Saving Tooth from a Root Canal

The joy of dentistry…one tooth at a time!

This patient presented with a filling on a lower molar that showed signs of bond failure due to the discolored line that had formed at the interface of the filling and tooth. Bond failure allows the ingress of bacteria in teeth which leads to tooth decay and infection. Though the decay seemed in its early stages, fortunately, we decided to take a proactive approach to replace it so that it does not progress and cause further damage to the inner layers of the tooth. Preserving as much healthy tooth structure as possible allows for the tooth to be as strong as possible.

We isolated her teeth under a rubber dam to prevent bacterial invasion from inhabitant oral bacteria and also achieve the ideal bonding of her new white fillings that would last her many long years. She was also more comfortable with the dam protecting her airway and disallowing the ingestion of water and the infected tooth structures that were removed.

Removal of the most superficial layers of the filling showed that the bond failure had not advanced into the dentin. Sadly though, as the remainder of the filling was removed, we observed a tremendous amount of decay that was not removed and left behind from the previous filling!

We proceeded to remove the infected tooth structure meticulously and judiciously as we were nearing the nerve of the tooth. Decay indicating dye was utilized to stain the infected tooth structure for additional visual aid. The decayed tooth structure is mushy. You can observe that a white rotary instrument was utilized on a slow rotation to selectively remove the mushy/decayed tooth substance without affecting the healthy tooth structure that we want to preserve.

As we continued to excavate further, we were getting closer to the nerve chamber of the tooth. It was at this point that we utilized airborne particle abrasion to more selectively & conservatively remove the very last remnants of the infected tooth structure. This is the most conservative and kindest protocol in removing decay and failed restorative materials so as not to mechanically expose the nerve.

Through the application of advanced biomimetic principles, high magnification under a dental operating microscope, airborne particle abrasion techniques, time & patience, we were able to successfully remove all infected tooth structures without violating the nerves of her teeth. In this fashion, the tooth was successfully saved from having a root canal as would be typical with traditional dentistry.

After successfully removing all infected dentin, achieving a 2mm peripheral zone of healthy tooth structure. We scrubbed 2% Chlorhexidine for 60 seconds for its antibacterial properties. We treated the fine lining remaining over her teeth’ nerves with high fluoride-releasing glass ionomer, Fuji Triage to give the tooth the nutrients it needs to encourage the formation of dentinal bridges through the production of reparative dentin. Over time we can observe on x-rays that the tooth nerve has formed a protective layer around itself and effectively distances itself from the proximity to the filling.

The tooth was then prepared for the bonding of her new white fillings.