General Information

Endodontists are specialist dentists who originally trained as dentists and then specialised in the field of endodontics through a University training courses of 2-3 years. Dental specialists are registered with the New Zealand Dental Council (www.dentalcouncil.org.nz) as such.

The word "endodontic" comes from "endo" meaning within and "odont" meaning tooth. The best description of the field of endodontics is: The diagnosis, treatment and prevention of diseases and conditions involving the dental pulp, periapical tissues and periradicular tissues of teeth. In laymans terms that is identifying and fixing problems arising from inside of the teeth (nerve or root canal) and the structures around the root of the tooth.

The type of procedures we offer are root canal treatment, redoing root canal treatment (root canal retreatment), periapical surgery, management of dental trauma, dental implant treatment, vital pulp therapy (keeping the nerve inside the tooth alive), diagnosis of chronic pain, and dental implant treatment to replace teeth that need to be extracted.

The first stage of any treatment is make a diagnosis. The cause of infection is usually quickly apparent but oral pain can be more difficult to isolate. Tooth aches or cracked / fractured teeth can often be difficult to pinpoint.  Because of the vast network of nerves in the mouth, the pain of a damaged or diseased tooth often is felt in another tooth and/or in the head, neck, or ear. Occasionally pain may arise in teeth but the cause is not a tooth. There can be a number of causes for these chronic pains and elimination of teeth as a cause of these pains is important. An endodontist is a specialist in diagnosing and, in most cases, treating oral pain.

If the dental pulp inside the root canal becomes inflamed a tooth ache may result. If left, then the end result of this inflammation is the nerve inside the tooth dying.

The tooth may be kept with a procedure called Root Canal Treatment. The space in which the dental pulp sits (root canals) needs to be cleaned out and then permanently sealed.  Firstly the decay or offending restoration is removed and the pulp chamber entered. Then the root canals are filed with fine instruments and washed with antiseptic solutions. The root canals are sometimes very fine or occasionally calcified or blocked completely. It can be difficult to find and negotiate these fine canals and an operating microscope is of great help. 

The abscess usually does not need to be removed but heals by itself once the root canals have been properly cleaned.

Sometimes the root canals are temporarily filled with an antiseptic paste for 1-2 weeks, before the final root filling is placed.  The benefit of this is that it appears to give a cleaner root canal before the final filling is placed.

The final root filling is made of a cement and a core material called gutta percha. This root filling is carefully packed into the root canals to completely seal the root canals.

The tooth is then protected by a strong filling which should also prevent the sides of the tooth flexing which could cause leakage and potentially failure. Some teeth require the added protection of a crown but this is generally done a little later and by the referring dentist.

Occasionally a tooth that has undergone endodontic treatment fails to heal or pain continues despite therapy. Often the cause of this is due to inadequate initial treatment. In these cases redoing the root canal treatment will allow any infection and pain to resolve. A careful analysis of these cases will be made to assess whether redoing the original treatment will resolve these problems. The other choices to consider for these teeth are extraction or periapical surgery.

In some cases surgery to remove a persistent lesion (abscess) around the end of the root is necessary. This is generally only done if root canal treatment has been completed to a high standard or if retreatment of the root canal is not possible due to a post or obstruction in the tooth.

The proceudre involves making the area numb with local anaesthetic, making an incision around the tooth and lifting back the gum to access the persistent lesion. This lesion, generally an abscess or a cyst, is then removed and generally the end of the root sealed.

Teeth damaged by trauma can be affected in two ways - fracture of the tooth or displacement of the tooth. Sometimes a tooth may be both displaced and fractured. There are a number of tissues that may be damaged as result of an accident; dentine, the dental pulp (nerve), the root, the periodontal ligament (connects the root to the bone), the bone around the root, and the gum (gingiva) around the tooth. Many of these tissues are able to heal if properly managed but sometimes treatment is necessary to keep these teeth.

Endodontists are specially trained to managing dental trauma and treating complications related to dental trauma.

Knocked out (avulsed) teeth

Prompt treatment can save a tooth that has been knocked out. The point is to keep the fragile tissues on the surface of the root alive. The best way to do this is to replant the tooth back into its socket and if this is not possible then store the tooth in an appropriate solution. Milk is one of the best solutions and in most cases is easily accessible. Your dentist or endodontist should be seen as soon as possible following this type of injury. The key points are:

1. Replant the tooth if possible, as soon as possible. The tooth may need a quick clean under water but do not scrub it.

2. If it can't be replanted then place in milk or under your childs lip

3. Visit your dentist, or endodontist, as soon as you can

Sometimes a tooth needs to be extracted to resolve an infection around a tooth or because the tooth is too weak to keep. A dental implant can be used to replace a tooth. This involves placing a titanium implant into the bone where the root was. This then acts as a foundation for a porcelain crown. Dental implants are not suitbale in all cases or for all patients but it is a valuable option to replace a missing tooth. Dental implant treatment is one of the most significant developments in dentistry over the last 40 years and overall offer a very good success rate. Careful maintenance of these cases is required.