Root Canal Treatment, also known as Endodontic Treatment is the treatment of the root canals of a tooth. The aim of root canal treatment is to remove infection and/or pain and to fill the root canals to prevent further infection.

The root canal is a thin channel that exists in the roots of the teeth. Normally these channels are filled with nerves and blood vessels that supply the tooth. The root canal system may become compromised (infected and/or painful) and need root canal treatment.

The most common cause of a tooth infection is tooth decay, tooth trauma, or a poorly fitting restoration such as a filling or a crown.
These conditions can cause bacteria to enter the pulp of the tooth. The blood vessels and nerves reside in the pulp of the tooth. They become inflamed and begin to die. The dead cells and bacteria progress to form an infection.

Sign & Symptoms

During the early stages of infection, pain may be minimal or even non-existent.
As the infection develops you may get pain or swelling.
When there are no symptoms, it may only be visible to your dentist on examination. In these situations, the dentist would normally see a small spot or opening on the gum (called a sinus tract) where the infection has created a path to come out of the bone. Sometimes the dentist can also see a shadow at the bottom of the root on the x-ray.

The main symptoms of early infection are tenderness to bite on and/or pain to hot and cold that lasts more than a few seconds.
The longer you leave the infection to spread through the root canal system, the more painful it may become until you feel a constant toothache.
In serious cases or in advanced infection, a dental abscess may form which will present as swelling of the gum or even the face.

Treatment Options

A tooth infection can only be treated by either root canal treatment or removal of the tooth. Antibiotics are only a temporary measure until you can have the infection treated properly. Antibiotics will not remove the infection permanently.

If a tooth infection is left untreated the surrounding bone will be affected and bone will be lost. A small infection may develop into an abscess or even a swelling of the face that may need urgent treatment in hospital.

Consultation

Before starting treatment it is important to see our specialist Endodontist, Dr Aram Navai, for a consultation. At this appointment Dr Navai will assess your tooth and take some x-rays in order to diagnose and plan your treatment accurately. In some complex cases, 3D Cone Beam CT imaging may be recommended for this as well, as the root canal system is a 3-dimensional network of canals and tubules that cannot always be visualised accurately on a 2-dimensional standard x-ray.
The consultation is an important and integral part of your root canal treatment. Every patient is different and unique, with different expectations, past dental experiences and levels of anxiety. Dr Navai will discuss all options with you and answer all your questions before commencing treatment. This way the treatment as a whole can be tailored specifically to you in order to achieve a positive treatment experience and a successful outcome.

Depending on various factors, the treatment can be done in a single session start to finish or in multiple sessions. This will be discussed with you at your consultation.

Procedure

With the advanced approaches practiced by Dr Aram Navai at The Wellington Clinic, root canal treatment is almost always predictably pain free and comfortable. Dr Navai uses a combination local anaesthetic regime when required and ensures your comfort throughout the procedure. At The Wellington Clinic you will also be provided with TV entertainment and headphones allowing you to relax throughout the procedure.

Once the root canal has been accessed via the crown (top) of the tooth, the microscope is used to investigate the canals further and to identify micro canals that extend off the main canals so that these are not missed. A full examination under microscope is also carried out to identify cracks and other complications.
The canals are thoroughly cleaned using precisely measured files and disinfected with antibacterial irrigants.
If carried out in multiple appointments, the canals will then be dressed with antibacterial medication and a temporary filling placed.
Once the canals have been thoroughly cleaned, they are shaped to receive the root filling material, a rubber based material called Gutta Percha, coated in an antimicrobial sealant paste. The root canal system is a very complex system with many fine asymmetric irregularities three dimensionally. The Gutta-Percha is therefore compressed into the root canal system with heat so that it can shape itself and fit the root canal system most optimally in all three dimensions. The gutta percha then cools and solidifies forming the permanent root canal filling.
After the root canal treatment has been completed, the top part of the tooth is then sealed up with a core restoration. You will then be referred back to your dentist for the permanent restoration that goes on the top of the core restoration.

Complicated Teeth

Some Endodontic Specialists with advanced skills like Dr Aram Navai are also able to treat complicated teeth that would otherwise need to be extracted. If the root canal has a perforation from previous treatment, Dr Navai can repair this. If there is a fractured portion of instrument separated in the canal from previous treatment Dr Navai will most often be able to bypass or remove this for you. If there is a post in the root canal, Dr Navai can either remove it for you or provide root treatment from the other end of the tooth; known as an apicectomy or apical microsurgery. An apicectomy is also useful if it is not possible to access the tooth from the crown (top). If a previous root canal treatment is perfectly filled but for some reason has still failed, Dr Navai may carry out Endodontic microsurgery to treat the infection. If a tooth has multiple roots and one root has too many complications, Dr Navai can carry out root resection surgery to remove the infected failing portion and thereby restoring the rest of the tooth.

After Treatment

After root canal treatment, the tooth may become brittle as there is no longer a live blood supply within the tooth. It is important to prevent the tooth from future cracks and breakages so that you can increase the lifetime of the tooth. The most effective solution is to place a crown or onlay over the tooth. This is more durable and stronger than a composite filling and reduces the risk of tooth fracture or re-infection of the roots.

The success rate for root canal treatment can be high as 98% when carried out by a specialist. A successfully treated tooth will normally survive for years afterwards, in most cases for a lifetime.

Endodontic Specialist

Dr Aram Navai sees private patients at The Wellington Clinic for root canal treatments and he also sees many patients from his referring dentists. He has vast experience in treating cases with complex anatomy and those which have been previously treated and failed.

Dr Aram Navai also works as a Specialist Clinical Teacher and lecturer in Endodontology at Guy’s Hospital and King’s College London where he teaches and supervises both undergraduate and postgraduate students.

Aram originally qualified from the King’s College London Dental Institute in 2009 and was awarded membership of the Royal College of Surgeons of England in 2011. His previous positions include a year as a Senior House Officer in Oral and Maxillofacial Surgery in London, where he gained experience in complex surgeries including management of facial lacerations, wisdom tooth surgery and assisting in major cancer and trauma surgeries.

Dr Aram Navai is one of the very few dentists that was awarded a specialist training position in Endodontics at the prestigious Guy’s and King’s College Dental Institute where he successfully completed 4 years of advance training and passed all examinations with Distinction. He was also awarded the ‘Membership in Endodontics’ by the Royal College of Surgeons of Edinburgh, which is recognised as the highest qualification in the field.

You should see a Specialist Endodontist for root canal treatment in order to increase the success rate of the root treatment and to have a better chance of keeping the tooth for the rest of your life.
At The Wellington Clinic, Specialist Endodontist Dr Aram Navai has the expertise to provide outstanding treatment and care for you. Dr Navai uses state of the art equipment and technology to achieve optimum results. A dental operating microscope is used to view the root canal system under high magnification allowing a more thorough and complete treatment of the canals. In addition to this, further state of the art technologies and materials are used during your treatment to ensure superior results.
The Wellington Clinic invests in the latest research, materials and technologies to provide you with the best root canal treatments whilst staying at the forefront of the endodontic world.

You can book directly with the Endodontist and do not need to have a referral to see them.
Many dentists do however refer their patients to Dr Aram Navai at The Wellington Clinic for better continued care and communication. Dr Navai is then able to send reports of the consultation, investigation and treatment back to your dentist and can advise them on the best follow-up care required for long term results.

Cost

The cost will vary on a number of things; the number of root canals present, whether a root canal treatment has previously been performed on the tooth, and whether there are other complicating factors.

As a rough guide the costs tend to be based on the tooth being treated:

Incisors and Canines £845
Premolars £895
Molars £995

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