Treatments

What is it?

Root canal treatment/therapy is a specialised dental procedure performed by a highly-skilled expert that can be used to save a tooth with a damaged root that is badly decayed, cracked, or has become very painful/infected.

During the procedure, the pulp (tooth nerve) is removed from inside the tooth, and the area it vacates is then meticulously cleaned and sealed. Endodontics is the medical term for the field of dentistry that deals with root canal therapy and diseases of the dental pulp.

Who is it for?

Patients with a suspected infection of the tooth pulp who have been referred to us by their dentist, or individuals who have been told by their dentist that root canal treatment may be needed and that they should seek out expert help.

Some of the common symptoms of an infected pulp include persistent pain, swollen or tender gums, sensitivity to heat/cold, tooth discolouration and pain when you touch the tooth.

However, pulp-related issues will not be the cause in every case, which is why you should visit your local dentist before contacting us as they may diagnose a more minor problem that can be treated there and then.

How does it work?

Teeth have several layers: the outermost layer is composed of a hard substance known as enamel. Beneath this is an inner layer called dentin, which has a soft tissue known as pulp at its centre. This pulp contains blood vessels, nerves and the connective tissue that helps to form the dentin and enamel during tooth development.

When infection is suspected, a radiograph or Cone Beam CT (CBCT) scan is taken to verify this and, if infection is confirmed, an access hole is created into the tooth, the dentist usually viewing the infected area through a high-magnification loupe or endodontic operating microscope. This will help your consultant to locate all of the root canals whilst keeping tooth removal to an absolute minimum.

The infected nerve tissue and related debris is removed using specialist files and rotary instruments, as well as sonic and ultrasonic powered irrigation. Once the tooth has been thoroughly cleansed it is filled and sealed temporarily to allow it to heal. The temporary seal is then removed and a crown is added.

Does it hurt?

We understand that few people would readily say they enjoy going to the dentist, and as root canal treatments are on the complex side of dentistry, some people – quite understandably – are nervous. However, the notion that root canal treatment is painful is largely a myth as, in most cases, the nerve has actually died. That being said, we do everything we can to make your experience at The Endodontic Clinic as pleasant as possible, and this includes anaesthetising the infected area: this numbs the tooth and the surrounding area and keeps pain to an absolute minimum.

Our skilled and experienced staff, plus state-of-the-art facilities and the latest in dental technology, mean that patients are in the best possible hands. Pain management is always at the front of our minds.

What is it?

A second opinion report from The Endodontic Clinic offers reassurance to those who are not satisfied with a diagnosis from their current dentist. All dentists have unique backgrounds and even variations in training – a different, expert perspective can help you to make an informed decision about your treatment options. There are other instances in which a second opinion report may be required, as detailed below.

Who is it for?

Any individual who is worried about the level of care they are getting from their existing dentist, or who has just completed an expensive or complicated treatment elsewhere and is unhappy with the end result. Our second opinion reports can also be of benefit to those who are worried about a hospital or NHS referral that is taking too long; people who have had an accident and need to make a claim; those who need a dental report because of their job (for example, if they are working overseas for an extended period); and those who are simply ‘shopping around’ and want to get an idea of what a detailed treatment plan would look like and cost.

Another reason someone might want to seek a second opinion is if they have been told by their dentist that they need to see a dental specialist in a specific field; the Endodontic Clinic team will be able to advise the best course of action.

How does it work?

Our second opinion reports involve a full dental examination, oral and tongue cancer screening, full charting of the teeth (including Periodontal charting), small X-rays, a large extra-oral x-ray, a suggested written treatment plan (which can be taken to other dentists) and a copy of all of the patient’s notes, X-rays and signed paperwork.

The report is designed to offer patients all the information they need to take the next step – whatever they choose that to be.

Does it hurt?

Normally, not at all – though if someone comes to see us with a toothache there might be some minor additional discomfort while we examine the mouth in order to evaluate the situation.

What is it?

Cone Beam CT (CBCT) scans are a way for a dentist to get a vivid 3D image of the intricacies of a patient’s teeth and gums without having to undertake exploratory/invasive treatment procedures to try and ascertain what lies “beneath the surface”.

They are a state-of-the-art alternative to more traditional intra-oral x-rays, which show a two-dimensional image as opposed to the three-dimensional image created by a CBCT scan.

Who is it for?

A CBCT scan is an excellent, state-of-the art diagnostic tool that is well-suited to patients whose dental issue is not clear-cut. Much of what happens to a tooth is going on beneath the surface, and while skilled experts can often hypothesize with a great degree of skill about a patient’s dental issue, a CBCT scan removes all of the guesswork. CBCT scans are very often used during endodontics to ensure that root canal treatment is indeed required.

How does it work?

The team at The Endodontic Clinic are highly proficient in this relatively new way of diagnosing dental conditions, and are able to pinpoint the scan down to a very specific part of the mouth – thus limiting radiation to an incredibly small area.

The CBCT machine is similar to the CT scanner seen in hospitals, only much more compact. The 3D image it creates provides vital insight into the insides of the tooth and the area surrounding it, and can help identify tiny fractures, missed canal anatomy, diseases of the jaw and more.

