The Endodontics is the medical science in the field of Dentistry, which referred to the internal tissues of the tooth, diseases and related treatments. When these tissues or tissues surrounding the tooth root get sick or hurt due to caries or trauma, endodontic treatment makes it possible to save the tooth.

What is a root canal treatment or root canal or "root canal" of the tooth?

The endodontic treatment is an outpatient dental work that is necessary when the pulp (the soft tissue inside the tooth) is inflamed or infected for a damage caused by a deep caries, the outcome of interventions on the tooth, or by trauma (severe sudden or more light but repeated) that caused fracture or chipping or deep cracks.

The dental pulp, contained inside the teeth, popularly known as the nerve of the tooth, is in reality a highly specialized tissue consisting of arteries, veins, nerves, and connective tissue cells. In the age of development this fabric has the function of forming the supporting structure of the calcified tooth (dentin); in adults, for complete growth, the pulp - now thinned - remains confined in the pulp chamber and root canals, with residual functions of sensitivity to cold and moisture of the dentin.

A perturb the pulpal health may intervene various pathological situations, the most common of which is by far the dental caries (see below), namely the progressive decalcification and destruction of the hard tissues of the tooth to the action of microorganisms present in plaque bacterial. If the cavity is not treated promptly produced by decay it expands and deepens and extends until the pulp is achieved by bacteria with irreversible transformations due to infection. When you get to this stage, the conservative care that keeps the tooth while avoiding the extraction is endodontic therapy or root canal or even improperly called root canal treatment. In general the Endodontics aims to preserve teeth that have received significant damage to their structure which led to infection and necrosis of the pulp, with acute or chronic effects of surrounding tissue, more or less painful.

Modern Endodontics uses sophisticated tools for diagnosis and therapy, such as surgical stereo microscope, innovative biomaterials, instrumentation in special alloys.

What signs indicate the presence of a cavity?

Tooth decay can not give any early sign of his presence, or the symptoms are so mild that they do not induce concern. This is especially true in the early stages, but often even in the face to the complete destruction of the tooth the patient may not report any particular discomfort and show indeed surprised of what happened without pain. Only with regular monitoring by the dentist - that must be done even in the absence of pain - you can verify their presence until the very early stages and intervene early therapy and thus limited, minimizing damage and preventing sudden pains and care in emergency regime. Therefore the pain, in the case of teeth, is not a reliable warning signal and even a severity index of the damage: the solution is the periodic visit to the dentist.

The excessive sensitivity to cold is a symptom to consider, but it is not a unique index of the presence of a cavity. Can also be caused by the uncovering of the collars in level (the part of the teeth next to the gingiva) for periodontal disease, by abrasion from toothbrush used incorrectly, or for a particular acidity of the oral cavity (from excessive erosion intake of acidic foods such as citrus or vinegar, or even to pathological conditions such as gastroesophageal reflux). The grinding (bruxism), or cracks / fractures can lead to hypersensitivity to cold.

Besides the sign of pain in the cold or even to sweets or salty foods it is completely absent in the already treated teeth endodontically. the pulp is the sensitive part and if the pulp is necrotic, or has been removed to a previous root canal therapy, this symptom is lacking. Note in this regard that the caries attacks indifferently and with the same intensity both healthy teeth, is tooth previously cured or devitalized.

Excluding situations listed above, when the heat symptoms, cold, sweet, salty is accompanied by a more or less localized pain that lasts for a time later to the stimulus, this is a clear sign of the presence of a caries already at an advanced stage. The damage extends in rapid progression, and if not intercepted in time inevitably leads to painful phenomena of pulpitis (acute inflammation) and necrosis (cell death) of the pulp of the tooth itself. The care at this late stage is no longer the removal of the carious part and a filling more or less extended, but is requiring the processing endodontic (or root canal treatment, also called root canal treatment or channeling).

Endodontic treatment

What is it about?

The endodontic treatment (root canal or also called root canal treatment or channeling) consists in the removal of the pulp (dental nerve) inflamed and infected, present within the tooth and over the entire length of the roots, and in its replacement with permanent obturation in gutta-percha and cement root canal, after adequate cleaning and shaping of root canals.

What you get with the endodontic treatment?

The result is that the tooth will no longer be an infectious tank and, after adequate reconstruction of the crown, can continue to perform the same functions of an intact tooth. The percentage of success of a root canal proper care is, under normal conditions, very high. The percentage decreases in cases of endodontic retreatment, that is when you need to repeat the procedure for a previous failure (execution errors, anatomical complexity, objective difficulties)

How long?

Endodontic treatment is now also fast for molars, thanks to new techniques and modern equipment available. The operational steps are the following:

Local anesthesia to neutralize the pain even in cases with more sensitive pulp

temporary restoration of the dental crown when this is very destroyed, in order to eliminate all the cavities without giving up the walls of the tooth cavities (containment of liquid disinfectants and engagement of the insulating rubber sheet)

Isolation of the operating field by means of the rubber dam (necessary means for a good outcome of the root canal) consisting of a rubber latex sheet stretched by a headband and held in place by a hook placed around the tooth to be cured or to a tooth near

Opening the pulp chamber: access to the pulp through a cavity prepared by chewing the side of the tooth

Or retrieval of the root canal with the aid of optical magnification

Measurement of the working length of each channel that is present (by a reference on the crown to the root apex) by means of an X-ray and an electronic apex locator (the dose of radiation absorbed in the execution of a radiography for dental use is minimal)

Instrumentation of channels using endodontic instruments that remove the root canal pulp contaminated by bacteria and infectious substances, creating at the same time a form of walls suited to a complete filling

Washing with sodium hypochlorite, powerful disinfectant, to obtain an environment as clean and antiseptic as possible

Root filling using gutta-percha, plastic and moldable by heat, associated with a concrete canal

crown reconstruction

Radiographic testing of the end of care

Any fixed prosthesis (crown or bridge)

The Root canal care can hurt?

During treatment, endodontic pain is under control thanks to local anesthesia. A soreness, which can be subjectively more or less troublesome, may be present after the therapy, but is easily controlled with a common analgesic. Rarely, particularly in infected roots it can develop an abscess with pain and swelling due to the passage of bacteria in the bone surrounding the roots. The onset of these complications does not necessarily affect the success of the treatment in progress.

Source: Italian Endodontic Society