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Dr. Paul Gutt

Dr. Gutt is a Board Certified Endodontist and a member of the American Board of Endodontists. He is also a specialist member of the Michigan Association of Endodontists and the American Association of Endodontists. Dr. Gutt is also a member of the Michigan Dental Association and the Vacationland Dental Society.

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Endodontic Procedures

As an endodontic patient, what should I expect?
1. A comprehensive examination to diagnose facial pain and the extent of pulpal (tooth related) injury; and determine if the tooth is a good candidate for endodontic therapy.
2. Non-surgical treatment to eliminate the diseased pulp. The injured pulp is removed and the root canal system is thoroughly cleaned and sealed.
3. Under certain circumstances, microsurgery may be indicated on the adversely affected root(s). We are experts in performing this procedure and utilize advanced equipment, material and techniques to ensure the best result.

Endodontic Procedures

Root Canal

At the center of your tooth is the pulp. The pulp is a collection of blood vessels, nerve tissue and supportive cells that develop the tooth. Infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and fractures, or extensive dental procedures. Symptoms of irreversible infection & inflammation may include sensitivity to temperature, pain in the tooth and/or gums, radiating pain to other areas of the face and swelling.

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Non-operable Cases

If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of the consultation or when a complication becomes evident during or after treatment. You will be able to drive home after your treatment if a sedative was not used. There is typically slight soreness for 24-72 hours.

A root canal is one of the most common dental procedures performed, well over 14 million every year. This simple treatment can save your natural teeth and prevent the need for dental implants or bridges.
If you experience adverse symptoms, an evaluation will determine the best solution. If a root canal is indicated, then the injured pulp is removed and the root canal system is thoroughly cleaned and sealed. The root canal is typically completed in one visit, but overly inflamed and infected teeth may require placement of medication in the canal system and a second visit to complete.
You will be able to drive home after your treatment if a sedative was not used. There is typically slight soreness for 24-72 hours. When your root canal therapy has been completed, a record of your treatment and radiographs (x-rays) will be sent to your restorative dentist. You should contact their office for a follow-up restoration within a few weeks of completion at our office. Your dentist will decide what type of restoration is necessary to protect your tooth; a crown is typically recommended for posterior teeth.
The cost associated with this procedure can vary depending on factors such as: the severity of damage to the affected tooth, and which tooth is affected. In general, endodontic treatment is less expensive than tooth removal and replacement with a bridge or an implant. Please contact our office for more specific information concerning treatment fees, insurance coverage, and payment options.

Endodontic Retreatment

With the appropriate care, your teeth that have had endodontic treatment can last as long as other natural teeth. Yet, a tooth that has received root canal treatment may fail to heal or discomfort may continue to exist. Sometimes signs of failure may occur months or years after treatment. If so, endodontic retreatment may be needed.

Inadequate healing may occur due to:

  • Complex anatomy not adequately treated
  • Missed canals
  • Crack or fracture within the tooth stucture
  • Delayed or inadequate restoration of the tooth
  • Recurrent decay or defective restoration
  • Compromised supporting structures (ex. gum disease, trauma)

Once the need for retreatment is confirmed, the inside of the tooth is accessed through the existing restoration to remove the root canal filling material. The canals will be disinfected and carefully examined microscopically. Once cleaned, medication will be placed in the canals for two to three weeks. You will return for a completion appointment at which time the medication will be removed, the canals will be sealed, and a temporary filling placed in the tooth.
It is very important to see your general dentist within a few weeks (or sooner) to have the tooth restored properly.

An apicoectomy is a simple surgical procedure where an incision is made in the gum tissue to reflect the gums and expose the underlying bone associated with the adversely affected area surrounding the root structure of concern.

The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to enhance the seal of the root and the gums are sutured. In most cases the bone will then naturally heal around the remaining root structure. Healing is confirmed radiographically 6-12 months post-operatively.

Following the procedure, there may be some discomfort or slight swelling while the site heals. This is normal for any surgical procedure. To alleviate any discomfort, appropriate pain medication will be recommended. Antibiotics may be prescribed if indicated. Patients are required to return for suture removal typically within 3-5 days.

In most cases, a root canal is all that is needed to save teeth with an injured pulp from extraction. Occasionally, this non- surgical procedure will not be sufficient to heal the tooth and your endodontist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain or infection from the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save a tooth with additional concerns is an apicoectomy or root-end resection.

Cracked Teeth

Cracked teeth demonstrate many types of symptoms; including pain when chewing, temperature sensitivities or pain on release of biting pressure. It is also common for pain to occur intermittently, making it difficult to diagnose.

