Endodontics

 

What is endodontics?

Endodontics is a specialty of Dentistry that deals with diseases of the dental pulp and its supporting structures.

We are a leading dental centre dedicated to Endodontics, the treatment carried out to save natural teeth, often referred to as root canal therapy. Our clinicians and specialists offer some of the best endodontic treatments and welcome referrals from dentists all over the UK and abroad. Endodontic Treatment is an economical way to preserve a tooth in function especially when the cost of tooth loss and replacement is so high.

Anatomy of a Tooth

In order to understand what Endodontic Treatment or Root Canal Treatment is, it helps to know something about the anatomy of a tooth.

Teeth have Several Layers

  • The outside layer of the tooth is composed of a hard layer called Enamel.

  • The Dentine layer which is protected by the Enamel layer has at its centre a soft tissue known as the Pulp.

  • The Pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding Dentine and Enamel during tooth development. The Pulp receives its nourishment supply from vessels which enter the end of the root.

  • Although the Pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

Why would I need Endodontic Treatment?

Endodontic Treatment or Root Canal Treatment is necessary when the Pulp becomes inflamed or infected.

The most common reasons for inflammation or infection are deep cavities (caries), repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth.

If Pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess (swelling).

Signs and Symptoms

Indications for treatment include

  • Prolonged sensitivity/pain to heat or cold

  • Swelling of the gum adjacent to the tooth

  • Tenderness of the tooth especially to biting or adjacent gums.

  • Sometimes there are no symptoms and the first sign of a problem maybe radiographic evidence corroborated with additional diagnostic testing by the Endodontist.

  • Discoloration of the tooth

How can Endodontics help me?

  • The Endodontist removes the inflamed or infected pulp, carefully cleans and shapes the canal system and then seals the prepared space.

  • Most treatment is performed within one or two appointments, ranging from 60-120 minutes (depending on the tooth and number of root canals).

  • Once treatment is completed, you will be instructed to return to your dentist for a permanent restoration which may be in the form of a crown or onlay.

  • The restoration of the tooth is an important part of treatment because it seals the cleaned and filled canals from the oral environment, protects the tooth and restores it to function.

  • In addition to conventional endodontic treatment your dentist may have referred you for Endodontic Retreatment, Endodontic Surgery, Cracked Tooth or Traumatic Injury.

 

Root Canal Treatment

Root canal treatment involves the location, shaping, disinfection and filling of the root canal space, to allow a tooth with an inflamed or infected pulp to be saved.

The procedure is carried out under local anaesthesia (injection in the gum) and we endeavour to provide pain-free treatment.

Following canal location, flexible instruments called root canal files are used to shape the narrow canals in the center of each root. Shaping allows the disinfectant access to the bacteria located at the end of the tooth.

Disinfection of the root canals is carried out with various disinfectant solutions and often an antibacterial paste may need to be left within the tooth between appointments.

The cleaned space is then filled with a rubber-based material known as gutta percha.

A dental operating microscope / magnification loupes is used during treatment to aid visualisation and assure precision during treatment.

Root canal therapy may be completed in one or two appointments, depending on the tooth and the number of canals present.

Once treatment is completed, you will be instructed to return to your dentist for a permanent restoration which may be in the form of a crown or onlay.

The restoration of the tooth is an important part of the treatment because it seals the cleaned and filled canals from the bacterial re-entry, protects the tooth and restores it to function.

Root Canal Treatment

 

Occasionally, teeth that have previously had root canal treatment become infected again. The main reasons for this are:

  • Bacterial infection through leaking fillings or crowns.

  • Missed anatomy such as extra root canals or canal branches. These areas may house bacteria.

  • Blockage of the narrow canal channels.

  • Fracture/separation of root canal files during treatment.

Revision of the treatment can save these teeth.

The procedure involves removal of the existing root-filling material, followed by the stages outlined for root canal treatment.

