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Endodontics

What is Endodontics?

According to the Portuguese Dental Association, Endodontics is the Dentistry field dedicated to treating and preventing the pathology of the dental pulp (dental nerve) and tissues surrounding the roots. In other words, Endodontics looks after the internal part of the tooth.

For many years, the teeth with problems in the dental pulp were extracted. Nowadays, with the development of techniques for disinfecting and sealing the root canal system and the appearance of 3D diagnosis techniques, these teeth are maintained, fulfilling their role perfectly at an aesthetic and masticatory level.

Endodontics is an area that goes hand in hand with Oral Rehabilitation and Periodontology. As far as Oral Rehabilitation is concerned, just as important as devitalising a tooth is having a compatible restoration that is healthy, durable and functional. Regarding periodontology, pulp inflammations involve the supporting tissues (dental bone and gums) and vice-versa. For these reasons, it is frequent that, when performing endodontic treatments, the intervention of the specialities mentioned above is also required. 

What leads to endodontic treatment?

Although numerous causes can lead to a tooth being devitalised (endodontically treated), the most prevalent is still tooth decay. The caries lesion begins in the enamel, the outermost and most resistant layer of the tooth, where its progression is slow. When it reaches the dentine, the lesion has a faster progression level and can start causing tooth sensitivity, which can be either sporadic or frequent. If left untreated, this lesion will affect the dental pulp.

Teeth are living organs and are generally asymptomatic. In other words, they do not cause pain. Nevertheless, disorders in the oral cavity caused by external or internal agents can trigger signs and symptoms of pulp inflammation.

 

The dental pulp

Lodged in the deeper dental layers, the dental pulp occupies the pulp chamber, and the canal system is distributed throughout the dental roots. Depending on the health status of the tooth, the pulp can experience 4 primary states:

  • Healthy pulp;
  • Reversible pulpitis – after the removal of the aggressor trigger, the pulp has the ability to recover;
  • Irreversible pulpitis – may or may not be asymptomatic and follows untreated reversible pulpitis. But, in this phase, the pulp loses the capacity to recover without medical intervention;
  • Pulp necrosis comes from irreversible pulpitis, which means the tooth has lost vitality.

This can be followed by an acute abscess with facial oedema (swelling) and pain or a chronic abscess (with the formation of a fistula). The abscess is the accumulation of pus resulting from the infection.

Pulpal lesions can be limited to the tooth roots, where the pulp is lodged, or can communicate with the surrounding supporting tissues (bone and gums). Periapical lesions, commonly called dental cysts, can be formed in such cases. These lesions are located around the edges of the tooth roots. On a two-dimensional radiograph, they appear as black spaces representing sites of infection with the destruction of the supporting bone.

Types of endodontic treatment

Endodontic treatment involves techniques ranging from pulp protection (Vital Pulp Therapy) to removing all pulp tissue and sealing the root canal system. Below we will explain each one of them.

VPT – Vital Pulp Therapy

The main purpose of  VPT – Vital Pulp Therapy is to maintain the health of all or part of the pulp. It includes a set of interventions aimed at forming a reparative barrier at the location of the damage, keeping the pulp tissue alive in the canal system.

It is a procedure that can be performed on teeth with deep caries lesions, with pulp involvement without damage to the supporting tissues, which depends on the patient’s immunological response and allows the delay of the devitalisation process.

It is essential to realise that the oral cavity is a dynamic system; therefore, VPT does not exclude the possible need for devitalisation in the future.

After this procedure, it is necessary to have re-evaluation check-ups in the first, third and sixth months.

Dental devitalisation and canal sealing

The non-surgical endodontic treatment aims to remove all the inflamed and damaged pulp tissue, with subsequent sealing of the canals, to allow all the supporting tissues to maintain or recover a healthy state.

Endodontic retreatment

Endodontic retreatment appears as an option for teeth whose first intervention has failed, in cases where bacteria have been reactivated around the tooth root, which may or may not involve the supporting tissues. In these cases, the old sealing material is removed, the canals are prepared again, a new disinfection is carried out, and the root system is sealed again with material suitable for this purpose. It consists of the most conservative approach in cases of reinfection of an endodontically treated tooth.

