After decades of pain, technological developments are giving root canal patients a reason to smile.
Root canal therapy is one of the most well-known dental procedures among the public, and has a reputation for being one of the most painful. However, dentists are beginning to utilize new technology to carry out more effective and less painful procedures.
Pulp problems
Tooth decay is a major issue that can have severe consequences if left untreated. Cavities, cracks, or other dental problems can expose the inside of the tooth, which contains the pulp. Pulp is a collection of nerves, blood vessels, and connective tissues that transport nutrients throughout the tooth.
Dr. Neville McDonald, the director of the graduate endodontics program at the University of Michigan, explained that there are three primary causes for pulp damage. First, direct trauma can crack the tooth. Second, the pulp tissue can become inflamed. And third, the tissue can be damaged beyond repair.
“In that scenario, if nothing is done, that tissue will break down and leak out through a little hole at the end of the tooth,” Dr. McDonald said. “Over time, the tissue that’s broken down will act as an irritant in the bone, and when the dentist takes a radiograph, there’s a shadow in the bone.”
This can make a tooth loose and create soreness when chewing. If left untreated for too long, there can be even more serious effects such as infections, brain abscesses, or meningitis. However, many cases are treated with a root canal well before they reach that point.
Root canal treatment
In simple terms, root canal treatment widens the canals inside the tooth so that dentists can remove damaged pulp tissue and bacteria and then they reseal the tooth.
“Most of the time, actually, root canals are pretty painless procedures, straightforward from the patient’s viewpoint,” Dr. McDonald explained. “They can be time-consuming, but straightforward. However, there are a handful of them that typically are the ones that need the cocktail surrogate after dinner.”
The latter case generally occurs when the pulp is acutely inflamed, which limits the options for which anaesthetic dentists are able to use. While dentists and researchers still are not sure exactly why inflammation limits the efficacy of local anaesthetics, the result is that patients feel the instrumentation much more acutely.
If the initial treatment is unsuccessful, which typically occurs if the procedure did not remove all the inflamed tissue or the tooth cracks, dentists can try it again or they might resort to more drastic measures.
These can include a surgical alternative called an apicoectomy, in which a surgeon actually removes the end of the damaged root, rather than trying to clean it up. If pain and inflammation persist, a last resort is tooth extraction. However, dentists typically try to avoid this unless there is a serious infection, as preserving natural teeth is a priority because of their superior ability to aid in digestion, breaking down food, and other key aspects of dental health.
New technology
Several key developments in the technology around the 1990s significantly improved the root canal experience. Around that time, dentists both began using microscopes more to get a better sense of what the teeth looked like and switched from stainless steel to nickel titanium instruments.
As Dr. McDonald explained, nickel titanium has proven to be much better about moving around the curves of teeth, giving dentists greater precision.
However, a new wave of technological advances has the capability to improve the procedure once more. One such technology, called the GentleWave procedure, has gained popularity in the last decade, and is slowly entering the mainstream, even in Toledo.
Frankel Dentistry in Toledo is one of the few general dentistry practices in the state of Ohio who currently uses one of the $100,000 machines. Dr. Cyrus Razmgar, who operates it at the practice, explained that he has found the investment worthwhile.
“I don’t think there is any debate as to the efficacy of the GentleWave,” Dr. Razmgar said. “It is superior in every capacity. But we often find that patients, post-operatively when I use the GentleWave, report not feeling sore. They feel really good.”
Rather than rely on dentists to manually remove bacteria or infected pulp from the tooth, the GentleWave procedure determines the optimal concoction of solutions and creates a pressure vacuum to help remove debris from inside the tooth.
This enhanced cleaning mechanism means that dentists do not have to create as wide of a gap in the tooth as they would if they had to manually operate, thus limiting the likelihood of a fracture.
While there is still not enough data to empirically measure the difference between a traditional root canal and the GentleWave, Dr. Razmgar is confident in its benefits.
“When I remove the seal in the end and I look inside the tooth, everyone that I know that uses the GentleWave, and this is from specialists to others, say without a doubt that they’ve never seen a tooth look more clean internally than after using a GentleWave,” he said. “It just obliterates anything that is there that is not hard tissue.”
Check your insurance
Dr. McDonald also explained that there is other technology evolving that uses lasers, rather than ultrasonic pressure, to achieve similar effects. However, he also cautioned that, while both of these methods certainly help clean the tooth, they are not a substitute for manual instrumentation altogether.
Despite the expense of the machinery, Dr. Razmgar said that GentleWave procedure only costs $100 more than a traditional root canal, which is the cost of a non-reusable instrument in the procedure. However, due to its relative novelty, many dental plans still do not cover it.
That cost, in addition to the cost of purchasing the machines, are two of the primary barriers standing between root canal patients and a less painful trip to the dentist’s office.
Contact Andrew Cramer at acramer@theblade
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