ENDODONTICS

Root canal therapy for vital elements

It is the branch of dentistry that deals with the treatment of the endodontium, a space inside the tooth that contains the dental pulp.

The endodontic therapy is used when a lesion (a traumatic one or caries,) causes an alteration of the pulp tissue, which results in necrosis.

It is also possible to use this method when the tooth will be involved in prosthetic rehabilitations that, due to the considerable reduction of the dental tissue (for the preparation of the tooth), lead to an increase of the residual sensitivity or to an irreversible alteration of the pulp (pulp necrosis due to iatrogenic causes).

It can also be necessary when there’s a wide destruction of the tooth, which doesn’t allow to reconstruct it successfully without using an “anchorage” of the filling around a pin that will be implemented in the canal to give stability to the reconstruction.

Root canal therapy for necrotic elements

After a carious process or in case of relapsing caries under a wide reconstruction, which affects the pulp chamber and causes necrosis, we are often forced to perform an endodontic treatment. These are the symptoms to determine if the pulp of a tooth is necrotic: thermal sensitivity test to cold with negative results; extreme pain tooth when hit; the patient complains about a subjective sensation called “high tooth.” In this case the procedure is the same as all root canal therapies and if necessary, before closing it, the endodontic space is treated with medical disinfectant substances that quickly reduce the symptoms described above.

Root canal re-treatment

The endodontic re-treatment is one of the practices which are sometimes more complex. The objectives of the re-treatment are identical to those obtained at the end of the endodontic therapy performed on an untreated tooth (a devitalized tooth, but without lesions at the top).

The need and the causes of root canal re-treatment can be very different. The presence of a periapical lesion that has been radiographically identified, accompanied by pain and/or recurring abscesses, is often considered as an absolute indication for surgery.
The cause of most of the failures of the endodontic treatment is an inadequate apical seal. In this case, the non-surgical endodontic treatment is often preferred to surgery or extraction. The removal of the previously placed root canal filling, a difficult and tedious procedure and the creation of a new apical seal are the requirements for a successful re-treatment. This type of treatment is not always possible if unremovable cements or pins had been placed in the canal.

Endodontic surgery and apicoectomy

If there are apical lesions that do not respond to conventional therapy or cannot be treated because the access to the canal is no longer possible due to the presence of crowns, root canal pins or foreign objects, then the lesion has to be removed via endodontic surgery or apicoectomy. The endodontic surgery is followed by the apical removal of 3-4 mm of a root of the tooth. It is not appropriate to perform an apicoectomy when the roots of the tooth are too short to take a further shortening, when the root/roots is/are fractured or when the tooth has to be extracted.