Endodontics

Endodontics from the Greek – the science of the “inside” of a tooth, root canal treatment. The goal of endodontic treatment is to destroy microorganisms in root canal system and to protect the tooth and its surrounding tissues from infection. For this purpose, tooth root canal must be cleaned and sealed. Using modern treatment methods and materials, root canal treatment is 98% successful.

The most common reason of root canal system infection is tooth decay, through which the bacteria get access to the tooth pulp.

If the canals are not treated, the bacteria infiltrate the surrounding tissue through the apical foramen and cause an inflammation. Eventually bone resorbs and an inflammatory focus forms around the affected tooth. All this can lead to more serious complications. Inflammatory foci can be visible in an X-ray.

Inflammatory focus before treatment and inflammatory focus 8 months after the treatment

Infected or damaged pulp (tooth “nerve”) is removed, the canals are chemomechanically prepared and sealed. Hermetic sealing of tooth root canal prevents microorganisms from spreading inside and outside the tooth (into periapical tissues). Treatment should be carried out under an X-ray control. Generally, at least 3 x-rays are done during the course of endodontic treatment. We use digital X-ray system, which emits 4-10 times reduced radiation dose.

Root canal treatment is a precise work which requires good visibility. For that reason the microscope is being used in endodontics. The endodontist sees a perfectly lit, many times enlarged view, which would not be possible to see for a naked human eye.

Unfortunately, the root canal treatment is not always successful. If microorganisms survive, clinical symptoms can occur – sensitivity when biting, swelling, tooth may feel raised. Often unsuccessful endodontic treatment is associated with poor chemomechanical preparation and sealing of the root canal, although sometimes a failure can be caused by treatment-resistant bacteria. In such cases, surgical or non-surgical root canal retreatment is necessary.

Non-surgical retreatment involves the removal of old filling from the root canal, new chemomechanical preparation, introduction of antimicrobial agents for one week and canal sealing afterwards.

Surgical retreatment involves tooth root resection – gingivoperiosteal flap is raised, root apex is reached through the bone, the apex is resected, the canal is sealed retrogradially.