Dr Areti Vrochari, Specialist Endodontist

Role: Specialist Endodontist, Smile Solutions

Qualifications: DDS, MS (Endo), DrMedDent

Registration: DEN0001909501 — Registered Dentist, Specialist, with Specialist Registration in Endodontics

This is a specialist registration. Under the Health Practitioner Regulation National Law, only a dentist holding specialist registration in a recognised specialty may use its title, and endodontics is one of the thirteen recognised dental specialties in Australia. Registration and specialty can be verified free on the AHPRA public register at ahpra.gov.au. The specialty page is Specialist Endodontists; the other specialists here are on Dentists and Registered Specialists and under Specialist Care.

Background

Dr Vrochari received her Dental Degree (DDS) from the School of Dentistry, National and Kapodistrian University of Athens, Greece.

She completed Advanced Training in Restorative Dentistry and Aesthetics at the Dental School and Hospital, Albert-Ludwigs-University of Freiburg, Germany, in 2008.

In 2023 she completed a three-year postgraduate combined specialty and MS programme in Endodontics at the School of Dentistry, University of Athens.

She also holds:

• A Doctorate Degree (DrMedDent) in Dental Biomaterials from Albert-Ludwigs-University of Freiburg
• A Master's Degree in Endodontics from the School of Dentistry, University of Athens

Dr Vrochari was a Clinical Instructor in the Department of Prosthodontics at the School of Dentistry, University of Athens, and a Lecturer at the School of Dentistry, Griffith University.

She has authored and co-authored clinical and research articles on dental biomaterials, aesthetic and restorative dentistry and prosthodontics; is a co-author of a textbook on all-ceramic restorations and the main author of a clinical manual on restorative dentistry; and is a reviewer for several international journals.

The biomaterials and restorative background is directly relevant here. Endodontics and restorative dentistry meet at the point most root canal treatments are won or lost — the restoration that seals the tooth afterwards. See What does restorative dentistry involve? and Specialist Prosthodontists.

What an endodontist is

All dentists are trained in root canal treatment and many perform it routinely. A specialist has completed a three-year full-time postgraduate qualification restricted to the field, and then holds specialist registration granted by the Dental Board of Australia. See Endodontist vs Dentist for Root Canal: Why It Makes a Difference and Why would I need to see a dental specialist?

The pathway is: a dental degree, then general practice experience, then the three-year postgraduate programme, then application for specialist registration. The degree and the registration are separate things — a university awards one, the Board grants the other.

Where specialist referral genuinely changes the outcome:

• Complex canal anatomy — curved, calcified or additional canals, which are common and easily missed
• Retreatment of a root canal that has failed
• Difficult diagnosis — pain that cannot be localised, or that may not be dental at all. See Tooth Pain and Toothaches and What are the causes of toothache and what are their symptoms?
• Trauma in immature teeth, where the root has not finished forming
• Resorption, cracks, and perforations — see Chipped and Cracked Teeth, Why does a cracked tooth hurt so much? and How will my cracked tooth be treated?
• Surgical endodontics, where a non-surgical approach has not worked

What root canal treatment actually is

The most misunderstood procedure in dentistry, so plainly — and at greater length in Everything you need to know about root canal treatment and Root canal treatment: who and what is involved?

Inside every tooth is a pulp — nerve and blood vessels. When it becomes irreversibly inflamed or infected, through deep decay, a crack, trauma or repeated restoration, it does not recover. The two options are to remove the pulp and keep the tooth, or to remove the tooth.

Root canal treatment removes the pulp, cleans and shapes the canal system, disinfects it, and seals it. The tooth stays. It is no longer alive in the sense of having a nerve supply, and it continues to function normally — held by the same ligament, in the same bone.

On pain: the procedure has a reputation it no longer deserves. People associate root canal treatment with pain because they arrive in pain — an inflamed pulp is one of the more severe pains in medicine. The treatment is what relieves it. Under effective local anaesthetic, the procedure itself is comparable to having a filling, and modern anaesthetic technique handles even the difficult cases of a ‘hot' pulp. See Dental Phobia: How do you give a virtually pain-free injection?

What it involves: usually one or two appointments; a rubber dam isolating the tooth, which is not optional and is a marker of proper technique; access through the biting surface; measurement of canal length; cleaning and disinfection; and filling with a sealer and gutta-percha. Radiographs are taken throughout, because the canal system cannot be seen directly — see How safe are dental x-rays.

