Endodontics: last resort to preserve diseased teeth

An endodontics, or what is commonly known as “killing the nerve”, consists, in general terms, of cleaning the diseased pulp tissue of the tooth and replenishing it with biocompatible material to later seal it.

This is one of the most used treatments in dentistry and aims to save a tooth that is considered dead, diseased or damaged.

Although there are other factors that can lead to this situation, the truth is that most of the time this problem is caused by the existence of deep decay that can damage the pulp of the tooth – located in the deepest part of each tooth.

Although in many occasions the decay can be treated with a dental filling or obturation- there are others in which the damage suffered by the tooth is so great that it is necessary to resort to endodontics.

Once this endodontics has been carried out, the tooth is reconstructed so that it has a natural appearance, regains its functionality and does not show any discomfort when carrying out daily activities, such as eating.

What is a root canal?

Endodontics or treatment of root canals is a conservative procedure that consists in the total or partial extraction of the injured pulp of a tooth and the sealing of the pulp canal.

The pulp of the tooth is a small soft tissue that contains the nerves and blood vessels . It is located in the innermost part of the tooth and communicates it with the maxillary bone. In addition to helping to form the tooth, the pulp serves to perceive external stimuli.

This intervention allows to maintain the functionality of the tooth, as well as its aesthetics, and is the last resort to save a diseased piece without needing to extract it.

As we have previously anticipated, the main reason why an injury occurs in this area is the existence of a caries that has not been properly taken care of – making a filling – and has been growing with the passage of time.

However, there may also be other reasons:

  • Trauma
  • Fractures
  • Other pathologies related to the root or bone surrounding the tooth

Since obturation is a much easier treatment than endodontics, our recommendation is always to go to the dentist as soon as we begin to notice strange signs in our mouth, such as sensitivity in a tooth.
Next, we will detail the symptoms that can indicate that we need a filling or endodontics.

What are your symptoms?
The mentioned lesions give rise to infection, inflammation and necrosis of the pulp, so that the person experiences a pain that can be intermittent or constant and vary in intensity.
Some of the symptoms presented by a patient who must undergo endodontics are the following:

  • Sensitivity to cold or heat
  • Chewing discomfort
  • Change color of the tooth to a darker shade
  • Appearance of a phlegmon or fistula

How many types of endodontics are there?

Depending on the type of tooth affected by the lesion, we find three different types of endodontics. Although the procedure itself is the same, it will be quicker and easier to endodonize a tooth from a duct than one that has three ducts:

  • Uni Radicular : the affected tooth has a single root and a single pulp duct
  • Bi Radicular : the affected piece has two roots and two pulp conduits
  • Poly Radicular : the tooth has more than two roots and more than two pulp conduits

How is an endodontics done?

First, it is convenient to point out that an endodontics can be carried out in one or several sessions. This is something that the dentist in Dubai will decide based on factors such as the technical complexity of the case or the patient’s clinical situation.

Either way, the steps to perform this procedure are:

Anesthesia and access to the pulp chamber

With the aim that root canal treatment does not hurt, the first step is to apply local anesthesia. Once we have the area desensitized, we performed a small hole in the tooth.

In this way, we access the pulp chamber – the central part of the tooth that is hollow and has numerous blood vessels and nerve endings.

Extraction of infected tissue and cleaning

Once we have agreed, we begin with the disinfection of the area. For this, we will opt for a rotating procedure instead of working with the traditional instruments used in the manual procedure.

That is, by means of a motor and a system of files of rotation we extract the infected tissue and clean the space that has been left free in the root canal – the channel resulting from the narrowing that takes place in the root of the pulp chamber.

Molded of each conduit and beginning of the filling

Once the area is disinfected, we model each duct giving it a conical shape to facilitate its filling with the filling material. The method used to make said obturation is that of hot gutta – percha .

Gutta-percha is a type of rubber derived from rubber and this method differs from other traditional procedures in that it uses a state- of-the-art oven that heats in seconds the obturators that are going to be subsequently placed.

The hot gutta-percha presents different advantages such as: shortens the time of postoperative discomfort, reduces the risk of fractures in the root of the tooth, facilitates the filling of the irregularities of the canal and reduces the risk of coronal leakage.

End of the filling and sealing of the final part of the duct

The filling material is inserted until reaching the final part of each duct and, once we have reached this final part, the ducts continue filling until we reach the pulp chamber.

At this point, it is especially important to seal the end of the duct well, so that no fluid can reach unclogged areas.

And, once this is done,  we rely on radiographs to make sure that the instruments reach the tip of the root but do not exceed it.

Reconstruction of the tooth

In the event that the dentist decides that more than one session is necessary to complete the treatment, he will not reconstruct the tooth definitively in the first visit, but will fill the dental piece with provisional material.

Once the endodontics is finished, we will proceed to the restoration of the tooth to restore its natural appearance .

Depending on the level of destruction that the dental piece has suffered, the repair can be of two types:

Aesthetic or amalgam composites

They are used on teeth that have suffered minor damage. Therefore, it will simply be necessary to fill the lost part of the tooth with composite.

Intraradicular post and crown

They are used on teeth that have suffered great destruction.

Since the missing part of the tooth can not be filled with composite , because it is too large, a bolt or fiberglass pole must be inserted and then a crown or sheath placed.

The placement of both – glass fiber and crown post or pole – is especially important in the molars , since they are teeth that are used constantly, as they actively participate in chewing.

For its part, fiberglass is a very resistant material, aesthetic and does not corrode .

With all this, we strengthen the dental piece and we give durability to the treatment.

Follow-up and subsequent control

Once the entire process is finished, it is essential to follow up later to check its evolution . Regular visits to the dentist and comparison between “before” and “after” x-rays will determine whether the treatment has fulfilled its purpose.

Will I have pain after endodontics?

As we have indicated previously, root canal treatment is performed under local anesthesia, so the patient does not experience any pain while undergoing this procedure.

However, once completed, the tissues surrounding the tooth will have been inflamed and discomfort may appear  when the effect of anesthesia passes.

For example, such annoyances may occur when doing daily activities, such as eating.

In the case of feeling some type of pain, it will disappear within a few days and can be controlled by medication prescribed by the doctors.

Each year, the teeth of millions of patients are treated with endodontics, so this is a usual treatment that poses virtually no risk.

On the contrary, it has a very high success rate and the failure of the treatment does not usually occur if all the steps mentioned above have been carried out correctly.