Microscopic Endodontics
What is Endodontics?
Endodontics is the branch of dentistry that treats the innermost part of the tooth (dental pulp and canal system existing inside the roots) as well as the infections that originate in the tissues surrounding the tooth. The most common treatment is endodontic treatment, also known as root canal treatment, and endodontic retreatment, which involves a previously treated tooth that is facing problems again.
In such situations in which conventional endodontic treatment is not enough to solve the problem, an endodontic microsurgery is performed.
In situations in which early intervention is possible and the tooth still has the capacity to respond immunologically, vital pulp therapy is carried out in order to avoid or postpone the root canal treatment of the tooth.
What is endodontic treatment?
Eradication of damaged pulp tissue, cleaning, disinfection, and sealing of the entire canal system within the roots of the teeth.
What is endodontic retreatment?
Removal of the old sealing material, placed at the time of the first root canal treatment. New preparation of the existing canal system inside the tooth, cleaning and disinfection of the canal system, and new sealing.
What is apical microsurgery?
A small surgery, performed using a microscope, which allows you to thoroughly treat, from the outside in, the root zone that remains problematic after endodontic treatment or retreatment.
What is vital pulp therapy?
It is a procedure used when there is only damage to the most superficial part of the dental pulp, but the tooth remains vital and responsive to aggression. This treatment eliminates the dental caries and analyses the pulp using a microscope. The most superficial pulp region that is affected by dental caries is removed, and a bioactive product that will stimulate the regeneration of the lost pulp tissue is applied.
What are the main signs and symptoms?
- Extreme persistent sensitivity to cold or hot that interferes with eating;
- Severe pain that does not go away with painkillers;
- Pain when chewing or feeling that the tooth is placed higher;
- Facial edema (face swelling);
- Identification of a “pimple” on the gums which contains a whitish liquid.
Health
Endodontic treatment aims to eliminate concentrated areas of inflammation or infection and thus avoid major problems, such as abscesses or systemic infections (infections that go beyond the mouth). It contributes to avoiding episodes of intense pain that interfere with simple day-to-day activities, or even more intense conditions, as for example the development of abscesses and subsequent treatment with medication (painkillers, antibiotics, or anti-inflammatory drugs).
Diagnosis
The diagnosis is made during a visit through clinical history, clinical examination and X-ray.
Aesthetics
Sometimes teeth go into states of non-symptomatic pulp necrosis, which is the spontaneous death of pulp tissues without any symptoms. This necrosis is often followed by a darkening of the tooth, with unpleasant effects on the smile aesthetics. In these situations, the root canal treatment is performed in order to proceed to the internal whitening of the tooth and thus restore the original colour.
Step by step
The endodontic consultation begins with a detailed clinical history in order to understand the origin and evolution of the problem. Clinical thermal and tactile sensitivity tests are performed, as well as intraoral x-rays or more detailed exams such as CBCT (a high-definition 3D digital exam that allows you to assess the tooth and adjacent structures in detail). After that, the most appropriate treatment for the situation is defined.
Endodontic treatment or retreatment:
Disinfecting the oral cavity by rinsing with adequate liquids;
Anesthesia of the tooth;
Isolation of the tooth or teeth with a rubber dam to maintain the asepsis of the area, fundamental for the success of the treatment;
Removal of old restorative materials and, if dental caries exists, elimination of all decayed tissue, leaving only healthy dental tissue that can be correctly restored;
Access to the pulp and root canal system;
Verifying, cleaning and disinfecting the canal system using a microscope;
Filling and sealing of the canal system to prevent future infections;
Preparing the tooth for the rehabilitation phase of the lost structure and placing a provisional restoration;
In more complex situations, you may have to take medication, such as anti-inflammatory, painkillers or antibiotics.
Responsible team
Dr. Sara Franco
Frequently Asked Questions
Whenever a tooth hurts or has sensitivity to cold, does a root canal treatment need to be performed?
Not all pain comes from within the tooth, which means not all of it translates into a need for devitalization. It is necessary to check with your doctor the source of the pain or sensitivity in order to perform the appropriate treatment.
Can devitalized teeth become problematic and painful again?
After an endodontic treatment, the tooth remains in the mouth and is still subject to the same factors that can cause problems in any other tooth. A devitalized tooth can revert to decay if proper oral hygiene is not performed; it can also fracture if not properly restored, or it can re-infect. Correct endodontic treatment with adequate rehabilitation and hygiene maintenance care minimizes the risk of having problems again in a previously treated tooth.
Why do abscesses appear? When they appear, do i always have to take antibiotics and devitalize the tooth?
Abscesses reflect infections caused by bacteria and can have multiple origins: an endodontic origin (inside the tooth), a periodontal origin (tissues surrounding the tooth), or a traumatic origin (trauma or fractures which lead to an infection due to being contaminated by bacteria from the oral cavity). The root canal treatment is only indicated if the cause is of endodontic origin. And often, by identifying and eliminating the source of the infection, it is possible to solve the problem without using antibiotics.
How many appointments are necessary to get a tooth devitalized?
The main success factor in endodontic treatment is microbial control, i.e. eliminating bacteria from inside the tooth and preventing the entry of new bacteria. The less time the treatment takes, the better. Ideally, endodontic treatments should be carried out in a single appointment (the length of the appointment depends on the complexity of the tooth), allowing a correct sealing of both the internal (root tip) and external ends and avoiding new bacterial contamination. The restoration phase can be done in another appointment, but the root canal treatment should be carried out, whenever possible, in a single appointment.
Why do i have to devitalize an already devitalized tooth?
The reasons that lead to a second root canal treatment can be:
– Previous unsatisfactory treatments with signs of infection;
– Contamination of the previous treatment by fracture or dental caries in the tooth, with exposure of the sealing material;
– Reinfection of the tooth with pain, abscess or dark lesion visible on X-ray.
What is the microscope for?
In order to perform a good treatment, proper cleaning and disinfection of an area as big as possible of the inside of the tooth is essential. The inner root zone of the teeth contains an intricate system of dark and very small canals, which are impossible to see with the naked eye. The microscope, with its magnifying capacity and LED lighting system, is an essential tool to be possible to visualize the inside of the tooth and thus perform a disinfection and sealing that significantly improves the treatment prognosis.
What is the rubber dam and what is it used for?
The rubber dam is an essential isolation system for several dental treatments, such as restorations to treat caries, the adhesion of prosthetic parts (crowns, veneers, etc.) and endodontic treatment (root canal treatment). It consists of a rubber sheet with a kind of spring that adapts to the teeth, protecting the entire oral cavity and leaving isolated only the teeth that need to be treated. This isolation not only allows the work to be done without saliva contamination, making it much more effective and longer lasting, but also allows no instruments or liquids to get in contact with the oral cavity, eliminating the risk of being swallowed, making the entire treatment safer for the patient. In addition, this whole system avoids uncomfortable contact of instruments with the tongue and cheeks, prevents excessive accumulation of water into the mouth and aids in opening, which makes the treatment more comfortable.
I was told that i have a cyst on the tip of the tooth root, but it never hurt. Why do i need to devitalize the tooth?
Periapical lesions (commonly called “cysts”) arise in teeth with no living pulp inside and, consequently, no defense system to fight bacteria. This happens in teeth that have suffered necrosis (spontaneous death of the tooth) or already devitalized teeth that have been re-infected by bacteria. These lesions reveal an active infection and the consequent destruction of bone around the tooth, causing a dark spot in the area near the tip of the tooth root, commonly called a cyst. Endodontic treatment or retreatment of the tooth can eliminate the source of infection within the tooth and allow regeneration of the surrounding bone.
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