Does it hurt?

There is not normally any pain associated with a CBCT scan at all. However, as with all x-rays, women should inform their consultant if they are pregnant.

What is it?

Sedation is the ultimate solution for anxious patients – or those who have been putting off dental work for fear that it will be painful. Did you know that almost 22 per cent of people skip their dental appointments because of fear? Thankfully, modern dentistry provides the answer in the form of IV sedation dentistry, which offers patients the chance to greatly reduce the stress that they may otherwise fear. It is a form of conscious sedation that does not put you fully to sleep, but it does make you relaxed and much less aware of your surroundings. It is also noted for its pain-reduction qualities, too.

Who is it for?

Sedation can be a godsend for people in need of restorative dental work who have been avoiding making an appointment because they fear the dentist. It provides a way for a patient to become far less aware of – and concerned by – their surroundings while treatment is being undertaken. It is fast-acting, and, when coupled with local anaesthetic, ensures that as little discomfort as possible is experienced during the procedure.

How does it work?

IV sedation is not readily available at all dental clinics and requires dedicated sedationists who have extensive clinical experience in the treatment of anxious patients. Those who work with The Endodontic Clinic are highly skilled and will hand-hold patients through every step of their treatment.

Does it hurt?

No, though there will be a small pin-prick when the IV needle is applied. What may be very appealing to some is that dental sedation creates a period of amnesia, so you won’t remember the procedure when you wake up. It can also be beneficial when multiple procedures are needed: when patients are relaxed and not experiencing any discomfort, they are more easily able to sit for longer spells in the dentist’s chair, with the result that several visits may be condensed into one.

What is it?

Unlike metal crowns of the past, the all-ceramic crowns used by The Endodontic Clinic are crafted using layers of porcelain that not only protect the remaining tooth structure, but look more realistic than past restorations. Metal-free crowns are the premium option for restoring a damaged tooth.

Who is it for?

Metal-free crowns are the most desirable solution for people who are looking for the most aesthetically-pleasing solution to a damaged tooth. Patients may either be referred to us by their dentist, or can contact us directly if they know they need a crown and would like to enjoy the unrivalled level of service and expertise that The Endodontic Clinic offers. Most commonly, however, we fit crowns as the final part of root canal treatment.

How does it work?

We first remove the damaged/decaying part of the tooth in question and then build up layers onto that area using porcelain Emax or Zirconia – two extremely strong substances that give people a newfound confidence in their ability to bite into things that has often been missing for some time.

The end result is designed to mirror the look of the original tooth as closely as possible – and as the material used is semi-translucent (as is the case with natural teeth), the effect is very convincing.

Does it hurt?

Having a metal-free crown fitted is much the same as having a filling, and we will ensure that discomfort is kept to a minimum by using local anaesthetic, which numbs both the tooth and the surrounding gum area.

What is it?

When decay affects a tooth at a comparatively superficial level – i.e. root canal treatment is not required – a dentist will often recommend a filling. Technology has moved on somewhat since the 1970s and 80s when metal fillings were widely used; today’s dentist has other options, and The Endodontic Clinic only fits white composite fillings, not least because these are aesthetically-pleasing.

Who is it for?

White composite fillings are a solution to tooth decay and cavities for patients of all ages. The quality of the filling material is second to none and is long-lasting, hard-wearing and virtually indistinguishable from the rest of the tooth.

How does it work?

With the affected area having first been treated with anaesthetic to numb it, we next use a diamond-coated drill to remove the decayed area. At The Endodontic Clinic, we have many years of experience in extracting the decayed tissue from teeth and will painstakingly ensure that all the affected area – and no more – is removed.

The space left behind is then prepared for filling by thoroughly cleansing the cavity to ensure no debris or bacteria remains, before a composite resin in a hue designed to match the existing tooth is added. The final step is to polish the filling.

Does it hurt?

Fillings perhaps represent the stereotypical ‘worst nightmare’ in terms of a visit to the dentists, often because of unpleasant experiences people had of having fillings when they were a child.

Fortunately, today’s technology both in terms of anaesthetics and methods for the removal of decayed material render these historic impressions something of a myth. At the Endodontic Clinic, you will be welcomed in a luxurious, calming environment and treated by experts who are well versed in keeping you relaxed and in as little discomfort as possible.

What is it?

Most of the time, root canal treatment undertaken by an expert will result in a saved tooth that will last a lifetime – but this isn’t always the case. Sometimes, the procedure hasn’t been performed to the exacting standards that this kind of therapy requires; in other cases the tooth simply hasn’t healed properly post-procedure.

The Endodontic Clinic’s experts are highly skilled in the field of root canal retreatment – which is the practice of performing root canal a second time with the aim of saving the tooth.

Who is it for?

Root canal retreatment will uniquely be of interest to those who have already been through root canal therapy and have gone on to experience problems with the tooth that was treated. The best way to proceed if you think this applies to you is to contact us for an evaluation.

How does it work?

During retreatment, we will reopen the tooth and remove the old filling materials that were placed in the root canals during the first procedure. We then carefully examine the tooth, looking for additional canals or new areas of infection.