Chewing can cause flexing of the tooth and allow irritants into the compromised structure. The pulp within the tooth may become irritated. At the same time when biting pressure is released, the crack can close quickly resulting in sharp pain. The pulp may become irreversibly inflamed or more extensively compromised and the tooth will consistently hurt, even when you are not chewing. It is possible that the cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.
These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults due to more extensive wear and are usually of little concern.
When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp will create greater exposure of the dentin and may cause exposure at the pulp or extend onto the root structure potentially making restoration difficult or impossible.
This type of crack extends from the chewing surface to the tooth and will migrate towards the root, either vertically, horizontally or obliquely. In some cases, the crack may extend below the gum line onto the root. Damage to the pulp is likely and root canal treatment is typically necessary. If the crack becomes a root fracture, the prognosis for saving the tooth may diminish significantly resulting in the need for extraction.
A split tooth can be the result of an untreated cracked tooth. It can be identified by a fracture with diverging segments. This type of tooth can never be saved in it's entirety. The position and extent of the fracture will dictate the tooth's prognosis. Most of these teeth require extraction.
A vertical root fracture may begin at the root and extend towards the chewing surface of the tooth, or more commonly be the result of a crack within the coronal (enamel covered area) of the tooth which has become more severe, frequently extending onto the root. Some fractures show minimal symptoms initially and may go unnoticed. Endodontic surgery may be effective in some specific situations, allowing for elimination of the fractured portion of the root or the entire root. Otherwise the tooth will have to be extracted.

Traumatic Injuries

Injuries to the mouth can cause teeth to be pushed back into their sockets. Dr. Gutt or your general dentist should reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth until it is determined the tooth can be sealed and restored.

Sometimes a tooth may be pushed partially out of the socket. Again, the tooth should be repositioned and stabilized ASAP. In some cases (children) the tooth may be observed for a period of time to determine whether root canal treatment will be necessary. Most teeth will require root canal treatment due to the loss of blood supply and necrosis. Resorption of the root may occur if medication is not placed in a timely manner.

If an injury causes a tooth to be completely knocked out of your mouth (avulsed), it is important that you are treated as soon as possible! If this happens to you, place the tooth in milk or a tooth preservation medium (commercial tooth saving container). If the tooth is clean it may be reasonable to place it back into the socket (do not scrub the surface or soak in water; gently rinse debris and place in the socket or in milk for transport to the dentist). It is very important to not leave the tooth out of the socket for greater than an hour. The long-term prognosis for the tooth is much greater if replanted into the socket in the appropriate orientation or placed in appropriate transfer medium (milk) until a dentist or medical provider can properly replant the tooth. Follow up with your dentist for evaluation and referral to the endodontist for evaluation and treatment; root canal treatment will likely be necessary. The length of time a tooth is out of the socket and the way the tooth was stored will influence the prognosis and treatment options available. Traumatized teeth and other teeth involved in the traumatic incident should be assessed as soon as possible as other teeth may have been injured.

Injuries in Children

An injured immature permanent tooth may need one of the following procedures to improve the chances of saving the tooth:
This procedure encourages the root to continue development if the pulp is treated to maintain vitality. The pulp is covered with medication to encourage continued growth. It is important to try to achieve greater root formation and strength as the child ages. If the pulp heals and the root is adequately formed additional treatment may not be necessary. The more mature the root structure becomes, the greater the longevity of the tooth.
In this case, the unhealthy pulp inside the root is removed. The endodontist will place medication into the root to help form calcified tissue within the root structure and promote extension of the root end (apex). This hardened tissue provides a barrier for the root canal filling. At this point the hope is that the root structure develops further, making the tooth less susceptible to fracture and improving what is typically a guarded prognosis.

What Others Are Saying:

Susan D.

I too am afraid of the pain when going to a dentist. Dr. Gutt assured me it would be painless. He was right. The root canal was completed and I walked out a very satisfied patient.

-Susan D.
Jessica R.

The best! Dr. Gutt is the best at what he does. I've had 2 root canals by him and he's the only one who you can trust to make sure its done right. Also his assistant is a peach! Love her!

-Jessica R.
Jenelle B.

Dr. Gutt has certainly mastered his craft. I thoroughly enjoyed my time spent with him & his assistant Melanie. He & his staff are fantastic at what they do & we are very fortunate to have them available to us in our community. Thank you so much for taking such good care of me. You’re the best!!

-Jenelle B.

(231) 487 - 0515

pgutt@pauleguttdds.com

Address

Street Address
308 State St. Suite #5
City State
Petoskey, Michigan
zip
49770

Hours

Monday - Thursday
Monday - Thursday
09:00 - 17:00 (GMT 0)
8:30am - 5:30pm
Friday - Sunday
Friday - Sunday
Closed
CLOSED