Endodontics is the area of dental medicine dedicated to the treatment of pathologies of the internal structures of the tooth (dental pulp) as well as the tissues located around the roots (periodontal ligament and bone) with a view to the prevention, diagnosis and treatment of associated lesions, allowing for the preservation of teeth which might otherwise be extracted. Dental pulp (commonly known as nerve) lesions can originate from fractures resulting from trauma or deep caries and can lead to symptoms such as tooth sensitivity/pain when chewing or spontaneously, and, in more serious cases, abscesses.
Routinely known as “root canal treatment”, endodontic treatment aims to preserve the compromised teeth by means of a prior diagnosis and subsequent treatment plan. It consists of the elimination of the pulp tissue or “nerve”, which is inflamed or with infection, disinfection and hermetic sealing of the entire space, designated the “canal system”, preventing infiltration by bacteria that lead to future complications.
The diagnosis is usually made first with an anamnesis, in which the dentist asks the person a series of questions to evaluate the symptoms.
Then they do an oral examination to see if there are any lesions, complementary tests to evaluate the sensitivity and inflammation of the tooth pulp and also X-rays.
From here they arrive at the diagnosis and then start planning the endodontic treatment.
When it has been determined that the endodontic treatment is the most recommended for the individual’s case, firstly local anaesthesia is applied to the tooth, absolute isolation (operative field), which is fundamental to allow treatment with excellent disinfection, later removal of all the existing caries lesion and access to the root canals. When the root canals have been identified and found, the procedure is to remove all the inflamed or infected pulp tissue and clean and disinfect the entire space in order to eliminate bacteria and prevent future infections. After all the disinfection and cleaning of the root canals, what remains is their filling, which is nothing more than the hermetic filling of all that space with biocompatible materials accepted by the body.
After obturation, the endodontic treatment or devitalisation is only finished when the entire reconstruction of the tooth has been carried out. This reconstruction must be strategically planned and carried out in order to protect the tooth, which is weakened, from the forces of chewing and thus increase its durability.
This restoration can be performed using Composite Resins or Indirect Restorations. Composite resins are more suitable for the treatment of not very deep cavities and preferably located in a part of the tooth that is not subject to a great masticatory load. Indirect restorations are performed using inlays, onlays, overlays or laboratory-created crowns, and are capable of better withstanding the forces exerted on the tooth surface, and in the same way mimic the aesthetics of the natural dentition.
The preservation of treatments with the highest level of quality is fundamental. It is therefore important to choose procedures where the latest technology is applied in order to respect this objective.
The operating microscope is one of the tools that has contributed to this, allowing the clinicians to see better and, consequently, to work better.
As endodontics is carried out inside the tooth, the power of magnification made possible by the microscope was “gold”. It allowed a better observation of the structures and thus an improvement of the treatment, making it more conservative, safe and predictable.
X-rays in the area of endodontics play a fundamental role with regard to reaching the correct diagnosis. However, the X-rays that are routinely used in dental medicine appointments have the disadvantage of only allowing a two-dimensional view of an element that has three dimensions, leading to image distortion and superimposition of structures that may, in cases of greater diagnostic difficulty, bias the origin of the problem.
Endodontic treatment (root canal disinfection) can always be carried out in only one session/consultation when the inflammatory conditions of the tooth allow it and when the specialist professional has the treatment and consultation time planned for it. If during this consultation, after the chemical-mechanical disinfection, there are signs of infection, then another session will be necessary.
The treatment is carried out under local anaesthetic, and is not painful. In extreme situations it may be necessary to pre-medicate or directly anaesthetise the pulp in order to carry out the treatment painlessly.
Endodontics, in general terms, is the treatment that aims to chemically and mechanically clean the canals of the tooth and subsequently seal them hermetically.
The root canal is the space where the dental pulp is housed. The dental pulp is the vascular nerve bundle that enters through the tip of the root to the inner part of the crown of the tooth (pulp chamber). The pulp is what gives the tooth its vitality through irrigation and innervation.
Endodontic treatment is necessary when the internal tissues and/or the tissues around the roots are being attacked by a deep caries lesion that already irreversibly affects the pulp tissue (tooth nerve), by a fracture resulting from trauma or by reinfection of a tooth that has already had previous endodontic treatment.
Generally, the most frequent symptom, which most often leads people to go for emergency treatment, is severe, sharp pain. This pain can be provoked or exacerbated by thermal changes such as cold or hot, when chewing or simply by touching the tooth. Other times this pain can be diffuse and difficult to identify, sometimes manifesting itself as a pain radiating to the ear or head.
Another event that commonly brings a person to a consultation is the occurrence of an abscess, a swelling on the face or on the gum next to the tooth with the infection.
In summary, the symptoms that may be associated to endodontics are:
An endodontically treated (devitalised) tooth often has major loss of tooth structure due to either caries lesion or fracture, which led to the tooth needing endodontic treatment. On the other hand, the loss of vitality of these teeth makes them more fragile. These two associated factors – loss of tooth structure and loss of vitality – make the tooth susceptible to fractures. It is therefore essential to strategically reconstruct it using ceramic crowns/overlays/onlays in order to protect it and increase its durability.
Sometimes, fractures of the front teeth can cause the “death” of the nerve, and therefore the tooth can have a “grey or brownish” appearance.
In these cases, even after endodontic treatment, the colour of the teeth can remain unchanged, which can sometimes be aesthetically problematic for the person. In these situations, various treatments can be carried out to remedy this alteration, such as internal whitening, ceramic or composite resin veneers.