We will then remove any infection, disinfect, and shape the canals using ultrasonic powered irrigation techniques, before adding new filling materials. The opening is then sealed with a temporary filling. Once the tooth heals, a new crown or other restoration is placed on the tooth to protect it.

Does it hurt?

The level of discomfort is typically on a par with regular root canal treatment – and can, therefore, be minimised with expert care and local anaesthetic applied to the tooth in question. Sedation is also a possibility.

What is it?

When a tooth is decayed, bacteria can spread through the dental pulp (nerve tissues) in the root of the tooth and cause further complications. The aim of vital pulp therapy – also known as a pulpotomy – is to extract any infected pulp and safeguard the remainder.

Who is it for?

Vital pulp therapy may be appropriate when full root canal treatment is not required: it is a slightly less involved/invasive procedure and therefore both easier to perform and more affordable.

It is especially well suited to young adults with severe tooth decay as it can help a tooth regain its natural ability to regrow – though it is normally only suitable when there is no swelling or abscess around the tooth.

How does it work?

The portion of the pulp that is diseased is removed from the tooth and the space it leaves behind is filled with medicated material to preserve the remaining healthy pulp tissue. At The Endodontic Clinic, we use bioceramic materials (BC RRM putty) for this, because clinical research has shown very high success rates when this material is used as a protective agent against the remaining exposed pulp.

There are two different clinical practice types when it comes to vital pulp therapy – both involve pulp capping, which is a restorative procedure used to prevent exposed pulp from dying.

As with all of our treatments, we are happy to explain the two options – indirect pulp capping and direct pulp capping – to patients who are interested in this type of treatment or for whom our examination has indicated that this is the best course of action.

Does it hurt?

Ensuring patient comfort is a key aim at The Endodontic Clinic, which is why we administer anaesthetic in order to numb the area surrounding whichever tooth or teeth we are working on.

Additionally, patients who are especially anxious at the thought of undergoing a dental procedure can talk to us about optional sedation, which some patients say helps enormously.

What is it?

Regenerative endodontics is an emerging field in which Dr El Jabouri at The Endodontic Clinic is something of a pioneer. In simple terms, it allows us to try and revitalise or regenerate an immature tooth's natural tissue so that the root can continue to grow.

This is in contrast to the more traditional option in instances of a tooth with root damage, which would be to harden the root end and close the canal. While this solves the issue, it does mean that the tooth’s root will not continue to develop.

Who is it for?

Younger people suffering damage to the root of a tooth who not only want to save the tooth but are keen for it to continue to develop (and harden), too.

How does it work?

Regenerative endodontics uses the concept of tissue engineering to restore the pulp and root canals to a healthy state. Though tissue regeneration is still in its infancy, studies suggest that “dead,” immature teeth are capable of regenerating pulp-like tissues that foster root development. More information on the subject from the American Association of Endodontists can be found here

Does it hurt?

The treatment is similar to root canal therapy and we can give local anaesthetic. The tissue regeneration itself actually occurs after the treatment has been completed.

What is it?

Internal bleaching is a way of restoring a discoloured tooth’s original appearance that is often combined with crowning or bonding the tooth surface in order to mask discolouration.

Who is it for?

We are happy to discuss this cosmetic procedure with anyone who is concerned about the colour of one or more of their teeth.

How does it work?

Internal bleaching is the process of bleaching or whitening a tooth from the inside out. Unlike traditional tooth whitening, where whitening agents are applied to the outside of the tooth, internal bleaching is completed from the inside out. In cases of trauma or cavities, the discoloration begins from inside of the tooth and then spreads outwards.

Does it hurt?

Patients do not normally report pain or discomfort after internal bleaching treatment.

What is it?

Extraction is, as the word suggests, the extraction of a tooth or teeth, and can be pursued for a variety of reasons. As well as being an expert in root canal therapy, Dr El Jabouri at The Endodontic Clinic has performed many thousands of extractions and is able to advise on the removal of teeth when this is either desirable – such as with wisdom teeth as soon as they erupt – or essential, as is sometimes the case after severe infection.

Who is it for?

The Endodontic Clinic sometimes extracts teeth because the mouth has become too crowded and the removal of one or more teeth has been recommended by a specialist orthodontist. The goal of orthodontics is to properly align the teeth, which may not be possible if the teeth are too big or too numerous for the mouth.

Other instances in which we perform an extraction include severe infection that will not be remedied by root canal therapy; periodontal gum disease; and cases when people who have a compromised immune system – such as cancer patients – have an infected tooth and have been advised to remove it as a matter of urgency.

How does it work?

Before pulling the tooth, we will give you an injection of a local anaesthetic to numb the area where the tooth will be removed. If the tooth is impacted, we will cut away gum and bone tissue that covers the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.

Does it hurt?

There is little point in dressing up the fact that tooth extraction is one of the more demanding dental procedures in terms of the patient experience, though before pulling the tooth we will give you an injection of a local anaesthetic to numb the area where the tooth will be removed.

Our aim is always to ensure the comfort of the patient as best as our skills and the latest technology allow. In some instances, we may suggest intravenous sedation.