PROCEDURES





Traumatic Injuries

Dislodged Teeth (concussion, subluxation, extrusive luxation, lateral luxation, intrusion) 

Trauma to the face or mouth may cause dental traumatic injury, which can loosen or knock out (avulse) a tooth or teeth. Your endodontist or general dentist may reposition and stabilize your tooth. Based on the type of injury that takes place will determine the protocol for treatment.  Root canal treatment is usually started within a few weeks of the injury.  Endodontists are the most highly trained dental specialists to manage dental traumatic injuries.  If maxillofacial injuries (fracture of jaw or facial bones) are present, the addition of a an oral and maxillofacial facial surgeon is recommended.  Long term follow up care is also recommended after injury to monitor the health of the dental pulp of non-treated teeth.

  

Avulsed Teeth

If an injury causes a tooth to be completely knocked out (avulsed), it is important that the patient is treated immediately.  If this happens, attempt gently rinse the root of the tooth and replant the tooth immediately (if the patient is conscious). If this can not be done, keep the tooth moist and see your dentist or endodontist as soon as possible to replant the tooth. A tooth can be saved if it remains moist and is replanted within a reasonable amount of time. Placing the tooth in milk is better than tap water.  Your Endodontist may start root canal treatment, based upon the stage of root development. The length of time the tooth was out of the mouth and the way the tooth was stored may impact the long-term prognosis.  If the tooth can be kept moist and replanted within one hour of avusion, the long-term prognosis will be greatly improved.

 

Injuries in children

An injured immature adult tooth may need one of the following procedures.
 
Apexogenesis

This procedure encourages the root to continue development as the pulp is kept vital and alive. The dental pulp is covered with a special material with the intent to protect it and allow it to continue development. The tip of the root (apex) will continue to develop as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the long-term restorative prognosis.

Apexification

In this case, the unhealthy or infected pulp is removed. Dr. Horalek will place a medication inside the root to help a hard tissue barrier form, near the end of the root. This tissue barrier provides a barrier for the root canal filling material, usually mineral trioxide aggregate (MTA). At this point, the root canal walls will not be as thick as a fully-developed root, making the tooth more susceptible to fractures later in life.   

Revascularization

During this procedure, endodontic treatment of an undeveloped, infected (adult) tooth is initiated, and the root canal system is throughly disinfected.  Dr. Horalek then allows a matrix of blood clot into which cells can grow, which—over time—narrows the wide apical opening and allows for further natural root development.  This procedure sometimes allows for further root-thickening and sometimes continued root-length growth. The coronal access is sealed, and the tooth is radiographically and clinically monitored for signs of healing.    The overall effectiveness of this procedure is still being studied internationally.