endodonticsWhen needed, this is an intervention with the aid of the microscope that aims at preserving and lengthening the life of the tooth. It involves the removal of the root pulp, the cleaning of the root canal and the addition of a thick root filling for the long-term conservation of the tooth.
ROOT CANAL TREATMENTEndodontics or endodontology (from the Greek ἔνδον [endon] "inside", ὀδόντος [odontos] "tooth", λόγος [logos], "study of" − the study of tooth interiors) is the dental specialty mainly concerned with the study of diseases of the dental pulp and the periapical tissues. The purpose of an endodontic treatment is always the preservation of one's own natural teeth. Pulpitis is an acute or chronic inflammation of the pulpa (tooth pulp – blood and lymph vessels, nerves and connective tissue) or of the parodontium (periodontium) resulting from an endodontic disease.
The more common treatment in endodontics is treatment of the root canal. Moreover, there are cases in which the initial treatment of the root canals has failed and a subsequent "root canal treatment revision" is required. If this is likewise unsuccessful, then quite often a surgical root tip resection is carried out. In addition, pulp capping (covering of the opened tooth pulp) and all preservative measures relating to tooth pulp belong to the field of endodontology.
The first-time root canal treatment is generally performed in one or two treatment sessions and includes the following steps. In order to make the treatment painless, the tooth is often locally anaesthetized. Then a small elastically-tensioned rubber dam is applied around the tooth (coffer dam) to keep the treatment area free from saliva and bacteria. The tooth crown is opened and the pulp chamber is cleaned. The root canals are subsequently inspected and widened using small files. This "enlargement" enables the cleaning and disinfection of the entire root canal system.
Optical magnification devices (surgical loupes or dental microscope) are very helpful in the individual work steps, thus enabling recognition and treatment of the fine and complexly branched anatomy of the tooth canals during treatment. Using visual inspection, the root canal system and its main and side canals is checked, cleaned, disinfected to the greatest extent possible as well as shaped as needed. After shaping, cleaning and disinfection, the cavity is filled with a plastic sealing material. As the last step, the entrance in the tooth crown is closed with a bacteria-proof and stable filling. Proceeding as such, the tooth can either be built up again or, as generally the case, provided with a crown.
Revision treatmentTeeth that have been treated for root canals can basically be preserved just as long as non-root-canal-treated-teeth – ideally for the entire patient lifespan. However, since a root canal treatment represents one of the most complicated dental surgical procedures, it is possible that root canal treatment does not achieve the desired success in some cases.
Nonetheless, there is still the possibility to preserve the affected tooth by performing a repeat root canal treatment, a so-called revision treatment. It may be necessary if:
- narrow or crooked canals could not be adequately cleaned in the initial session
- complicated anatomical structures of the root canal system could not be completely cleaned during the first treatment
- the sealing filling or crown has become unsealed and bacteria has again penetrated into the root canal system
SURGICAL ENDODONTICSThe surgical intervention form of root canal treatment is the last chance for tooth preservation if the revision treatment did not succeed.
An endo-surgical intervention may prove necessary in rare cases, if:
- an extended diagnosis is needed if the patient still has unexplained symptoms
- due to very complicated anatomical conditions, the entire root canal system is not to be cleaned and disinfected
- especially resistant bacteria remain in canal branches or on the root surface
- if the root surface is damaged due to various causes
In the next step, all the inflamed or infected tissue can be removed. In doing so, the most extreme end of the root, the apex, is removed.
Afterwards, the interior of the root is cleaned via the tip opening. During this procedure, it makes sense to utilize optical magnification devices, such as a surgical loupe or a dental microscope, which facilitate location of possibly non-treated anatomical structures of the root canal system.
To seal the root canal system for the long term, a special filling is introduced starting from the root tip. In the following months, the bone substance heals around the root end.