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Root canal therapy is an important tool in a dentist’s arsenal to save and maintain our teeth. For many it is a scary procedure we try to avoid, but with a little knowledge, it can take some of the fear away and put your mind at ease. A root canal should not be avoided due to fear, understanding what to expect and why may help you get the treatment you need when you need it.

Root Canal Therapy Frequently Asked Questions

What Is Root Canal Therapy?

Root Canal Therapy (also referred to as root canal treatment or endodontic treatment)  is a dental procedure in which the diseased, decayed tooth, or damaged nerve of a tooth is removed and the inside areas (the nerve and canals within the roots) are cleaned, filled and sealed permanently to avoid infection. Without treatment, the surrounding tissues of the tooth (including the gums and bone) will become infected and a dental abscess can form.

A tooth’s nerve and blood vessel provide nutrients and hydration to a tooth as well as sense of temperature. It provides the sensation of hot or cold. The absence of a nerve will affect the strength of a tooth and make it become more brittle and susceptible to fracture if not protected by a crown.

How Do I Know If Root Canal Therapy Is Needed?

Common symptoms related to an infected tooth include tooth sensitivity (to hot or cold temperatures or even both), sensitivity to touch, toothache/sharp pain when chewing, swelling in the area of the tooth, or a bad taste in the mouth. These symptoms need to be evaluated by a dentist immediately to prevent further pain or damage.

What If I Ignore My Symptoms? Will They Just Go Away?

If the symptoms are ignored and treatment is not begun, the inflammation can progress to infection. Infection will continue to invade the tissues and tooth causing the tooth to become more painful and may become a health threat. Once the tooth “dies”, there are only two choices: extract the damaged tooth or perform root canal therapy.

How Is My Tooth Restored After Root Canal Therapy?

Depending on the extent of the damage to the tooth, your dentist can recommend a dental composite restoration to close the tooth or in most cases recommend a dental crown to protect the tooth against future damage. Over time, the tooth with the root canal therapy will dehydrate. This will make the tooth brittle and more susceptible to fracture/breaking. Most often, a crown is placed after root canal treatment is completed to protect the tooth and restore full function.

Is Root Canal Therapy Painful?

Typically, root canal therapy should cause no more discomfort than a simple dental filling). The pain most people associate with root canal therapy is due to the infection that develops. Root canal therapy actually relieves the pain by removing the dental infection and pressure.

What Are The Advantages Of Root Canal Therapy?

Saving the natural tooth with root canal treatment has many advantages:

-Efficient Chewing.

-Maintains Normal Biting Force And Sensation.

-Natural Looking Appearance.

-Protects other teeth from excessive wear or strain.

Root Canal Therapy helps you maintain your natural smile, continue eating the foods you love and limits the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last as long as other natural teeth and often for a lifetime.

Are There any Risks Or Complications?

Over 90 % of root canal therapy procedures are successful. However, there is a chance of a failed root canal. Sometimes the root canal therapy needs to be redone due to diseased canal offshoots that went unnoticed, the fracture of a filing instrument, or a fracture or perforation in the root. The signs of a root canal therapy failure are marked by a return of pain, pressure, and sensitivity.

Is There An Alternative To Root Canal Therapy?

There are other options. One includes extracting the infected tooth. Then the question becomes how to replace the tooth. A few options are possible and these include a dental bridge and a dental implant. The success rate of root canal therapy is over 90% so it is an excellent option to save your own natural tooth if at all possible.

What Can You Expect After Root Canal Therapy?

Most patients feel some sensitivity for a few days afterward. For many it is easily relieved with an over the counter pain medication (aleve or ibuprofen).

Can Root Canal Therapy Be Avoided?

Some tips include maintaining good dental hygiene, see your dentist and hygienist regularly, eat a well balanced diet, and wear a custom made sports mouthguards to decrease dental trauma. Root canals, unfortunately, are not entirely unavoidable, and may happen even with good hygiene and care.

Root Canal Therapy Conclusion

Many are fearful of the root canal therapy procedure but in reality it is not the horror that many believe it to be. Root canal therapy is an easy way to save your teeth in the event of dental trauma, decay, or dental infection. Knowing what to expect can go a long way to alleviating any fears you may have. It is important to save your natural teeth whenever possible.

With the movement of modern cosmetic dentistry into all porcelain crowns from traditional porcelain fused to metal crowns (PFM crowns), many have wondered if the

Porcelain Crowns Marielaina Perrone DDS

The Natural Look of Porcelain Crowns

porcelain crowns would be as effective in the long term. Well, recent studies have shown that they are just as strong and maintain their beauty over time as well.

