Root Canals
Short and anxiety-free
For Avoiding Tooth Removal
A root canal removes the inflamed or diseased nerve inside a tooth. By disinfecting the inside of a tooth after removing the nerve in the tooth and then sealing the internal structure of the tooth, it can be saved and rebuilt for continued years of function. The tooth feels like all your other teeth, with the exception of not feeling cold.
3D Xray imaging
While root canals are completed all the time using surgical loupes (the magnifiers you see on our glasses) and 2D Xray imaging, once the canal number increases from 1-2 or more canals the use of a surgical microscope and 3D imaging can attain superior outcomes. So goes the saying in endodontics “if you can see it, you can treat it” – meaning if you can see all the canals, generally you can treat all the canals in multi-rooted or multi-canal teeth. 3D imaging (cone beam CT) provides a starting map of where the canals are located within the tooth and the estimated canal lengths. It can also reveal abnormal canal anatomy that might necessitate a referral to a specialist to ensure success in treatment outcome (such as branching canals, C shaped canal systems, and internal resorption).
“if we can see it, we can treat it”
Surgical Microscope
A surgical microscope, like the loupes we use for every day dentistry, provides magnification to the area we are working in. However, a surgical microscope when used for endodontics far surpasses the use of surgical loupes in lighting, depth of field and magnification so that nothing is missed when a root canal is being performed on a molar or multi-rooted tooth.
Optional
IV sedation for root canals
There are times where it is nearly impossible to get a tooth numb because the nerve in the tooth is so inflamed and it simply won’t respond to local anesthesia or the infection around the root of the tooth is preventing local anesthesia from working. In cases like this, IV sedation is a way to get around this problem. With IV deep sedation / general anesthesia, we can simply shut off your body’s ability to feel pain for a short period of time. This allows us to proceed with treatment in a shorter period of time without the worry of you “feeling it”. If this is something you are interested in, check out our IV sedation page.
If you don’t have trouble getting numb, but simply want to float through your appointment, moderate IV sedation might be a better option. Unlike deep sedation where you are totally asleep, moderate sedation puts you in a dream-like state. You can respond to commands, but you are very relaxed and drift in and out of a twilight sleep. Both of these options far surpass nitrous oxide and oral sedation in depth of anesthesia, control of level of anesthesia, and anesthesia onset time (IV sedation works in 10-20 seconds).
What you Should expect
Modern Endodontics (root canals)
While you can get root canals at most general dentistry offices in central Iowa, we are the only general dentistry office in the area that uses both 3D Xray Imaging and a Surgical Microscope for all root canal treatments.
Saving a tooth is an investment in both time and money. If you’re looking for peace of mind of knowing you’re getting the most thorough possible care during the process, please check out our process for saving a tooth which can usually be done in one appointment either asleep or awake, or in-between.
1
3D imaging before actual treatment:
We take a small volume, high-resolution 3-D image of all teeth needing root canal therapy PRIOR to starting a root canal so that nothing is missed. A missed canal can cause a root canal-treated tooth to need further treatment, usually by a specialist (so you’re paying for it twice). If you’re getting a root canal done, we highly advise that this imaging is completed, especially if your provider hasn’t had post-graduate residency training at locating hidden canals in posterior teeth.
2
Trusted Care:
Dr Binkowski received an extra year of training after dental school within the US Air Force AEGD programs where he spent ¼ of his clinical residency completing numerous endodontic retreatments; essentially dismantling failing root canaled teeth, re-doing the root canal and finding what was missed, thereby saving the tooth for the active duty personnel or veteran. This included post removal, broken file retrieval or bypass, and the use of a surgical microscope. This extra training provided a healthy dose of “what not to do”, “what to do if x happens”, and when it is a good idea to refer to a specialist (knowing your limits and not treating your patients as new learning experiences).
3
Microscopic Dentistry:
Teeth are small, but the canals within the tooth are even smaller. The use of a Global Dental Microscope in our office with beam splitters allows our patients and our assistants to watch what we are doing in 4K resolution. The use of this microscope and the visualization that our assistant is able to directly observe allows us to see everything and efficiently complete the root canal in a reasonable amount of time.
4
IV Sedation:
If you simply want to sleep through your root canal, or require more than one root canal in one appointment, IV sedation is an incredibly reliable way to experience a root canal that is pain-free and memory-free every single time. It’s still the only “go to sleep and wake up when it’s done” option in the entire area.
5
No Limitations to care:
If you are needing more than one root canal completed, usually they can all be completed in one appointment, depending on the teeth needing attention. If you are awake, we usually limit ourselves to 2 root canals in one appointment as it is a long time to keep your mouth open. In cases where there is significant endodontic work to be done on many complex teeth, we find it is in the patient’s best interest to refer them to Dr Wicker, an endodontic specialist in Cedar Rapids, that we have worked closely with for a few years. He is able to complete as many root canals as needed in one appointment under IV sedation.
6
Crown fabrication chair side:
Other than missed canals, root canals can fail due to poor seal at the top of the tooth, or from a tooth fracture. The best way to prevent this is by immediately rebuilding the tooth with a new core while it is well isolated, then placing a crown on the tooth before you leave the office (much like a football helmet, a crown protects the tooth from fracture). We offer immediate crown fabrication chairside after your root canal is completed. With no temporaries and no need for a second trip to the dentist- you can literally walk out of our office with the root canal completed and the permanent crown cemented on it.
Xray imaging and general flow of a root canal appointment
Knowing what the inside of the tooth looks like before opening it up
Most of the root canals we do tend to be “one tooth problems,” meaning the tooth we are performing the root canal on usually is the only one causing problems. At our office, we excel at same day dentistry; root canals are no exception. The full root canal, core-buildup, crown-prep, crown fabrication, and cementation of the crown are completed in one appointment. However this can be dependent upon the complexity of the tooth being treated. To determine how difficult the root canal may be prior to numbing, we take a high-resolution 3-D Xray image to assess the complexity of internal anatomy of the tooth. By starting with a “map,” it drastically reduces the chance of a missed canal during the procedure, something we routinely see on new patients who have had a root canal completed on a maxillary first molars at offices who don’t utilize 3D imaging.
After administering local anesthesia, we place a rubber dam over the tooth to isolate it from bacteria and saliva in the mouth and a small hole is made in the biting surface of the tooth to access the pulp chamber. Once the canals are found, they are debrided, disinfected, and sealed internally with a bioceramic sealer. The tooth is then rebuilt with white resin and prepared for a crown to protect it from fracturing. The tooth is then scanned and a crown is designed on our CEREC PrimeScan system which mills it from a block of ceramic. It is then polished, sintered and cemented on the tooth. It is most ideal to place the crown right after the root canal is finished to protect the investment made in saving the tooth. However, we do understand that it may not be in every patient’s finances to do so and we don’t want them feeling pressured into immediately doing this.
If you are unable to lay nearly flat on your back in the dental chair, have a strong gag reflex, unable to open wide, or have moderate to severe dental anxiety that could interfere with treatment, consider the use of IV sedation for your treatment as it will negate all these issues. Because we are working through a microscope, patient movements are magnified in our field of view. Because we always want the very best outcome for our patients, we do ask that you let us know ahead of time if you have any of these issues so that IV sedation could be discussed in the event that you are unable to tolerate being open for a longer appointment.