Afterwards: tenderness for a few days is normal. Severe or increasing pain, or swelling, is not — go back. Swelling that is spreading is an emergency: see What is a tooth abscess? Should I have it treated? If so, how? and Can a dental abscess affect your general health?

The part most people are not told

A root-filled back tooth usually needs cuspal coverage — an onlay or crown — and the evidence for this is good.

A tooth needing root canal treatment has usually already lost structure to decay, to a previous large restoration, and to the access cavity. What remains is more likely to fracture, and a vertical root fracture generally means losing the tooth.

A root canal treatment left under a temporary filling, or under a large direct filling, is a treatment likely to fail — not because the root filling was poor, but because the tooth broke. Ask what the final restoration will be and when, and include it in the cost from the beginning. See Dental Crowns, What types of dental crowns are available? and What do I do if a temporary filling comes out?

Success, honestly stated

Root canal treatment has good long-term outcomes, and published success rates for well-performed initial treatment are high — but figures vary considerably with the tooth, the anatomy, whether infection was already present at the root tip, and the quality of the final restoration.

Averages do not predict any individual case, and no practitioner can promise an outcome. What can be said is that the strongest predictors are thorough disinfection, a well-sealed root filling, and a well-sealed final restoration placed promptly.

If treatment fails, the options are retreatment, surgery (apicectomy), or extraction. Failure is not necessarily anyone's error — canal systems are complex, and some are not fully cleanable. One specific mechanical risk is discussed in The risk of broken files during root canal treatment.

Technology, and what it is actually for

Specialist practice routinely uses operating microscopes and CBCT (cone beam CT) imaging.

The microscope is not a luxury. Canals can be a fraction of a millimetre across; finding a missed canal, locating a fracture, or removing a separated instrument is often only possible under magnification and coaxial light. See Why is the microscope so crucial in endodontic treatment by a specialist?

CBCT gives a three-dimensional view where a conventional radiograph compresses everything into two. It is used selectively — for complex anatomy, suspected fractures, resorption and difficult diagnosis — not routinely, because it carries a higher radiation dose than an ordinary dental radiograph and should be justified case by case. See How safe are dental X-rays and when do they become unsafe?

Root canal or extraction?

A fair question, and the answer is not automatic.

Keeping a natural tooth is generally preferable where it is restorable. A natural tooth has a periodontal ligament — it senses load, it moves slightly, and it maintains the bone around it. No implant reproduces that.

Extraction may be the better decision where the tooth is not restorable, where there is a vertical root fracture, where periodontal support is inadequate, or where the overall plan is better served by a different solution. The replacement options are compared in What are the replacement options for missing teeth? and Bridges, implants, or dentures for replacing missing teeth?

What should not drive the decision is the assumption that an implant is a permanent replacement. Implants are excellent and they also fail, need maintenance, and can develop peri-implantitis. Ask for the comparison as a written plan, including the cost of each over twenty years, not just today. See Understanding Your Treatment and the Price Guide.

Common questions

The tooth is swollen. Can I just have antibiotics and deal with it later?

No — and this is the most consequential misunderstanding on this page. The RACGP's clinical guidance on dental infection puts it in one sentence: “antibiotic treatment without dental treatment to remove the cause always fails.”

The reason is mechanical rather than microbiological. The source of the infection is inside a tooth that has no blood supply left; a medicine carried in the bloodstream does not reach it. Antibiotics can reduce the surrounding cellulitis and buy time, which is why they sometimes appear to work — but the cause is still there, and the swelling returns. The principle in the guidance is drainage first, meaning treatment of the tooth itself.

What is genuinely urgent, and what is an emergency, are different things. Go to a hospital emergency department, not a dental appointment, if there is difficulty swallowing, difficulty breathing, drooling, swelling crossing the midline of the neck, or an inability to open the mouth. The RACGP article — drawing on more than 1,000 cases — records that once infection spreads beyond the confines of the jaws “there is an increasing risk of airway obstruction”, and in the hospital cohort it describes, 64% of patients were assessed as being at high risk of airway obstruction.

One caveat from the same source that misleads people in the other direction: “fever and systemic symptoms may be absent.” Feeling systemically well does not rule out a significant abscess. See Emergency Dentistry and What is a tooth abscess?

I had this tooth root-filled years ago and it has started hurting again. Has it failed?

Possibly, but there are at least four things it could be, and which one it is decides what happens next. It is worth resisting the conclusion that the original treatment was done badly — that is one explanation among several, and usually not the first.