The main differences in porcelain crowns are the type of porcelain used, and how they are fabricated. Different porcelain types and strengths are used for different reasons. Remember also, that a lab created porcelain crown, is of higher fabrication quality and fit, than an in office computer milled crown.

Porcelain Crowns Long Term Study

The researchers at the Medical University at Innsbruck studied a little over 1,300 all porcelain crowns placed between 1987 and 2009. They were tested for predictability and strength and found to have a high,(93.5% probability of survival) success over a 10 year period. The study was published in the International Journal of Prosthodontics). The study included those with root canal teeth, and those who grind their teeth.

A total of 302 patients (120 men and 182 women) participated in the study. They were examined at the university during regularly scheduled visits for dental examination. Patient-specific data about sex, age, tooth sensitivity, smoking, and grinding  were noted, as well as self-reported data regarding their level of

Cosmetic Dentist Marielaina Perrone DDS

satisfaction with their restorations: excellent, good, medium, or none. The porcelain crowns were broken down into areas of mouth as well, into front( anterior), and back( premolar, and molar) regions.
All 1,335 porcelain crowns had been placed at the university between November 1987 and December 2009. Of these porcelain crowns, 451 were observed over a 10-year period, 84 for 15 years, and 24 over 20 years.

Dental examinations were completed by two dentists in the spring of 2010. One dentist had placed the majority of porcelain crowns, whereas the other dentist involved in examinations had placed none of them. California Dental Association/Ryge criteria were used to rate each porcelain crowns as a success, relative failure, or absolute failure.

Any porcelain crowns that had severe enough issues to warrant replacement were considered an absolute failure. If a finishing procedure or polishing was able to fix the issue, the porcelain crown was labeled a relative failure.

Of the 1,300+ porcelain crowns in the study, only 95 porcelain crowns were rated as failures, 79% of which were absolute failure. Most failures occurred in the anterior region, with 65, while 19 occurred in premolars and 11 occurred in molars.

Success rates remained strong over time. The estimated survival rate was 97.3% at five years, 96% at eight years, 94% at 10 years, 85.8% at 15 years, and 78.5% after 20

Porcelain Crowns Marielaina Perrone DDS

The Beauty Of Porcelain Crowns

years. Almost half of all porcelain crown failures happened in the first 8 years..

The most frequent reason for failure was fracture,(cracks) of the ceramic, according to the researchers, followed in order by cracks in the ceramic and decay.

Root canal teeth and patients who grind their teeth, had higher failure rates.

Patient responses to questions about satisfaction were very positive. With 96% rating it as excellent and 4% rating it as good. The surprising thing about this study was that even patients with failures thought that porcelain crowns were an ideal dental restoration and would do it all over again.

Porcelain Crowns Conclusion

Porcelain crowns are a proven part of cosmetic dentistry and with recent advances in dental porcelain (like e.max porcelain crowns) these results will be even better into the future. Porcelain crowns are an ideal restoration due to their color, shape, and light reflecting properties. The study just proves that they are an asset to any dental patient.

 

Avulsed Tooth is the complete displacement of a tooth from its socket in alveolar bone from trauma.

Dentists generally refer to a tooth that has been knocked out as an avulsed tooth. The accidental loss of a tooth through trauma ( avulsed tooth ) is considered a very serious dental emergency for a permanent tooth (occurs in about 1/10th of the population). For an avulsed primary tooth re-implantation is generally not successful, and is usually left alone. For a permanent tooth if you act quickly enough there is a chance the avulsed tooth can be saved and maintained for many years. Even the best techniques and intentions do not always lead to a successful outcome for an avulsed tooth.

The usual cause of an avulsed tooth is a  force sufficient to break the bond between the tooth and the connection (periodontal ligament ) to the bone. An avulsed tooth has no oxygen or blood flow and will die quickly if not re implanted. The primary goal of quick reimplementation is to maintain the periodontal ligament, so that the tooth is not rejected. The avulsed tooth will always need to be splinted to the other teeth, and usually, but not always, require a root canal. The speed in which the tooth is re implanted, the cleanliness of it, and how hydrated or wet it has been all play key roles in whether or not re-implantation of the avulsed tooth will be successful.

Instructions for an Avulsed Tooth

If a tooth has avulsed due to trauma it must be re implanted in its socket within 60 minutes (or sooner if possible) of the accident for the best chance of a positive result (i.e. tooth remains in position). It is important to keep the root surface of the avulsed tooth moist. This is the reason for the need for speed when re implanting the tooth.