Retreatment shares a similar success rate to first-time root canal treatment. Maintaining the tooth in this way therefore provides a cost-effective alternative to it’s removal and replacement.

Post Removal

Posts are used to restore teeth that have lost a lot of structure. They consist of metal or glass-fibre cylinders that are placed into the canals to retain the filling material and/or crown.

When teeth with posts have an endodontic infection, they can be treated in one of two ways:

  • Removal of the post, followed by root canal retreatment.

  • Leaving the post in place and treatment of the infection by carrying out Endodontic Microsurgery.

The choice of method will depend on the individual tooth and is made following an in-depth discussion regarding the pros and cons of both procedures.

The type of post dictates how we remove it. They can be unscrewed, loosened with ultrasonic vibration or removed by cutting into them. Depending on how well fitting the post is, the procedure can take from 30 to 90 minutes.

Separated/ Fractured file management

Occasionally, the small flexible files we use for root canal treatment can fail and separate from its handle during treatment.

In the absence of pain or infection, these can be left in place as they are made of an inert material remaining within the confines of the tooth.

However, if pain or an infection persists, root canal retreatment may be carried out to save the tooth.

Such a tooth may be treated in the following ways:

  • Removal of the file if it is accessible to retrieval. This may require removal of tooth structure above the fragment, which needs to be balanced with any possible resultant weakening of the tooth.

  • Leaving the file in place, whilst bypassing it with another file. This option achieves the objective of cleaning the canal without overtly weakening the tooth.

  • When bypassing the instrument is not possible, the root canal retreatment can be completed up to the instrument. Various methods can then be used to encourage the penetration of the disinfectant solution to the end of the root.

  • If the above procedures prove unsuccessful, Endodontic Microsurgery may be suggested as a way to maintain the tooth.

The option chosen will depend on the tooth and the broken fragment (position within the canal, length, type of file).

Studies have shown teeth with separated instruments can be treated successfully, provided the tooth can be disinfected as close to the root-end as possible.

Open apex

 

When the pulp of a young tooth dies before the root has fully developed the root canal is a very wide cylinder. The death of the pulp in these cases is usually due to dental decay or Dental Trauma.

Such teeth are challenging to treat as they are difficult to clean and fill.

Following disinfection of the cylindrical space, contemporary cement materials (MTA) are used to fill the canals. The treatment takes place under magnification with the dental operating microscope / surgical loupes to allow the accurate placement of the materials.

Endodontic microsurgery

 

In some cases a surgical approach to managing the root canal infection is recommended.

The indications for this are usually:

  • Persistent infection of the tooth, despite completion of root canal treatment.

  • The presence of bacteria on the outer root surface, where root canal procedures cannot reach.

  • Surgical investigation can be performed when the tooth fails to respond to treatment and a crack or fracture of the tooth root is suspected.

  • Repair of root surface defects such as root perforations or dental resorption.

In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed in the root to seal the end of the canal and a few stitches or sutures are placed in the gum to help the tissue heal properly.

The treatment is completed with modern microsurgical equipment and visualisation is aided with the dental operating microscope.

This procedure allows the retention of the natural tooth.

Dental Resorption

 

Resorption occurs when the cells of the body which are a normal part of the turnover of bone (osteoclasts) start to resorb/breakdown the tooth structure.

The following conditions have the potential to cause resorption to varying extends:

  • Dental trauma

  • Tooth restorative procedures (pulp inflammation)

  • Long-standing root canal infection

  • Orthodontic treatment

  • Systemic diseases

  • Unknown (idiopathic) causes.

In can affect the INTERNAL root canal surface or the EXTERNAL root surface. The extent of resorption can vary from a small area with no detrimental effect on the survival of the tooth to significant tooth loss, deeming the tooth non-restorable.

When teeth affected by resorption are assessed, we may need to take a small CT scan to assess the amount of tooth structure affected by the process.

Depending on the type, position and extent of resorption, the tooth can be managed by root canal treatment (link to rct page) or Endodontic surgery.