Endodontics

Endodontics is the medical science, which referred to the internal tissues of the tooth, the diseases and related treatments. When these tissues or tissues that surround the dental root become ill or damaged due to caries or trauma, the endodontic treatment allows to save the tooth.

What is an endodontic treatment, or root canal treatment or "devitalization" of the tooth?

The endodontic treatment is an outpatient dental work that is necessary when the pulp (the soft tissue inside the tooth) is inflamed or infected for a damage caused by a deep caries, the outcome of interventions on the tooth, or by trauma (severe and sudden or lighter but repeated) that caused fracture or chipping or deep cracking. 
The dental pulp, contained within the teeth, popularly known as the nerve of the tooth, is actually a highly specialized tissue consisting of arteries, veins, nerve endings and connective cells. In the age of development this tissue has the function of forming the calcified bearing structure of the tooth (dentin); in the adult, with growth completed, the pulp - now thinned - remains confined in the pulp chamber and in the root canals, with residual functions of sensitivity to cold and hydration of the dentin.

Disrupting the pulp health can occur in various pathological situations, the most frequent of which is dental caries (see below), namely the decalcification and progressive destruction of hard tooth tissues due to the action of microorganisms present in the plaque bacterial. If you do not intervene promptly, the cavity produced by the caries is enlarged and deepens and extends until the pulp is reached by bacteria with irreversible transformations due to infection. When it comes to this stage the conservative care that allows to keep the tooth avoiding the extraction is the endodontic therapy, or canal treatment or even more improperly devitalization.
In general, Endodontics aims to preserve teeth that have suffered serious damage to their structure which has led to infection and necrosis of the pulp, with acute or chronic effects of the surrounding tissues, more or less painful. Modern Endodontics uses sophisticated tools for diagnosis and therapy, such as the operating stereo microscope, innovative biomaterials, and special alloys instrumentation.

What signs indicate the presence of a caries?

Caries can not give any early sign of its presence, or the symptoms are so mild that it does not cause concern. This happens especially in the first stages, but often even in the face of complete destruction of the tooth, the patient may not report any particular discomfort and show himself surprised by what happened without pain. Only with the periodic check-up by the dentist - which must be carried out even in the absence of pain - it is possible to check its presence from the very first stages and intervene with an early and therefore limited therapy, minimizing damage and avoiding sudden pains and emergency treatment. Pain, therefore, in the case of the teeth, is not a reliable warning signal nor an index of damage severity: the solution is the periodic visit to the dentist. Excessive sensitivity to cold is a symptom to be taken into consideration, but it is not a univocal index of the presence of a caries. It can also be caused by the uncovering at the level of the collars (the part of the teeth close to the gum) for periodontal disease, for incorrectly used toothbrush abrasion, or for a particular acidity of the oral cavity (erosion by excessive intake of acidic foods) like citrus or vinegar, or for pathological situations such as gastroesophageal reflux). Even grinding (bruxism), or cracks / fractures can lead to hypersensitivity to cold. In addition, the sign of cold pain or even sweet or savory foods is completely absent in the teeth already treated endodontically. The sensitive part is the pulp and if the pulp is in necrosis, or it has been removed for a previous root canal therapy, this symptom is missing. It should be noted in this connection that caries attacks both healthy teeth and previously treated or devitalized teeth indifferently and with the same intensity. Excluding the situations listed above, when the hot, cold, sweet, salty symptoms are accompanied by a more or less localized pain that lasts for a certain time after the stimulus, this is an evident sign of the presence of an already advanced caries. The damage extends in rapid progression and if not intercepted in time inevitably leads to painful pulpitis (acute inflammation) and necrosis (cell death) of the pulp of the tooth itself. The cure at this late stage is no longer the removal of the carious part and a more or less extensive filling,

Endodontic treatment - What does it consist of?

The endodontic treatment (or root canal treatment also called devitalization or canalization) consists in the removal of the inflamed and infected pulp (nerve), present inside the tooth and along the whole length of the roots, and in its replacement with a permanent filling in gutta percha and root canal cement, after adequate cleansing and shaping of root canals.

What is achieved with endodontic treatment?

The result is that the tooth will no longer be an infectious reservoir and, after an adequate reconstruction of the crown, can continue to perform the same functions as an intact tooth. The success rate of a correct root canal treatment is, in normal conditions, very high. The percentage decreases in cases of endodontic reprocessing, when it is necessary to repeat the procedure for a previous failure (execution errors, anatomical complexity, objective difficulties)

How long does it take?

Endodontic treatment is now fast even for molars, thanks to new techniques and modern equipment available. The operational steps are as follows:

- Local anesthesia to neutralize the pain even in cases with still sensitive pulp 
- Temporary reconstruction of the dental crown when it is very destroyed, in order to eliminate all the caries without renouncing the walls of the tooth cavity (containing disinfecting liquids and attaching the sheet of insulating rubber) 
- Isolation of the operating field by means of the rubber dam (essential means for a successful root canal treatment) consisting of a sheet of rubber latex stretched from an arch and held in place by a hook placed around the tooth to be treated or a nearby tooth. 
- Opening of the pulp chamber: access to the pulp through a cavity prepared from the chewing side of the tooth
- Acquisition of the root canal (s) with the aid of optical enlargements. 
- Measurement of the working length, that is, of each channel present (from a reference on the crown to the root apex) by means of an x-ray and an electronic apex locator (the radiation dose absorbed in the execution of an x-ray for dental use is minimal ). 
- Instrumentation of the channels through endodontic instruments that remove the root canal pulp, contaminated by bacteria and infected substances, creating at the same time a shape of the walls suitable for a complete obturation. 
- Washing with sodium hypochlorite, a powerful disinfectant, to obtain the most clean and aseptic environment possible
- Root canal obturation by gutta-percha, plastic and heat-mouldable, associated with root canal cement 
- Crown reconstruction 
- X-ray inspection of the end of treatment 
- Possible fixed prosthesis (crown or bridge)

Can the Canalare Care hurt?

During endodontic treatment pain is under control thanks to local anesthesia. A soreness, which may be subjectively more or less annoying, may be present after therapy, but is easily controlled with a common analgesic. Rarely, in particularly infected roots, an abscess can develop with pain and swelling due to the passage of bacteria into the bone surrounding the roots. The onset of these complications does not necessarily compromise the success of the current treatment. 
Source: (Website of the Italian Society of Endodontics - SIE)