Root canal - what's going on?

General Questions
#1

I just had a re-treatment of an old root canal. I guess because the tooth was near the front and they gave me protective glasses to wear, I was able to see pretty much everything that was going on. (Normally, I just close my eyes.) I have some questions about instruments that were being used. First, there was a metal hook/loop that was hung from my on the opposite side of my mouth (the tooth being treated was on the bottom). After the procedure the assistant said that it was an apex locator used to find the end of the root. How does this thing work?

Second, the endodontist had a foam/sponge thing that he wore like a ring on one hand with numerous “bits” embedded in it. He used these by hand and would clean or dip them into the sponge ring between poking them into the canal. I’m guessing that they were progressively larger and that he was cleaning or preparing the hole?

Then, using tweezers, he took some white thin things and poked them into the canal. They looked to be about 3/4" long. What were they for? Nearer the end of the treatment he used two or three different instruments that were powered (attached to cables or hoses or something). One may have been a drill with an extremely thin bit but the other two were not drills and I don’t know what they did. That last one may have had something to do with curing the temporary filling but it didn’t look like other ones I’ve seen. When does the disinfecting take place?

Anyway, the whole thing was kind of interesting and the doc worked very fast but not hurried. Just very efficient. This is all he does and maybe there was another patient waiting but I was impressed. They also did a CAT scan of the tooth/jaw prior to the procedure and showed me what was going on before they started. The imaging technology is pretty cool.

Finally, I’ve heard of some technology called “Gentle Wave” that uses sonic waves and fluid to penetrate microscopic holes or cracks in the tooth. Is this whoo or legit?

#2

I’m sure an expert will be around to describe the process in detail, but having had many root canals in my day… they basically drill a hole, then file it down with a series of dental files (this part never fails to skeeve me out) and then fill the resulting space with rubbery “gutta percha” before sealing it back up.

#3

Dentist here. amaguri is basically correct.

The apex locator is used to find the end of the root so the dentist knows how far to go. It works by electrical resistance so the hook completes the circuit.
Correct on the foam sponge. Those “bits” are endodontic files. They are different sizes and as you surmised one starts small and works. one starts with a file that will reach the apex and then work up until the file fits the canal. This removes the pulp(nerve and blood vessels) and shapes and enlarges the canal to accept the filling material. The dentist wears them on a ring for easy access. I personally keep them on the counter next to me v. wearing them on a ring but still use the triangle sponge.

The powered instruments were rotary files. They clean and shape the canal faster and easier then the hand files. One uses the hand files first to get to a size that the rotary files will fit since they are a bit larger then the smallest hand files. Also hand files wile tend to push debris into the tooth while the rotary files auger the debris out of the canal. The white things were paper points used to dry the canal. He would have irrigated the canal prior to using them, usually with either dilute bleach or Peridex. You probably just didn’t notice that, only takes a couple of drops for a small syringe. That is when the disinfecting took place. Additionally one usually irrigates with disinfectant between the files. The other possibility on the powered hoses was it was an obturation(filling) system. Some dentists use a system that places a soft pace and then vibrates in to place(this is the sonic wave, legit). Others like me use a system where the obturator is more solid, warmed up outside the tooth and then placed into the tooth.

Hope this helps.

#4

Thanks, rsat. I knew it wouldn’t take long for an actual dentist to chime in. I thought about asking him to explain what he was doing as he went along but didn’t know how he’d feel about that. Once started, he we was all business. Plus, the rubber dam made speaking a wee bit difficult. This particular endodontist’s practice is limited to root canals. It seems to me that it would get boring after a a while. Is there enough variation to keep things interesting?

#5

You are very welcome. I enjoy explaining things when patients ask. A lot of times it makes it easier to work on them when they know what is going on. I don’t think just doing root canals would be too bad, but then I like doing them. Doing what you like helps and the satisfaction of saving a tooth that otherwise would be extracted is a nice feeling. If you waved a magic wand and made me an orthodontist I’d slit my wrists. :slight_smile:

#6

I had retreatment of a root canal in July. It had started to get infected, even though there was zero pain. It turned out the surgeon had missed one canal. It also turned out that the guy who did the retreatment was a friend of the guy who did the first root canal. He said, “I’m gonna bust his balls.” I suggested that he send the bill to the guy who did the original root canal.

#7

On one root canal I had the dentist heated to red hot a (pointy dental hook thing) with a flame and put it in the drilled hole. Some smoke/steam came out. I assume it was to sterilize it, but have never heard of such a practice.

#8

No it was to cut off the extra ends of the filling material. I haven’t done it that way in about 15 years but some dentists may still.

#9

rsat3acr, I have a root canal question but didn’t want to hijack and it’s more appropriate for IMHO anyway. Would appreciate your thoughts:

https://boards.straightdope.com/sdmb/showthread.php?p=21166045&posted=1#post21166045

#10

I had a root canal in 1987 that had to be done over in 2011, and then an apicoectomy when that failed. The procedure sounds gruesome, and while I sure hope I never have to have one again, it took about 10 minutes and was less traumatic than a filling, even though the gumline bled for several hours.

(DO NOT Google-image that if you’re squeamish.)

This link explains it in text only.

Anyway, the dentist who did these procedures said that he seldom used gutta percha any more, and filled my tooth with something else.

#11

I had only 1 root canal that lasted 10 years before it abscessed.
I ended up in the ED because it was on the weekend and nothing seemed to take the edge off the pain.
I also got blessed with acid reflux that was over the top!
The ED of course questioned if this was coronary symptoms and I didn’t think so but they gave me Nito and what a wonderful little pill that is! after 4 (each one reducing the pain by 1/2) I was feeling 100% and thanked them and bid them good evening and they said NO, I was going to be transported to a level 1 facility 90 miles away and away I went.
And it turns out I had just the abscess and reflux.
When I visited my dentist(not the one who did the canal) is when I found it was the root canal that went bad. That was certainly a big waste of cash! And Nitro worked where all the pain killers OTC didn’t come close!

#12

I foolishly googled that. Cheez-whiz, that’s bad!!

#13

I’ve always wanted Dentists and Endodontists to have a video camera installed in their magnifier goggles and an LCD monitor mounted on the ceiling right over the patient’s head so that I can see what the doctor is seeing.

I would think that it would be technically easy.

I wonder if there is a Practice does that?

#14

Like I said, not as bad as it looks, and as a result of that procedure, I still have an upper front tooth, so it was worth it. The gumline receded by a few millimeters, which is normal.

My physician had never heard of the procedure, and he cringed when I explained it to him, and was also in disbelief when I told him that it really wasn’t that bad.

Before I had it done, I had a fistula that would discharge pus at random times, and while I never vomited from it, I came close more than once. After that diseased tissue was removed, it never happened again.

#15

FWIW I’ve had 6 rootcanals, the first two had apicoectomys. I’m 60 and the RCTs were done when I was 14, 18, 20, 35, 40 and 55. All a result of too much sugar as a kid. All still holding up fine.

nearwildheaven, I’m not sure what your dentist is using but gutta percha is still the only thing I know that others are using. It comes in different styles but still the filler of choice.

#16

RSAT, I did Google that and it mentioned some other products that are used for this. He was an endodontist, FWIW.

#17

only other things I know of are silver points(which no one has used in 50 years) and Sargenti paste. It is still used in Europe and while I am sure it is used in the US most dentists won’t admit it in public due to the bad rep in the past.

#18

Maybe it was a modified gutta percha, like you said. He did say that the filler I had 30 years ago is not the same one that he was using in 2011, when I had the do-over.