Endodontic therapy or tooth root treatment is a microsurgical procedure we use to remove the remains of inflamed and infected dental pulp from the root canal and permanently fill the root canal with bio-inert material to prevent infection spreading from the root canal to adjacent tissues, periodontal and surrounding bone, thus curing and preserving the tooth.
Endodontic treatment itself is painless and it is performed with local anaesthesia.
Unfortunately, until recently, teeth in such bad condition were extracted, which subsequently caused major dysfunctions in the chewing system and aesthetic deficiencies in these patients, especially if the lost teeth were not replaced as soon as possible.
Dental pulp infection is most commonly caused due to the development and spreading of the caries process on the tooth. It can also occur as a result of tooth trauma or it may extend from the periodontal pocket to the dental pulp and thus infect it.
If the dental pulp infection is not treated, it can spread to the bone around the tooth where the bone degrades and granuloma or cyst formation occur. In severe cases, it may result in complication of the infection and swelling on the face with the appearance of an abscess, which can lead to more serious health problems.
Dental pulp is an organ located inside the pulp chamber and root canals of each tooth. It consists of blood vessels and nerves, connective tissue and several types of cells.
In the case of children, dental pulp is of great importance because it contributes to the growth and development of the tooth. In the case of adults, its function is primarily sensory. It helps us to feel warmth, coldness and pain if a tooth is damaged or if there is inflammation present.
It also has a partial reparative function because it can form hard dental tissues. Also, in cases of less aggressive caries processes, it can prevent the penetration of the caries deeper in the tooth and even stop the decaying process.
Dental pulp also participates in the nutrition of dental tissue, although the more important nutrition of the tooth is obtained through its fixing apparatus, periodontal. All this opens up the possibility of treating the root of the tooth by removing the infected dental pulp and still retain a functional tooth.
Whenever it is possible, it is extremely important to keep dental pulp healthy and preserve its vitality. We must be especially cautious during dental treatment procedures and never devitalise the tooth right away ("preventively, so it will not hurt")!
Endodontic Therapy Options
In addition to the treatment of dental roots, endodontic therapy also treats granulomas, cysts and gum abscesses in the dental root area. Sometimes we have to do this in conjunction with an oral-surgical procedure, the well-known apicoectomy, which is always preceded by endodontic tooth treatment.
Every properly endodontically treated tooth is a fully functional tooth and can be used as an independent dental unit or may be involved in any prosthetic work such as a bridge carrier or another prosthetic element.
Each endodontically properly treated tooth is more valuable and of a better quality than any implant and, more importantly, financially more favourable for the patient than implant placement, on several levels.
Therefore, if at all possible, the patient's tooth should be preserved at any cost. This is where endodontic treatments are of great importance and help.
Implanting an aesthetic crown on endodontically treated teeth
Prior to treatment, most endodontically treated teeth had a significant caries process or a large fill and therefore extensive loss of dental tissue on the crown of the teeth. Due to reduced nutrition due to the loss of dental pulp, the treated tooth loses moisture and elasticity over time and becomes brittle, and may eventually dampen and thus become a major aesthetic disadvantage.
Therefore, an aesthetic ceramic or zircon crown should always be implemented on a tooth that underwent endodontic treatments - to restore strength, proper function and aesthetics.
- Removal of inflamed and infected pulp tissue, cleaning and expansion of the root canal -
It is necessary to remove the remnants of the inflamed and infected pulp tissue and thoroughly clean and expand the root canal to obtain the correct conical channel shape and mechanically eliminate the infected root canal tissue. We do this by hand and also using technical instruments that have been sterilised beforehand.
During the cleaning of the root canal, we rinse it with antiseptics thus disinfecting it.
- Root Canal Filling - After disinfection, the root canal is dried with sterile paper points and filled with a special bio-inert material which hermetically seals the root canal and thus prevents the penetration of any infection in the root canal or through the canal into the surrounding bone.
The root canal must be filled to its very top, otherwise an infection of the canal can occur that can spread into the surrounding bone and lead to the formation of granulomas, cysts and pus abscesses in the root area of the tooth. It's also not good if the root canal is overfilled and the filling is transferred to the bone or other surrounding structures such as sinuses or bone canals through which the nerves pass.
- Root Canal Filling Control – To properly fill the root canal, it is extremely important to determine the exact length of the root canal during endodontic treatment.
For the exact determination of the length of the root canal we use an electronic measuring device, i.e. endometer.
The length and shape of the root canal and the filling are also controlled by an X-ray, before and during the endodontic treatment, using an RVG device (radiovisiography) so that nothing is left to chance and the filling of the tooth canal is controlled until it is filled to its fullest extent.
Endometer Radiovisiography (RVG)
Duration of the endodontic procedure - We always strive to do the endodontic procedure in as few visits as possible, just one visit is the best option, whenever possible. Sometimes, in the case of severe infections and in the treatment of granuloma, we perform the procedure in multiple visits, but again in the smallest possible number and shortest possible time.
In modern and efficient endodontics, lengthy treatment that lasted for months was abandoned a while ago, as this only made things even worse and often endodontic treatment ended with failure.
Aesthetic Fillings and Upgrades - after filling the root canal, we proceed with the aesthetic, adhesive composite filling by which we compensate the lost dental tissue and reconstruct the crown of the tooth.
When we have a case of extensive loss of tooth crown tissue, in order to re-establish an ample strength of the tooth crown, it is necessary to incorporate a composite retention pin into the root canal after the tooth treatment, whereby we make a composite fill and call it an upgrade.