A Specialist Endodontist is a GDC registered specialist dentist who is involved in the diagnosis and treatment of tooth-based pathology.

Endodontists receive three or more years of advanced education in Endodontics.

As a result of the specialist training, Endodontists are skilled in finding the cause of oral and facial pain, treating traumatic injuries to the tooth, diagnosing a cracked tooth, and performing other procedures that save teeth.

As an Endodontist, limiting my practice solely to Endodontic treatment, we perform routine as well as difficult and very complex procedures, including root canal treatment, root canal pretreatment, and Endodontic microsurgery.

We use the most advanced technology in the field and we are therefore the most efficient and precise.

This equates to positive experiences and faster healing.

We offer tremendous flexibility in accommodating emergency cases, so delays in treatment are kept to a minimum and patients can be relieved of dental pain quickly.

We are also readily available for post-treatment questions or concerns.

A root canal treatment is needed when the soft tissue located in a canal inside the root of a tooth, known as the pulp, experiences inlammation or infection.   The pulp is like the “heart of the tooth” and it contains blood vessels, nerves, and soft tissues.

The anatomy inside of a tooth is very complex and most of the time a single tooth presents more than one canal. 

Inflammation or infection can occur as a result of several things including deep decay, repeated dental procedures, faulty fillings or crowns, or trauma to the tooth.  

Problems with the tooth may present with Toothache, Tenderness to Bite, Pain to Cold, Pain to Heat, Localised or generalised.

Swelling, or a draining spot or lump on the gum (Sinus Drainage)

Sometimes you may not experience any symptoms but still be in need of Endodontic treatment and if left untreated, it can cause pain or lead to an abscess, or potentially negatively affect cardiac issues.

When your root canal therapy has been completed,  a record of your treatment will be sent to the dentist who referred you. 

We advise you to return to your general dentist between two to six weeks after your root canal treatment is completed to have your final restoration done unless advised differently by us.

This amount of time will allow most of your tenderness to subside before having further procedures done on your tooth. 

If your tooth does not get the necessary final restoration (Crown or Onlay) the tooth may fracture or leak leading to the tooth being re-infected and needing retreatment, microsurgery, or extraction.

The final restoration is either a filling ( Do by US) or a crown/Onlay will be placed ( by YOUR dentist) to protect your tooth from fracture and further contamination and restore your tooth to its full function.  

As the unrestored tooth is susceptible to fracture, please DO NOT chew or bite on the treated tooth until you have it restored by your dentist.

Retreatment is basically the same as primary root canal treatment; however, in many cases, complex restorative materials like crowns and posts must be disassembled and removed to permit access to the root canals.  

Removal of posts and broken instruments can be very time-consuming, as this needs to be performed prior to the “root canal treatment”

After removing the filling material (which can be rubber, plastic, or hard pastes), a search for any additional canals, hidden fractures, perforations (damage during previous treatments), broken instruments, or unusual anatomy that may require being dealt with prior to thorough cleaning similar to primary root treatments.

All shaping, cleaning, and obturation of the tooth can be performed with retreatments, there is a statistically lower success rate.

Treatments may also take longer due to more complex treatment protocols, additional visits for resolution or symptoms, or medical dressing of the tooth prior to final sealing.

Endodontic microsurgery is usually needed when the tooth does not heal as expected after initial root canal treatment or root canal retreatment.  

Other reasons for Apical surgery are when a patient has either new crowns or bridges, or full arch restorations making dismantling of the prosthesis either very expensive or would limit the longevity of the restoration.

In some cases, root canal treatment is insufficient to save your tooth.  In such a situation,  your endodontist may recommend alternative strategies, which may include endodontic microsurgery. 

Endodontic microsurgery is a surgical procedure performed under a microscope that allows the dentist to access part of the root or the tip which would not be possible with conventional treatment methods.

After conventional root treatment or Re-treatment, a tooth may fail to heal for several reasons. There are many situations in which

Endodontic surgery can help save your tooth where normal root canal therapy would be lacking:

Surgery may be used for extensive diagnosis. Some patients have recurring symptoms, but no visible problems appear on their X-rays. These cases can sometimes indicate a tiny fracture or break in the tooth structure or root that could not be detected during nonsurgical treatment. In such cases, Endodontic microsurgery can give your Endodontist a chance to thoroughly examine the tooth’s structure without relying on X-rays, find the problem and provide treatment or even confirmation of an untreatable condition.

In some cases, protective dentine deposits may make a canal too narrow for cleaning and shaping ( Pulp Canal Obliteration)

Blockages, ledges, and fractured instruments may prevent theEndodontist from reaching the end of the root of the tooth, therefore preventing adequate cleaning protocols

In some cases, a tooth may fail to heal after successful root canal treatment or retreatment. Symptoms or problems may persist or reoccur later. This may be due to extra-radicular infection or non-Endodontic pathology

Most infections at the end of the tooth that does not resolve are due to missed anatomy, blockages, and ledges, or infection that cannot be accessed from within the tooth. Removal of the infection beyond the tooth and resection of 3-4mm of root tip remove at 90% of the causative factors.

We use local Anesthesia in your tooth area and only start the treatment when we are sure you are fully numb.  

With the help of a dental microscope, we locate the underlying bone through a window in the gum near the area and remove any inflamed and infected tissue.  

At the very end, 3-4mm of the root is also removed. Special Ultrasonic instruments are used to clean out the inside of the canal up to 9mm in length to remove either the root canal filling material, a ledge, or a broken instrument. 

