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Medical Forum / General / Dentistry / February 2007Is there such a thing as a partial root canal?
Everything I've read about root canals says that the entire root is removed and replaced with gutta percha. But I would naively think that if only the upper portion of the root is infected, or there is no infection at all but only pain, that just the upper portion of the root could be removed instead, thereby leaving a stronger healthier tooth. Is such a "partial root canal" ever done, and if not why not? Thanks. > Everything I've read about root canals says that the entire root is > removed and replaced with gutta percha. But I would naively think that [quoted text clipped - 4 lines] > > Thanks. The traditional answer is that there is no such thing in legitimate dentistry, with the exception that pulpotomy (removal of the pulp in the chamber, usually followed by application of an antimicrobial agent) was done as a temporary expedient. Now, I'm starting to hear talk of direct pulp caps and even partial pulpectomies, usually involving the use of an agent known as MTA. In other words, this is an interesting area of endodontia in which the traditional thinking may have to change. Steve >> Everything I've read about root canals says that the entire root is >> removed and replaced with gutta percha. But I would naively think that [quoted text clipped - 15 lines] > >Steve Unlikely anytime soon IMO. >>>Everything I've read about root canals says that the entire root is >>>removed and replaced with gutta percha. But I would naively think that [quoted text clipped - 17 lines] > > Unlikely anytime soon IMO. I'm inclined to agree. Still, I'm hearing encouraging things about direct pulp caps and subtotal pulpectomies with MTA: http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2591.2003.00652.x/abs/ http://www.forp.usp.br/bdj/bdj12(2)/trab08122/trab08122.html I do hear that its handling characteristics make it difficult to place. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Everything I've read about root canals says that the entire root is >removed and replaced with gutta percha. But I would naively think that [quoted text clipped - 4 lines] > >Thanks. The root is not removed, the contents of the root canal are removed and sealed with GP plus a sealant in most cases. Partial RCT's are not done in adults because once the pulp becomes infected ultimately it will die. Pulpotomy is done on primary teeth but that is another animal entirely. See www.aae.org for more information. American Association of Endodontists > >Everything I've read about root canals says that the entire root is > >removed and replaced with gutta percha. But I would naively think that [quoted text clipped - 7 lines] > The root is not removed, the contents of the root canal are removed > and sealed with GP plus a sealant in most cases. I use the terms "root", "pulp" and "nerve" interchangeably. So, I think of the "root canal" as the entire root content of the tooth. And I understood "root canal therapy" to mean the removal of the entire root, aka a "pulpectomy". > Partial RCT's are not done in adults because once the pulp > becomes infected ultimately it will die. Why can't only the infected pulp be removed, leaving health pulp? Is it because it is difficult to tell infected from non-infected? What if there is only pain, but no sign of infection? Say the pulp nearest to a filling has become sensitive through repeated trauma. Why can't only it be removed leaving healthy pulp beneath it? > Pulpotomy is done on primary teeth but that is another animal entirely. So, "pulpotomy" seems to be partial removal of the root (pulp). My question was why is this never considered an option for adult teeth? (though from Steven Bornfeld's response, it seems to be a current area of research). BTW, I found a great site for information about teeth and dentistry. It's http://www.doctorspiller.com/. To my layman's mind, it's remarkably comprehensive and accurate. He mentions primary (baby) tooth pulpotomy and an adult tooth pulp cap, but not adult tooth pulpotomy, here: http://www.doctorspiller.com/Children's %20Dentistry.htm#pulpotomy >>>Everything I've read about root canals says that the entire root is >>>removed and replaced with gutta percha. But I would naively think that [quoted text clipped - 28 lines] > (though from Steven Bornfeld's response, it seems to be a current area > of research). Traditional pulpotomies (generally done with some fixative agent such as formocresol--awful stuff BTW) used to be done more as short-term fixes for emergency patients until a complete root canal can be done. I have seen them done and never completed, and some of these SEEM to work. Very commonly the tissue in the canals under the pulpotomy filling tend to sclerose, and if there are symptoms afterward it is difficult or impossible to pass these canals--they become blocked. Your use of the terms "pulp" and "nerve" interchangeably is understandable and not likely to cause misunderstanding. The same is not true for "root" and "root canal" (many roots contain multiple canals) and "pulpectomy" and "root canal treatment" (pulpectomy is the removal of the gross contents of the root canal; it specifically implies that the canals have not been entirely shaped and formed, and certainly implies that the canals have not been obturated. I agree with Newbie that it is unlikely that direct pulp capping and/or pulpotomy is likely to enter the field as a definitive (as opposed to interim) procedure any time soon. However, some work IS being done in this area--and I've been wrong before about what's going to be around in 10-20 years. Steve > BTW, I found a great site for information about teeth and dentistry. > It's http://www.doctorspiller.com/. To my layman's mind, it's > remarkably comprehensive and accurate. He mentions primary (baby) > tooth pulpotomy and an adult tooth pulp cap, but not adult tooth > pulpotomy, here: http://www.doctorspiller.com/Children's > %20Dentistry.htm#pulpotomy SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Why can't only the infected pulp be removed, leaving health pulp? Is > it because it is difficult to tell infected from non-infected? What > if there is only pain, but no sign of infection? Say the pulp nearest > to a filling has become sensitive through repeated trauma. Why can't > only it be removed leaving healthy pulp beneath it? So far, the type of tissue damage associated with partial removal of the pulp, seems to inflame/contaminate/doom the rest of the tissue. One theory that I've heard....... In other parts of the body, wounded tissue is surrounded on almost all sides by healthy tissue, and healing begins on many fronts. The canal space in a tooth is only entered through a tiny opening at the apex (roughly the size of one human hair). It restricts the access of healing chemicals and cells into the area of damage. It may also have something to do with the inflammatory response of the pulp tissue complicating normal blood circulation within the tooth through this small entrance/exit. No blood=dead tissue. At any rate, failing to perform a complete debridement and fill usually ends in failure. I can't say it will never work, but it doesn't work now. D >> Why can't only the infected pulp be removed, leaving health pulp? Is >> it because it is difficult to tell infected from non-infected? What [quoted text clipped - 26 lines] > >D Yep the vascular strangulation dooms the pulp to necrosis at this time. |
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