Endodontics – or root canal treatment
What is an endodontic treatment?
As the name suggests – formed by the joining of two Greek terms, namely: “endo” which means “inside” and “dont” meaning “tooth” – the endodontic (or root canal) treatment can be defined as the treatment of the inside of the tooth.
To help you visualize and understand what exactly happens with the healthy tooth when it gets sick and requires root canal (or endodontic) therapy, we include below two images which briefly present the anatomy of the healthy tooth by contrast with anatomy affected tooth.
As you can see in the images above, viewed from the outside inwardly, the tooth consists of several “layers”. Thus, just below the outer enamel there is a hard layer called the dentin, and inside it there is a soft tissue called the pulp. This contains blood vessels, nerves and connective tissue, and has a formative, nutritional and sensory role, ensuring, inter alia, tooth sensitivity. Occupying a fairly large area the pulp extends from the crown (where it is contained in the space known as the pulp chamber) up to the root tip (in the root canals). Normally, it is protected from harmful factors by three layers that surround it, namely the enamel, the dentin and the cementum. However, where these protective layers are perforated for various reasons (deep carious lesions, repeated treatments of the tooth in question, cracks, etc.), saliva microbes will infect the pulp, first at the level of the crown and then of the root, causing pain or dental abscess.
At this point, the treatment required is the endodontic treatment, through which the inflamed or infected pulp is carefully removed, and the inside part of the root canals are cleaned, re-shaped, and then completely sealed.
What are the risks of removing the pulp?
During tooth growth and development the pulp plays an essential part because, at this stage, in addition to the formative and sensory role, it also has a nutritional role. However, once the tooth matures, it can survive without the pulp, as it will be further nurtured by the tissues surrounding it. Therefore, the removal of mature pulp in a tooth does not present any major risks in the short or long term.
What are the risks failing to remove the pulp?
If the inflamed or infected tooth pulp is not removed in time, the pathology will worsen, the pulp will die, causing the formation of pulp gangrene, while the hard and support tissues will also deteriorate gradually, which will ultimately lead to tooth loss. In addition, there is a risk for the infection to spread to the bone, causing significant destructions at this level and increasing the risk of complications.
Signs that may suggest the existence of pathologies that require root canal treatment
Such signs may include, without necessarily involving them: pain, prolonged sensitivity to heat or cold, sensitivity to touch and chewing, tooth discoloration, swelling, sensitivity of the lymph nodes and at the level of the bone tissue and gums. There are also situations where the patient shows no symptoms.
Stages of root canal treatment
Any effective treatment involves establishing a correct diagnosis and monitoring therapy effectiveness. Since, as noted above, the root canal treatment is a treatment of the interior of the tooth, which is a part that cannot be observed directly, in this case, the only way of establishing the diagnosis and of monitoring the therapy is based on at least three dental X-rays, namely:
- An initial X-ray, upon examination, based on which the endodontist will establish the diagnosis and therapeutic conduct
- A second X-ray, which will be performed during treatment, in order for the endodontist to monitor the effectiveness of the intervention, and finally,
- A third control X-ray, at the end of the treatment or after a period recommended by the endodontist.
There is concern among patients relating to the risks of conducting repeated dental X-rays. It must be said that the modern radiological equipment currently in use exposes the patient to a minimum radiation dose, which does not justify such fears.
Although the root canal treatment can also be performed in a single visit, for best results, in some cases it is preferred to be carried out in two separate sessions, at a distance of a few days of each other.
Stage 1 – Removal of the infection. After examining the X-ray, your endodontist will administer you a local anesthetic, will isolate the tooth by placing a protection membrane (called a “rubber dam”) on a special frame in your mouth to keep the tooth clean during the procedure, thus preventing contamination by germs and bacteria contained in the saliva. Through a hole opened in the crown of the tooth, the pulp is carefully removed from the pulp chamber and from all the root canals, which will then be cleaned and shaped.
Step 2 – Tooth protection against microbial invasion. Once the pulp is removed, the pulp chamber and root canals remain empty, and need to be completely sealed; otherwise, this space would soon be populated by bacteria. Sealing is achieved through a process known as warm vertical condensation, using a biocompatible non-resorbable and compact material, known as gutta-percha, mixed with an adhesive cement or sealer. This process ensures homogeneous obturation and sustainable results.
Step 3 – Tooth reconstruction. After completing the endodontic treatment, the crown of the tooth has to be restored, so that the tooth can resume its normal functioning. The endodontist will complete the treatment through a definitive filling.
When endodontic treatment is performed in two sessions, the opening of the dental crown can be sealed with a temporary material in a first phase, which will then be replaced with a permanent filling at the completion of treatment.
In most cases, however, the crown of a tooth that requires endodontic treatment is generally compromised. In these situations, a mere filling is not enough. Your dentist will place a fibreglass post inside the tooth, thus increasing its resistance. Subsequently, the tooth structure and aesthetic appearance are restored using either metal-ceramic, zirconium-ceramic or ceramic crowns.
Microscope-aided endodontic treatment
The microscope can be used successfully in almost all dental procedures, because it offers the possibility of viewing certain details that cannot be seen with the naked eye, but which may have considerable importance for the diagnosis and achievement of a quality dental treatment.
But the use of the microscope in root canal treatments is no longer a matter of choice. As we have already mentioned, root canal treatments involve removing the pulp from the pulp chamber and from the root canals, and their thorough subsequent cleaning. It must be known that teeth can have one to three roots, with up to three root canals each, some of which can be as thin as hair. In order for root canal treatments to be effective, all root canals must be detected and treated. For these reasons, in this type of treatment the microscope is an indispensable tool, as it allows:
- identification of all root canals
- identification of root canal inlets
- identification and treatment of calcified canals
- identification of root perforations and their sealing
- detection of root fractures
- visualization and removal of any needles previously broken on these canals
- retreatment of incorrect root canal treatments
- thorough and proper cleaning of the root canals before sealing them.