An avulsed tooth, whose structure is maintained without any major fracture, must be re-implanted in its socket within an hour after the accident for best chances for it to remain in position. The best option is to attempt re-implantation within the first few minutes at the site where the accident occurred. The avulsed tooth should be attempted to be cleaned and placed back into the socket ( hole in jaw ) by an adult. This can be either the person who lost his or her tooth or by an adult if a child has suffered the trauma. If the avulsed tooth goes back into its socket where it was originally then it would be considered to be a successful re-implantation.

smileIf the avulsed tooth is dirty, it is vitally important that it is cleaned, the best way is with the patient’s own saliva by putting it in their mouth. Once the avulsed tooth is cleaned in this manner the patient should spit out any blood and dirt in mouth. While spitting, you probably will remove the blood clot forming in the avulsed tooth socket. This will allow an easier re-implantation of the avulsed tooth into the socket. the tooth can also be rinsed with cold water or milk. When the avulsed tooth is as clean as you can get it, it should be placed back in the socket as soon as possible. The quicker it is done, the better the chance for success. There are also “tooth saver” kits made to hold and keep the avulsed tooth wet for transport to a dentist.

If the avulsed tooth cannot be repositioned in its socket for any reason, then it should be brought to the dentist as soon as possible. There are a few ways to accomplish this:

1) The avulsed tooth should be rinsed and cleaned as explained above. The person who had the accident must then keep the avulsed tooth in their mouth. They should keep the avulsed tooth under the tongue or between the cheek and back teeth or lip and front teeth. If the trauma happened to a young child the previous advice should be disregarded as they can swallow the tooth. In such a case, the avulsed tooth should be rinsed and placed in milk, or in water with salt. Go to your dentist as soon as possible.

2) After cleaning with saliva, the avulsed tooth can be put in a solution of water and salt. A half a teaspoon of salt should be mixed in a cup of water. It is best to use bottled water if it is  available, but tap water can also be used in a pinch.

3) The avulsed tooth can also be placed in fresh room temperature milk. The patient and avulsed tooth in solution should be brought to the dentist as soon as possibleSave-a-tooth avulsed tooth kit

4) There is a commercial product available for the storage of an avulsed tooth. It is called Save-A-Tooth. This is a small container containing fluid to help preserve the avulsed tooth  for easy transport and re-implantation.

Exceptions to the Rule

The instructions above are recommended for adult teeth only. If a primary tooth (also called baby tooth) has avulsed following an accident, the re-implantation will not really work.

-If the adult avulsed tooth is broken or has visible fractures following the trauma, and or its root remained in the socket, the re-implantation will not be successful. This is because the tooth will not reattach to its root, and a fractured tooth will continue to break down.

Prognosis of Avulsed Tooth following Re-Implantation

It should be remembered that even if you follow all of these recommendations precisely, the tooth in question may eventually need to be extracted. If the instructions are followed correctly, chances are better that the tooth may remain in position.  An immediate splinting to the other teeth is optimal to take stress off the tooth and allow for healing. It may eventually need root canal treatment and possibly a crown to restore the avulsed tooth to its full form and function.

The re implanted  tooth can also seem to be fine for a few months or even a few years before it eventually becomes a problem.

At the Dentist Office

Putting the avulsed tooth back in its socket sometimes can be quite easy. And sometimes it can be very complicated, such as when the tooth or bone is fractured or broken. Your dentist may use water to flush debris from the socket. Then they will attempt to slide the avulsed tooth back into place. As mentioned earlier, it is most important to re implant the tooth as soon as possible. Ideally, this should occur within the hour of the accident.

The best course to take will depend upon how long the tooth was out of the mouth and amount of trauma. In either case, the dentist will splint the avulsed tooth to the teeth on either side with a soft wire and/or a resin material. This will be used to maintain the tooth in place for days-weeks.

If the bone around the tooth was not fractured, the root usually will reattach firmly to the bone in about three to four weeks. More extensive damage to the area may need 6-8 weeks of healing time.

Your dentist should examine the tooth again in three to six months to ensure the tooth is doing fine with no evidence of infection occurring. If there are no signs of infection, the next visit will be at your yearly dental examination. The dentist will then continue to monitor the tooth for the next 2-3 years to ensure that the tooth re implanted successfully.

 

Porcelain crowns have been a staple in cosmetic dentistry for years. It gives the dentist and patient a much more aesthetic appearance as a final product. In the past crowns and bridges were traditionally made of porcelain fused to metal (PFM). With the development of modern porcelain, which are incredibly strong and reflect light similar to natural teeth, full porcelain crowns can be used in most areas in which porcelain fused to metal crowns were used. This is especially true in a cosmetic area of the mouth.

