What is endodontics?
Endodontics is the branch of dentistry that deals with the diagnosis and treatment of the dental pulp (nerve) and tissue at the apex of the tooth. Dental pulp is a substance composed of connective tissue, nerve tissue and blood vessels. It is responsible for the nourishment and internal sensitivity of the tooth.
Endodontics
Dental pulp treatment.
Symptoms
Pain, sensitivity and swelling.
Root canal treatment
The "cleaning" of tooth canals of infected tissue.
Apicectomy
The removal of the root apex of a tooth, which averts total extraction.
Are they painful?
They can cause discomfort in the following days.
Purposes of endodontic treatment
Differential diagnosis between the various types of dental pain to understand when the tooth really needs to be treated.
Treatment of vital pulp with pulp capping.
When is endodontic treatment necessary?
Endodontic treatment becomes necessary when the pulp becomes inflamed due to bacteria in the mouth. Normally, bacteria cannot reach the tooth pulp, thanks to the protection provided by the enamel.
However, when the tooth is damaged, by deep caries or a fracture, the bacteria have a free way. Once they reach the pulp, they cause inflammation and then necrosis (decay).
Necrosis affects the entire nerve, up to the apex of the tooth, causing a granuloma and then an abscess.
The abscess, as it expands, consumes the bone, consequently piercing the gingiva that covers it, resulting in the escape of pus.
The devitalised tooth is inevitably weakened, so we must recognise the symptoms in advance to avoid having to resort to this type of treatment. Obviously, as always, frequent check-ups and thorough dental hygiene are the basis of prevention, but we must also be able to recognise certain specific symptoms:
sensitivity to heat and cold;
nocturnal pain;
pain when chewing;
swelling;
enlarged lymph nodes;
presence of abscess.
How is endodontic treatment performed?
How does endodontics save the tooth?
Inflamed or necrotic tissue is removed with specific instruments and products, trying to get to the root apex. Root canal obturation is then performed. Next, the destroyed part of the tooth is restored, often using carbon or fiberglass endocanal posts to give greater strength. In order for the tooth to be able to withstand chewing stresses, veneering with inlays or crowns (caps) is often recommended.
Is it a painful treatment?
Thanks to anesthesia, the procedure becomes painless. There may be chewing sensitivity in the following days due to the invasion of the root canal filling material into the apical space.
How to achieve quality endodontic treatment?
First, an X-ray of the tooth to be devitalized is necessary, sometimes including a CT scan to best highlight the roots and any lesions present.
Isolate the tooth from the rest of the cavity. The use of a rubber dam is necessary to avoid bacterial contamination that could enter with saliva, to prevent instruments and disinfectant liquids from slipping into the mouth.
The use of radiographs and special sensors makes it possible to be sure to get to the dental apex. It is very important to clean all infected pulp well and seal the canal tightly with appropriate cements.
What is apicectomy?
The apical lesion (granuloma/cyst) may sometimes not heal, or there may be situations that make it impossible to clean the canals by entering from the dental crown (e.g. due to the presence of pre-stent metal pins or cements that are impossible to remove).
How dental apicoectomy is performed
The apical lesion (granuloma /cyst) may sometimes not heal, or there may be situations that make it impossible to clean out the canals by entering the dental crown (e.g. due to the presence of pre-existing metal posts or cements that cannot be removed).
Therefore, in order to preserve the tooth, it is necessary to eliminate the infection anyway, acting with a surgical procedure called Apicoectomy. The operation is performed by incising the gum at the exact point corresponding to the tooth apex. The root is exposed, the inflammatory lesion and the infected root tip are removed. The root can then be cleaned on the opposite side of the crown and the canal filled with biocompatible materials. The gingiva is closed with a few stitches. One waits a few months to take a control X-ray again. At least 6 months are necessary to be able to show the healing at its best.
Does apicoectomy cause pain?
Dental apicoectomy is performed under anaesthesia, so no pain is felt during the procedure. Adequate antibiotic and anti-inflammatory therapy is required in such cases. In the following days, swelling and pain may occur, but these are well controlled if the instructions given beforehand are followed.
Clinical cases
The phases of the route
The dental diagnosis
Specific clinical tests are performed: percussion test to show pain; cold/hot vitality test to have reactions. After radiographic examinations, diagnosis is made and treatment options for root canal treatment are presented.
1
The use of rubber dam
The tooth is insulated with a thin sheet of rubber (rubber dam) to protect the throat from liquids and debris, preventing saliva from entering the tooth and subsequent bacterial contamination.
3
The treatment
Once the endodontic treatment is chosen, a local anesthetic is then administered.
2
The endodontic procedure
During endodontic surgery, the damaged or infected pulp is removed (devitalization of the tooth). After thoroughly cleaning and shaping the inside of the tooth, this space is then filled and sealed. On the tooth thus devitalized, a crown or other restoration is placed to protect it and restore it to full function.
4
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28 ott 2021
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