faster, and more accurately due to the new technology available. To you as a consumer, if your dentist says there is nothing "new" in doing root canals, consider a referral for a second opinion.

Healthy Tooth

 

 

 

 

 

 

Root Canal Therapy is a dental procedure, performed with local anesthetic, which involves the removal of the nerve inside of the tooth because it has become irreversibly damaged or infected. This is usually due to the entry of bacteria into the center most part of the tooth called the dental pulp (nerve). ROOT CANAL is a commonly used term for endodontic therapy or root canal therapy. This procedure involves the removal of the entire nerve system, as well as cleaning, shaping and 3-dimensional filling of the canal system with gutta percha and a dental sealer. The procedure enables you to keep your natural tooth, which is preferable to any type of replacement. Following root canal therapy, you then return to your family dentist to have your tooth fully restored.

Decayed Tooth

 

 

 

 

 

 

Root Canal Therapy is a dental procedure, performed with local anesthetic, which involves the removal of the nerve inside of the tooth because it has become irreversibly damaged or infected. This is usually due to the entry of bacteria into the center most part of the tooth called the dental pulp (nerve). ROOT CANAL is a commonly used term for endodontic therapy or root canal therapy. This procedure involves the removal of the entire nerve system, as well as cleaning, shaping and 3-dimensional filling of the canal system with gutta percha and a dental sealer. The procedure enables you to keep your natural tooth, which is preferable to any type of replacement. Following root canal therapy, you then return to your family dentist to have your tooth fully restored.

Decayed Tooth

 

 

 

 

 

 

Root Canal Therapy

 

 

After the tooth is "numbed", a small opening is made into the pulp chamber. The canals are located and measured, so they can be cleansed and shaped using a series of hand files and engine-driven instruments.

 

 

Temporary Filling

 

 

The canals are filled with a rubber-like material called gutta-percha and the opening is sealed with sterile cotton pellets and a temporary filling.

 

 

Crown

 

 

The tooth is restored by your family dentist within a few weeks. Most often, a crown is placed in order to protect the tooth, and if the tooth lacks sufficient tooth structure to hold the core build-up, a post may be placed inside. Any areas of infection around the roots will begin to heal.

 

The number of visits necessary to complete a root canal will vary depending upon the degree of infection, the number of canals in the tooth, if the canals are calcified, the anatomy of your tooth, and the complexity of the procedure. We always strive to achieve the best possible result; therefore, your treatment may take one visit, or it may take more.

 

 

Apicoectomy:
Apicoectomy (L. apex, apicis: a summit or a tip), also known as root-end resection, is an endodontic surgical procedure whereby a tooth's root tip is removed. This is generally necessitated when an abscess forms following root canal therapy or re-treatment.

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip of each root is called the apex. Nerves and blood vessels enter the tooth through the apex, travel through a canal inside the root, and into the pulp chamber, which is inside the crown (the part of the tooth visible in the mouth).                                                

An apicoectomy may be needed when an infection develops or persists after root canal treatment or retreatment. During root canal treatment, the canals are cleaned and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.

If a root canal becomes infected again after a root canal has been done, it's often because of a problem near the apex of the root.  An apicoectomy is done only after a tooth has had at least one root canal procedure.
In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

If you're having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist, who will take X-rays and do an exam. If your dentist feels you need a retreatment or an apicoectomy, you will need to set up an appointment for a consultation.

abscessAn Apicoectomy, or Root-End Resection, is the removal of the root tip and the surrounding infected tissue of an abscessed tooth. This procedure may be necessary when inflammation and infection persists in the area around the root tip after root canal therapy or root canal retreatment.

 

 

 

removalAfter the tooth is "numbed", the gum is reflected (lifted) to uncover the underlying bone and the root end of the tooth. The root-end is resected (removed) with all the surrounding infected tissue.

 

 

 

 

suture
A root-end filling is placed to seal the end of the root canal, the gum is repositioned, and a few sutures (stitches) are placed to hold the gum tissue back in its place until healing occurs.

 

 

 

healed

After a few months, the bone around the root-end has healed, and all symptoms have resolved.

 

 

 

 

 

Internal Bleaching:
Internal, or non-vital, bleaching is used to lighten a darkly discolored tooth that has had root canal therapy. A chemical oxidizing agent is placed within the coronal portion of a tooth to remove tooth discoloration. This method is known as "walking bleach". In this procedure, bleach crystals are placed inside the tooth, left for several days and then the patient returns to the dental office to have the bleach crystals removed. Again, this procedure may be performed one or more times, depending upon the discoloration of the tooth. An endodontist commonly performs these procedures.

 
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