The internals of the root can then be cleaned and prepared for a retrograde filling.

The tip of the root is then dried and filled with a bio ceramic sealer and putty to occlude and seal the end of the root.

This material is completely biocompatible and allows for increased rates of bony healing and ligament formation.

The small access flap is placed back, compressed with damp gauze to allow for better adaption of the soft tissue.

Multiple very fine sutures are placed to hold the surgical area still and allow for healing.

Post operatively we usually provide Ice Packs to reduce swelling and advise the use of pain killers such as Paracetamol and anti-inflammatories such as Ibuprofen.

Gentle brushing and hot, salty mouth wash will keep the area clean and reduce the risk of infection.

Sutures are usually removed at approximately 5 days.

In many cases, the only alternative to endodontic surgery is the removal (or extraction) of the tooth. After this procedure,  the tooth must be replaced with an artificial replacement  –  an implant,  bridge, or denture  –  to restore the tooth’s function and prevent the surrounding teeth from moving. 

These alternatives usually require surgery or procedures on adjacent healthy teeth, which means that endodontic surgery is not only cost-effective, it is the most natural and least destructive

How long does my treatment take?

The time taken will depend on the complexity of the treatment. If

the tooth has to be restored prior to treatment or additional restoration after root canal treatment this will take longer.

Around 90% of treatments are done in a single visit of approximately 1.5 hours.

If there is complex restoration, removal of crowns or broken instruments this time may be increased to 2 hours.

Occasionally we will book two appointments of 1 hour if there is marked infection or we wish to see resolution of a symptom prior to completion of treatment.

If the patient requires any additional appointments there is no increase in fees.

We will review most patients to follow up on their treatment. There is NO fee for any follow-up appointments.

What do I do prior to my RCT appointment?

If you are on any medication please do not stop any of these unless advised by your GP or Endodontist

Please visit the lavatory prior to treatment.

Please ensure that you have eaten prior to treatment if you are diabetic

Please wear something comfortable.

Please do NOT wear expensive or personally important clothing due to the use of bleaching chemicals

Please bring with you any EpiPens, GTN sprays, inhalers

Please feel free to bring headphones, blankets, and moral support if this will help you relax

IF you are in pain prior to treatment please take any normal painkillers as this will help with the ability to numb you up.

What happens at the appointment?

The patient will be guided through consent and the procedure

Please inform us if you are diabetic, as we can numb you up in such a way that your tongue and lips will NOT feel numb postoperatively

The patient will be Anesthetised and pulpal numbness confirmed

The patient will receive a rubber dam ( which is a sheet of non-latex rubber) over the tooth to be treated to protect their airway from any accidental swallowing of instruments and cleaning agents.

The tooth will be root treated in 1 visit or dressed with medication ( for varying reasons) prior to the 2 nd visit to finish treatment.

The tooth will be sealed with most commonly a white composite filling ready to be restored by their dentist.

This increases the long-term outcome and ensures that the dentist does not have to disturb any of our work.

What happens after the appointment?

You will be sent back with a permanent filling in the tooth concerned.

You will be referred BACK to YOUR dentist on completion of treatment

Your dentist will receive a letter explaining the diagnosis, treatment, and follow-up procedures required.

YOUR DENTIST will provide any necessary post-operative crown or onlay.

You will receive a post-operative phone call to monitor how you are doing after a treatment.

You will receive a post-operative review appointment (s) as required.

Guidance AFTER root canal treatment

If you have had conventional dental anaesthesia please DO NOT eat or drink anything hot until all numbness has resolved

Please take anti-inflammatory pain killers for at least 72 hours

The tooth will normally be taken out of the bite to aid healing especially if it was painful to bite on.

Please keep the gum margin clean, as the rubber dam clamp can traumatise the gum and ulcerate it.

Please keep the tooth clean with interproximal brushes (Tepes, Curaprox), and interdental brushes as you may be more likely to have food trapping.

This can give you a low- grade dull ache and tenderness to biting.

IF you have any concerns regarding pain, swelling please contact the practice directly

IF you have had swelling or incision and drainage please use hot, salty mouthwashes as often as possible to aid healing.

Avoid heavy loading of the root-treated tooth until your dentist has permanently restored the tooth

Once all signs and symptoms have resolved please contact your dentist ASAP to plan for the protection of the root- treated tooth.

At Justendo@thecastleclinic we treat the most COMPLEX cases that require either Facial Pain Diagnosis, Primary Root Canal Treatments, Re-Root canal treatment (Revision), and Apical Microsurgery. The success rates are very high and comparable to dental implants, therefore removal of the tooth and implant placement should be the LAST resort.

All patients will be given an idea of the potential prognosis or success rates. This will also include ALTERNATIVE options where the prognosis indicates a potentially better outcome with another treatment

The academic quoted success rates are as follows;

Root Canal Treatment 88-97% (with infection 74-91%)

Re- Treatment 93-97% ( with infection approx. 85%)

Apicectomy (Old Fashioned treatment ) 44-70%

Apical Microsurgery with re-treatment 85-95%

Endodontic treatment can fail for a number of reasons: It was not possible to treat narrow or curved canals well enough or the canals were not fully cleaned during the initial procedure. The tooth may have additional complicated anatomy that was not found during the initial treatment. It may also be due to undiagnosed fractures or fractured instruments. Microscopes and CBCT are more likely to be able to aid the clinician in diagnosis as well as treatment feasibility.

The final restoration was not placed quickly enough or the final restoration leaked due to a poor fit, fracture, or recurrent decay around it.