When the nerve of your tooth becomes infected, a successful root canal treatment lets you keep the tooth rather than having to pull it out. Keeping your tooth helps prevent your other teeth from drifting out of line and causing jaw problems. Saving a natural tooth avoids having to replace it with an artificial one.

What is Root Canal Treatment? 

Root canal treatment, also known as endodontic treatment, is the process of removing infected, injured or dead pulp from your tooth. The space inside the hard layers of each tooth is called the root canal system. This system is filled with soft dental pulp made up of nerves and blood vessels that help your tooth grow and develop. 

When bacteria (germs) enter your tooth through deep cavities, cracks or flawed fillings, your tooth can become abscessed. An abscessed tooth is a tooth with an infection in the pulp. If pulp becomes infected, it needs to be removed. An abscessed tooth may cause pain and/or swelling. Your dentist may notice the infection from a dental x-ray or other changes with the tooth. If left untreated, an abscessed tooth can cause serious oral health problems. 

Who Does This Procedure?

Your dentist may do root canal treatment or refer you to an endodontist. An endodontist is a dentist who has completed a university post-graduate specialty program in endodontics. Endodontics is a specialty of dentistry concerned with the treatment of the dental pulp or nerve of the tooth.

If your child’s primary (baby) tooth is damaged, your dentist may refer you to a pediatric dentist for this procedure. A pediatric dentist has at least 2 years of extra university training in treating children. 

How is a Root Canal Treatment Done?

1. The dentist gives you a local anesthetic (freezing).
2. To protect your tooth from bacteria in your saliva during the treatment, the dentist places a rubber dam around the tooth being treated.
3. The dentist makes an opening in the tooth to reach the root canal system and the damaged pulp.
4. Using very fine dental instruments, the dentist removes the pulp by cleaning and enlarging the root canal system.
5. After the canal has been cleaned, the dentist fills and seals the canal.
6. The opening of the tooth is then sealed with either a temporary or permanent filling.

Tooth Restoration After Root Canal Treatment

After a root canal treatment, your tooth has to be restored to look, feel and work as much like a natural tooth as possible. If an endodontist performed your root canal treatment, he or she will fill the opening of the tooth with a temporary filling and send you back to your dentist or prosthodontist for tooth restoration. 

A prosthodontist is a dental specialist who restores and replaces teeth using crowns, bridges, dentures and implants. Your dentist or specialist may use a permanent filling or a crown to restore your tooth. The choice of restoration will depend on the strength of the part of the tooth that’s left. A back tooth will likely need a crown because chewing puts a great deal of force on back teeth. If there is not enough of the tooth left, posts may be used to help support the crown. 

What Else Should I Know?

Root canal treatment may be done in 1 or 2 appointments. After root canal treatment, your tooth may be tender for the first week or two. Bad pain or swelling are NOT common. If this happens, call your dentist or endodontist. 

You can still get a cavity or gum disease after a root canal treatment. Root canal treatment does not protect your tooth from other types of damage. With proper care and regular dental visits, the tooth could last as long as your other teeth. Most of the time, a tooth that has had a root canal treatment can be saved. However, there are cases where everything possible has been done to save a tooth and still the tooth must be extracted.

Most root canal treatments are successful. But in some rare cases, a second root canal treatment is needed. This is called retreatment. When retreating a tooth, the root canal filling material is taken out and the canal is cleaned, reshaped and refilled.

Root Canal Surgery 
Sometimes root canal surgery is needed when a regular root canal treatment cannot be done or when it has not worked. Surgery is done to: 

• Check the end of the root for fractures (cracks).
• Remove parts of the root that could not be cleaned during regular root canal treatment.
• Clear up an infection that did not heal after regular treatment.

If one or more of your teeth are missing, there are a number of ways to replace them. An alternative to bridges, partials or complete dentures may be dental implants. Implants are used to replace missing roots and support artificial replacement teeth. They are comfortable and look like natural teeth. 

What are dental implants?

A dental implant is an artificial root made of titanium metal. It is inserted into the jawbone to replace the root of the natural tooth. An artificial replacement tooth is attached to the implant. The implant acts as an anchor to hold the replacement tooth in place. 

Who does this procedure?

If you are having an implant, your dentist may refer you to a dental specialist who has further training in this area. Specialists who place implants are periodontists or oral and maxillofacial surgeons, also called oral surgeons. Specialists who place crowns, bridges and dentures on implants are called prosthodontists. 

Who can get dental implants?

If you are in good general health, have healthy gums and have enough bone in the jaw to hold an implant, dental implants might be right for you. If your jawbone has shrunk or if it has not developed normally, you may be able to have a bone graft to build up the bone. A bone graft is a way of adding new bone to your jawbone. Your dentist or dental specialist will tell you if bone grafting can be done. 

