Endodontics is a branch of dentistry that deals with the treatment of endodontic space, i.e. the space inside the tooth where the dental pulp (nerve), the pulp chamber and root canals are found.
When is endodontic treatment required?
There are several situations in which a tooth needs to be devitalized:
- The most common one is the evolution of the caries, with complications. Complications of dental caries are:
- Pulpitis, which is an inflammation of the pulp, which is very sensitive. This complication generates extreme pain in the presence of various stimuli in the oral cavity
- Gangrene, which is a septic (bacterial) mortification of dental pulp. In this case, the tooth no longer responds to stimuli in the oral cavity
- Apical periodontitis (granuloma, abscess ), which is an infection of the tissues surrounding the root tip, due to bacteria present along the root canals, marked with painful symptoms, even in the early stages
- Dental trauma – dental fractures
- Therapeutic reasons: devitalization of prosthetic teeth (coating crowns, bridges) that must be polished and covered. Devitalization (removal of the nerve) is not as harmful as speculated, endodontic treatment being applied in order to keep the tooth on the dental arch and to maintain its functionality (via obturations or dentures), losing only its sensory function.
What are the signs and symptoms indicating pulp damage?
The most common signs are spontaneous pain, pain occurring during chewing and prolonged sensitivity to thermal stimuli (hot and cold).
Another symptom that might indicate an infection of the tooth pulp is swelling of the gums or the surrounding tissue (abscess). Also, if the pulp becomes mortified, the colour of the tooth may change.
However, in many cases there is no pain or other signs, only your dentist can detect the disease through dental consultation and using an X-ray
Do antibiotics work?
No, as it restricted the amount of blood that reaches inside the tooth and, thus, the amount of antibiotics. Therefore, antibiotics cannot work properly. For the same reason, its protective and repairing ability is very low.
Therefore all infected tissue inside the tooth must be removed and replaced with a filling material that will successfully replace the dental pulp.
What is the duration of treatment?
One session may be enough, but the more complex the issue gets, the more sessions may be required, as the space subject to treatment may need to be dressed with medicine during several sessions.
What are the stages of an endodontic treatment?
- In a first step, tooth isolation is achieved, in order to prevent contamination with saliva and bacteria inside the tooth.
Isolation with rubber dam is a simple system containing a thin sheet of latex that adheres very well, with a metal clamp, to the tooth or teeth that are to be treated.
Besides the isolation effect, the rubber dam provides better visibility on the tooth and it better protects you (prevents ingestion or inhalation of dental debris, protects against the action of irritating dental substances and even some unfortunate accidents due to the mechanical action of the bur)
- The caries will be removed and the pulp chamber will be opened if the caries has not already done so.
- The root canals’ positions and their permeability will be determined, setting the working length of the mechanical treatment on the canal (using radiological and electronic, modern means- apex locator)
- Canal mechanical treatment:
It can be classic, with manual instruments, which will be done by completely removing the infected tissue and shaping the root canal so as to be able to receive the canal obturation.
Our office is equipped with modern rotary tools (ProTaper) for canal treatment, which have various advantages: more efficient preparation for a better obturation, reducing the time required to prepare the canals and the flexibility of the nickel-titanium alloy allows for optimal preparation even for the most curved of canals. A steel instrument with an emphasised conical shape would be very stiff and unusable in curved canals.
- Washes with an antiseptic solution. A canal obturation can only be performed if you have a clean, dry, free of pus or blood. Otherwise an antiseptic dressing medical is applied and left in place for at least 7 days.
- Obturation of root channel is performed using modern materials – gutta, a sterile plastic material, which allows it to successfully replace dental pulp, in the endodontic space.
After the root obturation is completed its accuracy (length, homogeneity) will be checked using X-rays.