Why might you need endodontic dental treatment?

Endodontics is the treatment of the inner space of the tooth. We perform it on teeth that develop inflammatory damage or even necrosis of the dental pulp due to untreated tooth decay. The purpose of the treatment is to preserve the necrotic tooth, to allow the client to use it as a natural "implant". Endodontic procedures are demanding in terms of accuracy and for their greater efficiency, it is necessary to have experience with dentistry as well as modern imaging technology. Both are a matter of course at the DENT MEDICO clinic.

When do we perform endodontics

When deciding on endodontic treatment, several factors play a role, such as the importance of the tooth, its condition or a biological factor, the extent of of the problem in the clinical crown of the tooth or the preservation of the so-called ferrule, i.e. a certain amount of healthy hard tooth tissue around the tooth root above the gum level. Important factors are the anatomy of the root and technical factors that might make treatment problematic, such as restrictions on mouth opening, damage to the jaw joint or some general diseases suffered of the client. We also assess whether the tooth will be able to serve as a pillar of a prosthetic replacement after treatment.

How does the endodontic treatment work

The purpose of endodontics is to preserve the tooth in the oral cavity and restore its function. To achieve this, the tooth root canal system must be properly treated. During the procedure, we mechanically widen, chemically disinfect, and fill the canals of the damaged tooth so that we can subsequently reconstruct the tooth and, if necessary, address any inflammation of the bone bed if diagnosed.

Depending on the complexity of each case, we divide the endodontic treatment into the appropriate number of visits. Each visit lasts approximately two hours. Endodontic procedures are performed under local anesthesia, or in controlled analgesia for enhanced patient comfort. The treated tooth is first isolated with a special elastic membrane (called a rubber dam). In cases of significant damage to the tooth crown, we perform adhesive reconstruction of the crown walls before isolating the tooth.

Throughout the treatment, we use special instruments and take X-rays for precise monitoring. First, we remove the infected tissue from the crown portion of the dental pulp and locate the entrances to the root canals using an operating microscope. The root canal system is then mechanically widened using manual and rotary tools, and disinfectant solutions are applied to eliminate harmful microorganisms.

The exact length of each root canal is determined using an electronic apex locator. Once the canals have been expanded and disinfected, they are filled and sealed with gutta-percha pins. In cases where the root system contains infected or inflamed tissue, a disinfectant paste with calcium hydroxide is applied initially, and the root canals are filled definitively during a subsequent visit. Finally, we complete the core buildup of the tooth crown, preparing it for any necessary prosthetic restoration.

What to expect after endodontics

Although the root canal system can be quite complex and may present anatomical complications, the modern operating microscope under which the entire treatment takes place allows our dentists to work very precisely and minimize the risk of complications during the procedure. After the treatment, you may notice an increased sensitivity of the treated teeth for several days, which gradually subsides. If necessary, we can suppress it with drugs with analgesic effect.

Complications and possible risks of endodontics

During the mechanical processing of the root canals, the root instrument may also separate or the tooth root may be perforated. It cannot be guaranteed that all root canals can be found, cleared, widened, disinfected and filled, that the obstruction(s) in the canal are removed or, for example, that the perforated root can be sealed, or that the dental bed inflammation is healed.

The risk of this method of treatment lies primarily in the higher risk of bending the instrument or perforation of the root canal wall, then the need to fill the canal with a substance that shrinks in the canal and does not guarantee a hermetic seal. Subsequently, reinfection of the canal may occur, which may result in the loss of a tooth, or the need for a time-consuming, technically and financially much more demanding procedure (reendodontic, i.e. re-treatment of the root canal). Any further treatment of the root canal is potentially dangerous because of the possible weakening of the tooth and its subsequent loss due to crown or root breakage.

During the procedure, activation of the chronic lesion with the subsequent outbreak of acute inflammation is also not ruled out. This could be solved by the administration of antibiotics or surgical treatment, depending on the situation. The success rate of the above procedures is high, but the individual anatomical proportions of the tooth do not guarantee that it will always be cured and preserved. Sometimes, even after successful filling of the root system, complete healing of the inflammatory deposit in the alveolar bone cannot be achieved. In this case, the primarily conservative root canal filling procedure must be supplemented by surgical intervention in the apex (root tip) to remove the inflammatory lesion and revise the periapical space. This procedure is also performed under the control of a microscope and aims to minimize the extent of surgical intervention.