Root Canal ( Endodontics) are complex procedures that, when properly executed, need not be a source of complications, with endless trips to the clinic and immediate or future complications . They should be done by a Specialist in this area with state-of-the-art technology!
They are a fundamental tool that allows us to save many teeth that would otherwise be extracted. In an era where implants are the order of the day, with aggressive marketing, professionals are sometimes tempted to opt for this more radical and costly solution before trying everything to save a tooth. Although Implants are an excellent tool and an area I’m particularly comfortable in, the tooth is the best implant in the world and you should do everything to keep it. See the article on Implants here!
What is Endodontics (Root Canal)
Endodontics is the discipline of Dentistry dedicated to the study and treatment of diseases of the dental pulp (internal and vital part of the tooth). When this tissue is affected, either by fracture, caries, infections the Endodontic treatment (root canal ) is the only way to keep the tooth healthy and in function.
Current Endodontics have very predictable results when done by a Specialist with the support of a Clinical Microscope (which allows an appropriate approach to the root canals, even with complicated anatomies by expanding the field of view).
Root canal treatment
Root canal treatments have been carried out for a long time, but in recent years they have evolved enormously.
These are highly specialized treatments that require specific training, state-of-the-art material for canal preparation and obturation, and if we want to greatly increase the success rate in all the cases, even the most difficult ones, the use of a Clinical Microscope.
For this reason, Root Canal Treatments are carried out at my Clinic by Endodontists with the support of a Clinical Microscope to make sure my patients get the best that is currently available in this area.
What does this mean in practical terms:
- High success rate both in 1st time treatments and retreatments (in teeth that have a previous root canal that is not properly done).
- Reduction in the number of sessions needed to perform a root canal with the possibility of “Single Session” in many cases.
- Possibility of saving teeth with old canal treatments and that have complaints (such as pain when chewing) or that radiographically present incompletely treated canals and/or with images at the tip of the roots indicating the existence of granulomas or cysts (result of chronic infection in that tooth).
What exactly is a root canal, when is it done and what does it consist of?
The tooth has a hard, mineralized external layer, composed of Dentin covered by Enamel, and an inner core, the Dental Pulp, better known as the “nerve”.
When cavities get close to or invade the pulp the tooth usually (but not always) hurts as the bacteria from the cavities will infect the pulp.
At this stage several things can happen:
- There may be sharp pain, which gets worse at night and can be unbearable (pulpitis, the pulp becomes inflamed and has nowhere to expand because it is confined by hard
tissues). - There may be an abscess
- The process can become chronic with less exuberant or non-existent complaints and later we discover penetrating cavities and images of granulomas and cysts on an X-ray.
At this stage we have 2 options:
- pull out the tooth
- do a root canal
It’s an easy choice, we should always keep our teeth as much as possible.
Root canal Step by Step
Under local anesthesia, an access is done on the tooth to reach the pulp (nerve), which is completely removed , and the canal or canals are prepared to receive a filling that will properly seal them.
This is very important: if the canals are not completely cleaned (up to the tip of the root) and sealed, the door is open to failure as bacteria will colonize these untreated spaces.
This treatment was, until recently, always done in a minimum of 2 sessions (sometimes many more). Today, in many cases, we can do longer single sessions, prepare and fill the canals in the same session.
Now the canals are treated, what to do with the tooth?
Once the root canals are treated, it is necessary to know what to do with the tooth: especially in teeth that sustain great masticatory load, premolars and molars.
Devitalized teeth not only show substantial loss of structure due to caries (often only thin walls of the tooth are left filled with giant fillings) but, after root canal treatment, they will become dehydrated and more fragile, with a great risk of fractures that extend to the root.
One should not go ahead with a root canal treatment of such teeth without informing the patient that it is not enough to fill the tooth, it is necessary to protect it with an overlay or a ceramic crown, to prevent the tooth fractures that may dictate the loss of the tooth.
See the case of “Tidying up the house”, in this case, in addition to other treatments, two ceramic overlays were placed on the molars on the right that had root canal treatments and giant fillings. This situation is very common and almost always leads to tooth loss due to fracture. It is mandatory to cover the entire occlusal plate with ceramic, which not only protects the tooth but also restores the anatomy.
