Root canal treatment is carried out on a tooth which has a dead nerve, an abscess of the roots, or a painful and irreversible inflammation of the nerve.  It involves making an access hole on top of the tooth, and removing the nerve tissue within the canals with special files.  These canals are then widened and irrigated to remove any remaining infected tissue, after which they are dried and ultimately filled with a special paste, which is intended to seal the canal space.

There is a common misconception that because of the controversy surrounding root canals, many people avoid treatment of dead teeth despite the fact that these dead nerves act as a mini gangrene made up of the utmost toxic material. These teeth have to be treated at all costs.

Alternative treatment includes extraction of the tooth, which then necessitates the placement of a bridge or an implant to cover the space of the missing tooth and to restore the bite.

Root canal risks:

• Some roots, which are thin, bent, flat, or decayed may be perforated or fractured by the root canal procedure. This compromises the outcome of the treatment and the tooth might need to be extracted.
• Root canalled teeth are more brittle because they are dead and do not receive nutrition from the pulp. This makes them more vulnerable to fractures.
• Vertical fractures may develop in a root canalled tooth due to the propagation of an existing micro-fracture already present in a tooth that has had a previous root canal, due to a post placed to build the tooth up for a crown, or due to a heavy bite.  Because a root canalled tooth is dead, the ligament surrounding it and suspending it in the bone is prone to inflammation, which may cause long-standing tenderness to biting.

Disinfection and canal treatment protocols:

• Laser disinfection by the Waterlase laser
• Ozone injection into the canals
• Irrigation with antiseptic liquids

Materials:  We rarely use gutta percha in our office. The permanent filler materials we use are one of four options (three general and one special):

1. ENDOREZ:  a resin-based material. This material is known to seal the canal systems thoroughly and even bond to the walls with resin tags.
2. ENDOSEQUENCE: A bioceramic material that is also very biocompatible and sets to a hard consistency.
3. MTA: Mineral Trioxide Aggragate is extremely biocompatible, but we only use it for canals that are of certain size and accessibility.
4. ENDOCAL: a calcium-oxide, zinc-oxide based material. Highly biocompatible, and known for diffusing through the canal systems and disinfecting large portions of the root structure. Due to its multiple drawbacks, however, Dr. Sarkissian uses it only in special circumstances, or only for the purpose of medicating the canals for 2-4 weeks prior to being replaced by another material.

Drawbacks of Endocal:  it is not as visible as Gutta percha in x-rays, making it harder to distinguish between filled vs. non-filled portions within the root canal complex.  This means that future dentists may mistake it as an insufficiently filled root canal, and many insurance companies may deny claims for reimbursement. The American Association of Endodontists disapproves of its use due to claims of a higher incidence of root fractures.