We perform root canal therapy, root canal retreatment, endodontic surgery, cracked teeth, management of traumatic dental injuries, and other specialized endodontic treatments.
Dr. Yamauchi has been trained to perform all endodontic procedures under a dental operating microscope. The microscope has greatly improved the efficiency and predictability of endodontic procedures. Each operatory is equipped with a microscope with digital photography capabilities in order to carefully document each case and show patients exactly what procedures are being performed.
Island Endodontics also uses advanced cone beam computed tomography (CBCT) 3D imaging. Below is an example of CBCT imaging.
It enables us to view the teeth and surrounding structures in 3D and can greatly help improve diagnosis and treatment for many of our endodontic procedures. Island Endodontics is one of the very few practices equipped with CBCT technology.
In order to understand endodontic treatment, it helps to know something about the anatomy of a tooth. Teeth have several layers. The outside layer of the tooth is composed of a hard layer called enamel. Enamel is supported by an inner layer called dentin, in which there is a center a soft tissue known as the pulp. Endodontics is a specialty of dentistry that specializes with diseases of the dental pulp and the surrounding area.
An endodontist is a dentist who has undergone a minimum of two years of extra training in endodontics after graduating from dental school. Dr. Yamauchi completed a three-year residency program after dental school. Additionally, Dr. Yamauchi completed a master’s thesis in endodontic research as part of his program.
Endodontists are experienced at finding the cause of oral and facial pain that has been difficult to diagnose. Although some general dentists may perform endodontic treatment, patients are often referred to an endodontist when a case is complicated or more difficult than usual. They have been trained in utilizing a dental operating microscope which allows for much more precise treatment.
Endodontic treatment is necessary when the pulp becomes irritated, inflamed or infected. The most common reasons for inflammation or infection are deep cavities (known as caries), repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often discolors the tooth. If pulp inflammation or infection is left untreated, it can cause pain and swelling, or lead to an abscess.
Indications for endodontic treatment include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling or tenderness of the tooth, or adjacent gums. Many times, however, there are no symptoms, which is why it’s important to have regular check-ups with your general dentist and endodontist.
The endodontist removes the inflamed or infected pulp, carefully cleans the canal system and then seals the tooth with either a permanent or temporary restoration. Once treatment is completed, you may be instructed to return to your dentist for the permanent restoration, such as a crown. The restoration of the tooth is a very important part of treatment because it seals and protects the root canal and tooth, allowing it to be functional once again.
Tooth pain can be a primary reason patients seek treatment. Fortunately, modern anesthetics can make the procedure pain-free in most cases. Seeking treatment early makes the procedure more comfortable, so don't wait. When caught early, treatment should feel no different than having a regular filling.
For the first few days after treatment, there may be some discomfort and/or sensitivity to biting pressure, especially if there was pain or infection before the procedure. Sometimes it takes several days for the inflammation to subside. If needed, over-the-counter anti-inflammatory medications like ibuprofen or acetaminophen are recommended.
First, you will meet Dr. Yamauchi to discuss your case and answer any questions you may have. Generally, the treatment process involves several steps. First, a local anesthetic will usually be administered for comfort. Next, a sheet of latex called a "rubber dam" (we have non-latex ones too) will be placed around the tooth to isolate it, and keep it clean and dry during treatment. Then the endodontic treatment is performed, followed by placing either a permanent or temporary filling. Afterwards, you will be referred back to your general dentist to continue your care.
The number of office visits will depend on your particular case. Some treatments can be performed in one visit, but most will require at least two visits. Typically we believe in cleaning the root canal spaces and placing a medicament inside the tooth for a few weeks to allow time for more disinfection and healing before we seal the roots with a filling. The number of required visits depends on the level of infection and inflammation, and the degree of treatment difficulty.
There are, of course, no guarantees when it comes to dental treatments. But endodontic therapy has a high degree of success when treated properly. We will discuss with you the chances of success and other options available before beginning any endodontic procedure to help you make an informed decision about your tooth.
Once endodontic therapy is completed your tooth should be examined periodically, usually every six to 12 months. This allows us to make sure the tooth is healing properly.
Occasionally, when a tooth has undergone endodontic treatment it fails to heal or pain continues despite therapy. Sometimes there are missed or untreated canals inside the tooth that allows bacteria to remain and cause continued infection (Fig. 1). Sometimes a tooth initially responds to root canal therapy but becomes painful or diseased months or years later if a new cavity forms under the restoration and bacteria get back in (Fig 2). When either of these situations occur, the tooth often can be maintained with a second endodontic treatment. Basically, the old root canal fillings are taken out, all the root canal spaces are cleaned/re-cleaned, and then refilled and sealed.
Teeth with persistent infection that can't be retreated, or don't heal despite retreatment, can be treated through endodontic surgery. This is a minor dental surgery and involves making a small incision in the gums to directly access and clean out the infection around the root end. After the infection is cleaned, the root end is sealed. Endodontic surgery has a high success rate if treated properly. Dr. Yamauchi perform all surgeries using a dental operating microscope for high precision and technique.
An endodontist is specially trained in diagnosing and treating traumatic dental injuries. Many times after facial and dental trauma, the teeth and supporting tissues can be damaged. This can lead to pain and/or infection which often require endodontic treatment.
Sometimes teeth just cannot be predictably saved. Depending on the health of the tooth and supporting tissues, teeth may have an unfavorable prognosis. Sometimes the tooth can develop a crack. Depending on the extent of the crack, the tooth may not have a good prognosis. If the crack or fracture extends on the root of the tooth, the prognosis is unfavorable. Or if the tooth and root canal have been too damaged from previous treatments, this can lead to an unfavorable prognosis because the tooth is too weak. In these cases, extraction of the tooth may be needed. If extraction is necessary, the space that is left can be replaced by dental implant treatment, bridges, or removable appliances.
GentleWave® Procedure is an innovative alternative to standard root canal treatment. It presents a major advancement that helps us achieve our goal to effectively clean a tooth’s entire root canal system, no matter how complex. The root canal system consists of intricate channels for the nerves and blood vessels. We are always evaluating technological advancements and incorporating them into our practice when we believe that doing so will help us provide a higher level of care than previously possible and help us save more teeth for more of our patients.
We are very proud and excited to offer this level of care to our patients. Island Endodontics is fully certified in the use of the GentleWave® System and will gladly answer any questions you may have about this exciting new technology. Here is a quick video of patients who have received the GentleWave procedure.