In some situations, access to the tooth’s canal system is performed directly through the roots by surgical approach. This procedure is performed in specific cases of teeth with previous endodontic treatment.

Don’t let your guard down

The survival rates of a tooth with endodontic treatment are higher than 80% (83-98%, depending on the initial condition of the tooth). But even if it survives, we cannot assume that a devitalised tooth is immune to dental caries – therefore, maintenance and control visits are essential for the early diagnosis of possible complications.

The reoccurrence of the oral disease depends on numerous factors that often go beyond the patient’s correct oral hygiene habits, so professional monitoring is the best way to ensure good Oral Health.

 

Our commitment is to you

As you can well imagine, Oral Health is very serious for us. That is why we do our best and resort to the tools we consider most appropriate to observe and care for your teeth, both inside and out.

 

Magnification and safety

As you can well imagine, Oral Health is very serious for us. That is why we do our best and resort to the tools we consider most appropriate to observe and care for your teeth, both inside and out.

 

Stability and longevity

A correct sealing of the canals is compatible with excellent and long-lasting clinical results.

 

Absolute isolation

The safety of our patients always comes first, which is why these treatments are performed under ideal and comfortable conditions, both for the patient and the dentist.

 

Step-by-step endodontic treatment

Learn exactly how our endodontic treatments are performed through our step-by-step.

 

  1. Coronary opening and access to the canals

The first step in endodontic treatment is anaesthetising and opening the tooth to expose the pulp tissue. In this stage, the root canals are located.

 

  1. Chemical-mechanical preparation

Mechanical preparation and chemical disinfection of the canals are essential. We use mechanised files that shape the canals so the irrigating solutions can act on the largest possible area of the canal surface.

 

  1. Obturation of canals

Three-dimensional filling of the canals with proper materials and techniques adapted to each case.

 

  1. Restoration

Once the endodontic treatment has been completed, the final restoration is performed by Dentistry or Oral Rehabilitation, which are fundamental for the overall success of the treatment.

References

  • Yong, D., & Cathro, P. (2021). Conservative pulp therapy in the management of reversible and irreversible pulpitis. Australian Dental Journal. doi:10.1111/adj.12841
  • Sadaf, D. (2020). Survival Rates of Endodontically Treated Teeth After Placement of Definitive Coronal Restoration: 8-Year Retrospective Study. Therapeutics and Clinical Risk Management, Volume 16, 125–131. doi:10.2147/tcrm.s223233
  • Moghaddam, A. S., Radafshar, G., Taramsari, M., & Darabi, F. (2014). Long-term survival rate of teeth receiving multidisciplinary endodontic, periodontal and prosthodontic treatments. Journal of Oral Rehabilitation, 41(3), 236–242. doi:10.1111/joor.12136
  • Chércoles-Ruiz, A., Sánchez-Torres, A., & Gay-Escoda, C. (2017). Endodontics, Endodontic Retreatment, and Apical Surgery Versus Tooth Extraction and Implant Placement: A Systematic Review. Journal of Endodontics, 43(5), 679–686. doi:10.1016/j.joen.2017.01.004
  • Prada, I., Mico-Munoz, P., Giner-Lluesma, T., Mico-Martinez, P., Collado-Castellano, N., & Manzano-Saiz, A. (2019). Influence of microbiology on endodontic failure. Literature review. Medicina Oral Patología Oral y Cirugia Bucal, e364–e372. doi:10.4317/medoral.22907
  • Setzer, F. C., & Lee, S.-M. (2021). Radiology in Endodontics. Dental Clinics of North America, 65(3), 475–486. doi:10.1016/j.cden.2021.02.004
  • Bhuva, B., & Ikram, O. (2020). Complications in Endodontics. Primary Dental Journal, 9(4), 52–58. doi:10.1177/2050168420963306
  • https://www.aae.org/specialty/communique/successful-local-anesthesia-what-endodontists-need-to-know/
  • https://www.sbdmj.com/141/141-05.pdf