How dental implants are done

• Your dentist or specialist will carefully examine your mouth and take x-rays of your head, jaw and teeth to find out if dental implants are right for you.
• During the first stage of surgery, your dentist or specialist will put a dental implant into your jawbone beneath the gum tissue. The gum tissue is then stitched back into place. As the tissue heals, the implant will bond with the bone and attach to the gum. It can take several months to heal.
• During the second stage of surgery and once the tissue is healed, your dentist or specialist will attach an abutment to the implant. An abutment is a post that connects the replacement tooth to the implant. In some cases, the first and second stage of implant surgery may be done in one single stage.
• An artificial replacement tooth is made and your dentist or specialist attaches it to the abutment. It may take several appointments to properly fit the replacement tooth to the abutment.
• When replacing several teeth or all of your teeth, a fixed bridge is anchored to your dental implants. A bridge is a dental restoration that replaces one or more missing teeth by spanning an area that has no teeth. The bridge is held firmly in place by dental implants on each side of the missing tooth or teeth.

Caring for my dental implant(s)

Because dental implants are placed in the jawbone, artificial replacement teeth attached to implants look and act much like natural teeth. Like natural teeth, implants need to be kept clean using a toothbrush and floss. Your dentist will show you the proper cleaning procedure for implants. Regular dental check-ups are important so your dentist can make sure that your bite is right and that your implants are not loose. 

What else should I know?

• Several visits to your dentist or dental specialist may be needed until the process is done.
• Check-ups will be scheduled during the following year so your dentist can be sure your implants are working properly.
• You will need to take very good care of your implants.
• Implants can cost more than other kinds of replacement teeth and might not be covered by your dental plan. But in most cases, this is a one-time cost, unlike other kinds of tooth replacement procedures.
• Although rare, possible complications due to dental implants include bleeding, infection, numbness or injury to nearby muscles or the sinus cavity. In some cases, the implant may not be successful because it didn’t bond to the bone.

If your tooth is damaged but not lost, a crown can be used to restore its shape, appearance and function. You may need a crown if you have a root canal, a large filling in a tooth or a broken tooth.

A crown, also called a cap, is a hollow, artificial tooth used to cover a damaged or decayed tooth. The crown restores the tooth and protects it from further damage. Crowns can also be used to cover a discoloured or misshapen tooth. A tooth that has been fixed with a crown looks and works very much like a natural tooth. 

Who does this procedure?

If you need to have a tooth crowned, your dentist may do it, or he or she may refer you to a prosthodontist. A prosthodontist is a dentist who has completed a university post-graduate specialty program in prosthodontics. Prosthodontics is a specialty of dentistry that deals with restoring and replacing natural teeth and tissues with artificial substitutes. 

How a crown is done

1. Your dentist gives you a local anesthetic.
2. To make room for the crown, your dentist files down the tooth that needs to be restored.
3. An impression of the filed-down tooth and nearby teeth is taken. This impression is used to custom make your final crown. The crown is built using restorative material (material used for fillings) based on the impression. The final crown will be the right shape for your mouth.
4. Until your final crown is ready, your dentist places a temporary crown over the tooth that needs to be restored. The temporary crown is made from an impression of your tooth before it was filed down. It protects your tooth until the final crown is ready. A temporary crown may not have the same shape and colour as a final crown.
5. On your next visit, your dentist takes off the temporary crown and puts on the final one. Your dentist checks to make sure the crown is the right fit, shape, colour and bite. If it is, your dentist cements the crown into place.

These are the steps dentists most often follow in making a crown, but your tooth may need special care. You may need orthodontic treatment, gum treatment or root canal treatment. It may take more than 2 visits to your dentist, or your visits may last longer.

Different types of crowns

Crowns are made from various types of materials. Depending on which tooth needs a crown, your dentist will suggest a material, or combination of materials, that is right for you. 

Metal crowns are made of gold. They generally last a long time and won’t chip or break. They tend not to wear down your opposing natural teeth. However, the gold colour does not look natural, particularly on front teeth. 

Composite crowns look natural. They won’t chip as easily as porcelain crowns, but they tend to wear more quickly from chewing. Tooth brushing tends to remove the highly polished surface of composite crowns and this causes them to stain more easily. 

Porcelain crowns look the most natural. They are more brittle than metal or composite and may chip more easily. Because of this, they are not usually placed on back teeth. 

Porcelain-fused-to-metal crowns look natural and are stronger than porcelain or composite crowns. They won’t chip as easily as porcelain or ceramic crowns. However, depending on their design, the metal may show if your gums are thin or shrink. 

What else should I know?

Crowns are strong and generally last for about 10 years or longer if you take good care of them. Brush and floss your crown, just like you clean your natural teeth. Crowns may not be as strong as your natural teeth. So, like your natural teeth, remember not to bite down on hard objects or use your teeth to open or cut things.