Services We Provide

Root Canal Therapy

Root Canal Therapy San Diego

Are you having excruciating tooth ache, pain leading to unable to sleep, sensitive to hot or cold food items, pain on biting down on food or your dentist did a crown or filling and now your tooth hurts and your general dentist told you to need to visit an endodontist for root canal treatment? If so, you’re not alone. We have saved thousands of teeth each year which were treated with root canal, or endodontic treatment.
To understand a root canal procedure, it is important to understand the inside of tooth. The outermost hard white calcified layer of tooth structure is called as enamel, the middle layer of tooth is called as the dentin and the innermost soft tissue is called the pulp containing blood vessels, nerve and connective tissue. The tooth is surrounded by periodontium and the bone. In a fully developed tooth, the tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.
Endodontic treatment treats the pulp of the tooth. Endodontic treatment is necessary when bacteria causing dental decay infects the pulp or a dental trauma or fracture involves the nerve causing it to be inflamed or infected or necrose. If left untreated, it can cause pain or lead to an infection or an abscess with ability to spread across the entire body.

How does endodontic treatment save the tooth?
Root canal treatment removes the inflamed, infected pulp or necrosed pulp inside of the tooth and also cleans carefully the infected tooth structure and filling the void with a rubber-like material called gutta-percha. Afterwards, the tooth is restored with a crown or filling for protection. After final restoration, the tooth is as strong as natural tooth and continues to function like any other tooth in the mouth maintaining balanced bite and esthetics.

Advantages in saving the natural tooth with root canal treatment are:

  • Cost efficiency as compared to replacement via Implants.
  • Maintain chewing efficiency and ability to eat food you like the most.
  • Space loss and movement of other teeth in mouth.
  • Natural appearance

With proper care, most teeth that have had root canal treatment can last as long as other natural teeth and often for a lifetime.

Root Canal Retreatment Therapy

Re-root Canal Therapy San Diego

Root canal treated teeth can last as long as other natural teeth. In some cases, a tooth which has been previously treated with root canal treatment fails to heal. This tooth deserves a second chance to heal using re-treatment of previously completed root canal. There are several reasons for failure of previous root canal treatment:

  • Bacterial contamination of tooth as a final restoration was delayed following endodontic treatment.
  • The dentist did not adequately note the complicated canal anatomy leading to missed narrow or unnegotiated curved canals.
  • Tooth fracture
  • Previous dentist leaving a separated instrument inside the tooth.
  • Inadequate cleaning or shaping of canals leaving infected tooth structure.

Root Canal Retreatment Therapy Treatment

Root canal treated teeth can last as long as other natural teeth. In some cases, a tooth which has been previously treated with root canal treatment fails to heal. This tooth deserves a second chance to heal using re-treatment of previously completed root canal. There are several reasons for failure of previous root canal treatment:
If retreatment is necessary, using high magnification your experienced endodontist Dr. Thomas Acierno will reopen the tooth.
Most teeth that have had root canal (endodontic) therapy can last as long as other natural teeth. In some cases, a tooth that has had endodontic treatment fails to heal. Occasionally, the tooth can become painful or diseased months or even years after successful root canal therapy. If your tooth has not healed or has developed new problems, you have a second chance at saving your tooth. Another procedure, root canal retreatment may be performed by your endodontist. As with any dental or medical procedures, occasionally, a tooth may fail to heal following the initial treatment for several reasons:

  • The final restoration was delayed following endodontic treatment.
  • During initial treatment, narrow or curved canals were not properly cleansed.
  • The endodontist did not notice complicated canal anatomy during the first treatment.
  • The restoration did not protect the central portion of the treated tooth from salivary contamination.


Sometimes a new problem can develop in a tooth that was successfully treated during the initial procedure. These include:

  • A fracture occurs.
  • New decay develops, exposing the canal to bacteria and a new infection.
  • Infection can occur if the crown or filling becomes loose or cracked.


If retreatment is necessary, using a microscope, your endodontist will reopen the tooth and remove previous filled and infected filling material within the canals, clean the canals thoroughly using intracanal medicaments and instruments carefully assess for any missed canals, calcified canals and unnegotiated spaces within the canal. Once the canals are comprehensively cleaned, Dr. Acierno will place a temporary filling.

In some cases, An endodontic surgery Apicoectomy, root section may also be necessary if the canals are very narrow complex anatomy, calcified canals, separated infected instrument or fractured root. Apicoectomy is also known as a root-end resection means the removal of the apex of the root of the tooth. This procedure also treats the surrounding bony area of the infected root area. The opening at the level of the root is replaced by a biocompatible small plug or filling. After retreatment is completed, within two to five weeks, you will need to see your dentist for the final restoration. We encourage preserving your natural tooth as much as possible unless an implant is a better long term prognosis.

Emergency Root Canal in San Diego

If you need an emergency root canal treatment in San Diego by our experienced endodontist Dr.Acierno, our office is always ready to serve you. Please feel free to contact us during work hours through our office phone number. After hours, leave a voicemail and we will get back to you the same working day or the next day to help resolve your dental pain. Call  +1 619-276-5526 to schedule an appointment with Dr. Acierno.

Endodontic Surgery

Endodontic Surgery at San Diego

In rare situations, root canal therapy is not alone sufficient to save your tooth. There are several situations in which endodontic surgery can help save your tooth where adequate root canal therapy is missing:

  • Patients have recurring symptoms on the tooth previously treated with root canal, although there are no visible problems on their X-rays. These cases can sometimes indicate a fracture or crack in the tooth structure or root. They are often diagnosed by pain on biting on a hard food item. The pain is relieved by Endodontic surgery such as Apicoectomy or root resection that can give your endodontist a chance to thoroughly examine the tooth’s structure without relying on X-rays.
  • Patients with complex root canal anatomy or calcified canals a endodontic surgery is warranted in order to save natural tooth.
  • In some rare cases, the root canal therapy is done adequately but the symptoms or problems may persist, or reoccur. A endodontic surgery may be considered as a second chance prior giving the tooth hopeless prognosis and replacement using implants.


The most common type of endodontic surgery is called an apicoectomy, or “root-end resection”

Cracked Tooth

Cracked Tooth Surgery at San Diego

Advancement in science and medicine has increased life span of patients thereby leading to increased in crack-related tooth injuries. Life-style stress is expressed by either clenching or grinding and or chewing on hard objects such as ice, which ultimately makes teeth vulnerable to cracking.
Patients having cracked teeth can have various symptoms, including increased sensitivity and pain while chewing or being exposed to extreme temperature changes.
Early diagnosis is extremely important and sooner the crack is detected and treated, the better the prognosis of saving your tooth.
A root canal therapy will be necessary to treat the damaged tooth. Following treatment, your general dentist will place a crown over the tooth to hold the pieces together and protect it from further damage.


Apicoectomy Surgery at San Diego

Your endodontist will open your gum tissue of the concerning tooth to examine and diagnose the reasons for failure of root canal therapy, fracture root segments, surrounding bone and to remove any infected tissue. After this, the endodontist remove infected tissue, disinfect, back-fill the end of the tooth’s root and will close and suture the gum tissue back together to encourage proper healing. Over the next few months, the new bone tissue will gradually fill in to replace the removed infected tissue. Most patients can return to their normal routine as early as the next day after their surgery. As with any treatment, success is not guaranteed, so it is important that you take your endodontist before proceeding with any treatment. In many cases, the only alternative to any endodontic surgery is the extraction or removal of the tooth followed by replacement by either an implant, bridge or denture. Of course, nothing is better than preserving your natural tooth.