It may be the root canal. Canal systems are complex, a canal can be missed, and bacteria can persist or re-enter through a leaking restoration. That is what retreatment is for.

It may be the tooth rather than the root filling. A vertical root fracture in a root-filled tooth typically presents years later, and it is the single commonest reason such teeth are eventually extracted — in one long-term study of 598 root-filled teeth followed for a mean of 21 years, vertical root fracture accounted for 33.3% of all extractions, with progression of periodontal disease the next largest cause.

It may be the gum, not the pulp. Periodontal breakdown around a root-filled tooth produces pain and swelling that can look identical from the outside and needs entirely different treatment.

And it may not be that tooth at all. Referred pain is common, particularly between upper teeth and the sinus, and between adjacent teeth — which is exactly the situation where specialist diagnosis earns its place.

So the useful first step is diagnosis rather than a decision. Ask which of those is suspected and on what evidence, and what a CBCT would change before agreeing to one. The options once it is known are retreatment, surgical endodontics, or extraction — and they are not interchangeable.

Why not just take it out and put an implant in? It sounds simpler.

It is simpler on the day and rarely simpler over twenty years — and the honest comparison needs the numbers from both sides.

Implants perform well. A retrospective analysis of 158,824 implants placed in 53,874 patients between 2014 and 2022 found an overall failure rate of 2.21%, with 1.56% failing early, during osseointegration and before the prosthetic work. That is a strong record and it should not be talked down.

But survival of the implant is not the same as absence of trouble. A systematic review reported that peri-implantitis and soft tissue complications occurred in 11.7% of implants after 5 years. Peri-implantitis is the implant equivalent of gum disease, it is managed rather than cured, and it is the reason an implant is a long-term maintenance commitment rather than a finished job.

And an extraction is rarely the end of the spending. Losing the tooth means replacing it — implant, bridge or denture — and each of those has its own lifespan, its own maintenance and its own failure modes. Against that, root canal treatment on a restorable tooth has published success of 87.8% at tooth level (95% CI 84% to 90%), with cumulative success around 81% even at 30 years in the long-term study cited above.

The one thing no implant reproduces is the periodontal ligament — the tissue that senses load, allows slight movement and maintains the bone. That is the argument for keeping a restorable tooth, and it is not sentimental.

Ask for both plans in writing, costed over twenty years rather than today, including the final restoration on the root-filled tooth and the maintenance on the implant. See Understanding Your Treatment, Bridges, implants, or dentures for replacing missing teeth? and the Price Guide.

The tooth has gone grey since the treatment. Can anything be done?

It is a recognised change and there are options, but the first step is working out which kind of discolouration it is — because that decides what will and will not work.

A root-treated tooth can darken because of what was in the pulp chamber before treatment, or because of restorative material left in the crown. That is internal discolouration, coming from within the tooth, and it behaves quite differently from the surface staining that tea, coffee and red wine produce. The practical consequence is that ordinary whitening will not fix it. Whitening acts on natural enamel from the outside; it will not change the colour of a crown, a veneer or a tooth-coloured filling, and it does not address discolouration sitting inside the tooth.

So the options are a conversation rather than a product. They range from approaches directed at the inside of the tooth to covering it with a restoration, and which is appropriate depends on how much sound tooth structure remains, on whether the tooth needs cuspal coverage anyway, and on how the colour sits against the teeth either side. A tooth that is going to be crowned for structural reasons has already answered the colour question.

Two things to check first. That the root canal treatment itself is settled and the tooth is asymptomatic — colour is a cosmetic problem and should not be treated ahead of a functional one. And what the neighbouring teeth will look like afterwards, because matching a single tooth to its neighbours is the hard part of any anterior case.

See I want to whiten my teeth but one of my front teeth has a porcelain crown — what are my options?, Teeth Whitening and Dental Crowns.

Related pages: Specialist Endodontists, Root Canal Therapy, Dental Crowns, Tooth Pain and Toothaches, Our Team.

Practical details

Dr Vrochari's registration and specialty can be verified free on the AHPRA public register at ahpra.gov.au. For consultation or referral, call 13 13 96, or see Contact Us.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Location and directions.

This page records qualifications and career history as published by the practice. General information only — it is not a diagnosis, a treatment plan or a promise of any particular clinical outcome. Outcomes vary between individuals and all treatment carries risks. Figures attributed to the RACGP, the published implant and endodontic literature above are those publishers' and are population-level findings, not predictions about any individual tooth.

Smile Solutions trades under ABN 28 193 514 103.