Indent - Endodontics & Microscopic Dentistry; Dr. Andreea Petrovits

Endodontics & Microscopic Dentistry

What is endodontics?

Endodontics is the branch of dentistry that deals with the diagnosis and the treatment of dental pulp disease and its related structures.

The dental pulp is represented by the soft tissue found inside the tooth (the dental canals), meaning blood vessels, nerves and conjunctive tissue. During the tooth development, these structures are responsible for the formation of hard tooth structures (enamel and dentine). Although the tooth pulp is responsible for the tooth nutrition through the blood vessels that penetrate into the tooth by the root tip, it is not responsible for the tooth functionality. Even if the pulp is removed following an endodontic treatment the tooth continues to be supplied through the vasculature structures nearby.

Why should I go to a dentist trained in micro- endodontic treatments?

The dentist trained in micro-endodontic treatments has thorough knowledge about the often diversified anatomy of the internal tooth architecture, the necessary clinical experience and, not least, the absolute necessary equipment to give a correct diagnoses of any pulp diseases and all of the necessary state of the art equipment to complete any and all endodontic treatments. (surgery microscope, dental radiology, etc.). He is able to detect the tooth involved in the development of orofacial pain, so feared by most people, being difficult to be diagnosed due to the nature of the pain which is often diffused or irradiated.

When do I need an endodontic treatment?

The need for the endodontic treatment comes once the pulp is no longer functional due to irreversible damage, respectively its inflammation caused by the invading viruses. The causes of the inflammation are represented by the deep caries, the invasive polishing of the teeth during the prosthetic treatments (mechanical and thermal damages), dental traumas, fissures and / or dental fractures.

The symptoms may vary, starting from emphasized reactions causing pains to cold, hot and pressure on the tooth (biting on it), continuing with dental discoloration (following the necrosis/death of the dental pulp) or with abscess accompanied by osseous tumefaction and emphasized pain and, sometimes, by pus draining through the so called sinus tracts. Just pay attention because in some of the cases the disease may grow almost without any symptom, being discovered in advanced phases, following a clinically consultation and a radiological examination.

What does an endodontic treatment entail?

Knowing the causes of endodontic disease, respectively the microbes which colonize the dental pulp located in the tooth inner shrine (dental channels), the treatment will follow a clear line: removing the infected content with mechanical and chemical means. Modern anaesthesia ensures patient comfort during procedure. Treatment will usually be completed in silence.  Do not delay treatment due to fear or belief that the disease will go away by itself (even if symptoms will alleviate or disappear, the infection will continue to progress).  If treatment is done in early stages of the damage, the procedure is relatively comfortable and similar to tooth restoration.

Working to the highest hygienic standards, modern endodontic treatment enforces the use of the “rubber dam”, a dental latex foil (there are also latex free, non-allergic formulas) fixed on the tooth with special clamps, which isolates the tooth from the oral microbial environment (the mouth has the highest microbial load of the body), thereby ensuring no cross contamination risks.

After this phase the actual procedure will start, by the compulsory use of dental magnifying equipment, (dental surgery microscope or dental magnifying glass). The internal space of the tooth (root canal) is very limited. Without magnifying equipment, we would practically be working blindly. The magnifying and lighting equipment allows us to see into the dental canal in all of its minute detail and to treat it accordingly.

The infected dental pulp will be removed from the tooth canal (evidated) using root canal files, which are used to enlarge the narrow tooth canals thereby allowing the proper irrigation with flushing fluids (sodium hypochlorite) which are designed to chemically assist in the disintegration and removal of the infected soft tissues.  The files are specially designed nickel-titanium, rotated by endodontic motors with controlled power and rotation, enabling a faster and superior mechanical shaping of the root canal.

After this phase the inner area of the tooth (root canal) is sealed, effectively blocking any possibility of reinfestation and/ or multiplication of any residual microbes. The current standard is the root canal filling with gutta-percha cones (substance extracted from rubber tree) which are thermo-plastified (softened under temperature) and in this way filling all areas of the inner tooth canal.

Occasionally after endodontic treatment, the tooth may be slightly sensitive to pressure for a few days and this is more likely if prior to treatment the patient had experienced a painful phenomena.  Usually the symptoms are alleviated by anti-inflammatory administration (ex: ibuprofen). Only in exceptional cases could a prescription drug be needed.

As the long-term endodontic treatment success depends on quality of the tooth coronary restoration, it is a necessity to place an adhesive coronary filling.

As with all fillings the extent of the rebuilding will determine if additional retention is needed such as fibre post. Today, prefabricated fibre posts are used instead of metal ones (manufactured or casted by the dental technicians), as these more closely resemble natural dental structure and reducing the possibility of future breakages and fractures.

It is worth mentioning that current studies are highlighting the fact that endodontic treated teeth are not becoming anymore breakable by dehydration, as it was believed in the past. However, due to the loss of pretty much tooth structure, it is advisable to crown this teeth (the current studies show that the endodontic treated teeth that are not covered with crowns have a fracture rate of 65%).Topped with a crown where necessary this treatment has a minimal failure rate.

What means retreatment?

Teeth with old insufficient root canal treatments represent a real biological bomb with delayed explosion. Even if these teeth remain symptom free over a long period of time or create just occasionally discomfort, we have to be suspicious. The microbes embedded inside the tooth will produce toxins which will create chronic inflammatory lesions in the bone surrounding the root tip (they can be detected with x-rays). As long as the immune system of the body maintains the balance at this level, the lesion stays silent (latent). As soon as there appears some disturbance in the immune response, the lesion becomes acute leading to serious problems (abscess/swelling/pain).

In the past, many of this problems were treated surgically (root resection) or even more radically, extracting the tooth. Nowadays, the first intention is to retreat the tooth, which means a new correct endodontic re’treatment, followed by a decrease in microbial content and consequently to healing of bone lesion.

The endodontic literature considers that the success rate of root canal therapy is about 90%, compared to 65% for retreatment. This is due to the former pathology of the tooth (microbial content) and to the complexity of the root canal system.

Success of endodontic treatment means a symptom free tooth and also no radiological signs of bone lesion.

When do we need endodontic surgery?

When the non-surgical treatment fails, the tooth has to undergo surgical endodontic treatment, known maybe better as root resection. This implies removing of the infected root tip, sealing the communication between root canal system and bone by placing a retrograde filling and cleaning of the diseased bone.

Micro instruments, new materials, as well as the use of magnification improved a lot this technique, making this treatment more predictable than it was in the past.