Porcelain crowns are very versatile and used in many ways. The cosmetic enhancement use of porcelain crowns include, changing color of teeth, closing gaps between teeth, fixing teeth that are crooked or crowded, changing shape or size of teeth. Porcelain crowns are also used to cover and protect damaged teeth, (tooth that has a root canal, broken, cracked, large fillings), and to act as a new tooth in the case of dental implants. Their versatility gives the dentist a greater flexibility in using them to fix potential issues for the patient.

cosmetic dentist emax crown

Emax Porcelain Crowns

The first step often times includes impressions for study models and photos. The patient and dentist can then discuss and plan what the end result should be. The treatment includes preparation of the tooth surface for the porcelain crowns. The outer enamel and sometimes a bit of  the dentin are removed. This allows room for the porcelain crowns to fit over the teeth and be in perfect cosmetic alignment with the others. Impressions are taken of the newly reshaped teeth and temporary crowns are made.  The porcelain crowns are custom made in the laboratory. The porcelain crowns are then cemented or bonded onto the teeth using an adhesive bonding material. The placement of the porcelain crown will normally take about 30 minutes (depends on amount of porcelain crowns being placed). Once completed,  the patient can eat normally and enjoy the benefits of a beautiful new porcelain crown that matches and blends perfectly with the patients existing teeth. Only you and the dentist should know anything was done.

Advantages of All Porcelain Crowns

-No PFM gray or black lines at the Gum Line of Teeth. You may have noticed a person with a dark line in the gum area along a PFM crown edge. With PFM crowns, the soft tissue around the tooth can recede over time. This allows a reveal of the metal framework underneath. This cannot happen with an all porcelain crowns because they are metal free.

-Perfect Fit. Porcelain crowns are created in state of the art facilities. Porcelain crowns will fit so well you will even forget they are present.

-Cosmetically Perfect Match. All porcelain crowns have the ability with modern porcelains to match your existing shade of tooth color as well as mimic the light reflecting properties of your natural teeth. Porcelain crowns will be undetectable to anyone but you and your dentist. Dental porcelain can be shaped custom colored and sculpted to closely copy the look of your own natural tooth enamel. All the while providing the desired strength and resilience.

Some disadvantages of an all porcelain crowns:

-Higher cost over traditional PFM crowns.

-Durability. While porcelain crowns are very durable, they do not have the flexibility of natural teeth, they can fracture. Avoiding certain foods may be necessary. For example, Biting into sandwich with a hard bread. Patients who grind and clench their teeth will need to be fitted with a mouth guard to protect the porcelain crown from unnecessary and excessive pressures.

-Porcelain crowns may need a bit more reduction of tooth structure than traditional PFM crowns.

-Sensitivity may happen for a short time, (hot, cold sensitivity), especially with bonded porcelain crowns.

Follow-up Maintenance of All Porcelain Crowns

The maintenance of porcelain crowns is actually very easy.  They require routine brushing with non-abrasive fluoride toothpaste and regular flossing as well as regular visits to the dentist. A follow-up appointment will be scheduled to evaluate the porcelain crowns about 2-4 weeks after they are placed in the mouth This allows the dentist to review the work with tissues all healed and see how your oral tissues are reacting to the crowns. Even if you think the crowns are successful, this appointment is an important part of your future oral health.
There are several types of all porcelain crowns generally used in dental offices today. They have all proven to give the best cosmetic dental results.
-Zirconia Crowns or Lava Crowns (made by 3M Espe). This type of all porcelain crowns are made out of a zirconium core with porcelain pressed or layered over the crown to follow the natural contours of teeth. These crowns offer good strength and durability. Due to great strength, the material can be used to make a bridge.
-Procera Crowns (made by Nobel Biocare). These are made of an Alumina core with porcelain pressed or layered over the crown to follow the natural contours of the teeth. These crowns offer great strength and durability and are esthetically quite beautiful. Often used in the back of the mouth, (premolars, molars), these are cemented in with traditional cement and have less post-placement sensitivity.
-Empress II Crowns (made by Ivoclar Vivadent).These highly cosmetic porcelain crowns are used in the front of the mouth. They are used mostly for cosmetics, are very beautiful, but can fracture.
-eMAX Crowns or IPS e.MAX Crowns (made by Ivoclar Vivadent). These porcelain crowns are entirely made out of porcelain without a underlying framework. The absence of this framework offers a great advantage over Zirconia crowns, Lava crowns and Procera crowns in that e.MAX crowns allow for more light transmission through the crown translating to a more superior cosmetic dental result. The strength of these porcelain crowns is such that they can be used in any area of the mouth, can be made thinner than most porcelains, and can be used for an implant without much worry of fracture.
Cosmetic Dentistry is the art and science of creating a beautiful smile. The all porcelain crowns are just one more tool that the dentist can use to give you that smile you’ve always dreamed of.
Procera Porcelain CrownsLava Crowns Ivoclar VivadentPorcelain Crowns 3M Espe