Endodontics
is the area of dentistry dealing with the prevention, diagnosis,
and treatment of disorders of the dental pulp.
Endodontic therapy (root canal) is a treatment modality that
will save diseased or injured teeth. The alternative to endodontics
is extraction. Typically, a severely decayed tooth or a tooth
with a large filling will begin to ache. The pain might be intermittent
at first and over time progress to a constant dull throbbing
pain or a severe ache that might be felt on all the teeth on
the affected side. Sometimes there is no pain and an abscess
might be discovered on a routine x-ray.
The
pulp is the soft tissue that is located inside the tooth structure.
It contains nerves, arteries, veins, and lymph tissue. It is
contained in the canals located in thin tube-like spaces in
the roots and in the pulp chamber located within the crown of
the tooth.
This
image shows how the progression of decay, if not treated, will
lead to destruction of the tooth's hard tissue and pulp. If
treated at the beginning of the decay process (first image),
a small filling would resolve the problem. If allowed to continue
as in the last image, root canal therapy would be necessary.
Decay
progressing from a white spot lesion(A), into the enamel(B),
into the dentin(C), towards the pulp(D), into the pulp(E), resulting
in the formation of an abscess in the jaw bone.
When
the pulp is diseased or injured and unable to repair itself,
it becomes infected. Left untreated, the pulp will die and become
necrotic. Pus can build up at the root tip, forming an abscess
that can destroy the bone surrounding the tooth. Endodontic
treatment is the removal of the diseased pulp tissue, which
will enable the body's defense system to repair the damage caused
by the infection.
Endodontic therapy normally takes two or three visits to complete.
The
following steps are involved in the treatment of the tooth:
-
A local anesthetic is used so the procedure will be pain free.
The tooth will then be isolated by placing a rubber dam over
it. This thin sheet of rubber provides a clean and aseptic working
environment.
-
An opening is then made through the top of the tooth into the
pulp chamber.
-
The pulp is removed from the pulp chamber and the root canals
are cleaned, enlarged, and shaped to a form that can be filled
and sealed latter.
-
A temporary filling is placed in the the opening in the tooth
to seal it between visits. There can be some discomfort in the
area of the tooth for a day or two following the initial visit.
Occasionally the pain can be more severe.
-
During the next stage of treatment, the temporary filling is
removed and the root canals are filled and sealed. This completes
the endodontic treatment.
The
dark area at the end of the root is a large abscess before endodontic
treatment.
___________________________________
This
shows the healed abscess after endodontic treatment.
Following completion the tooth will need to be restored. Due
to the large amount of tooth structure usually lost from decay
and old fillings the preferred restoration is a crown. A post
may be placed into the root to give additional structural support.
Tooth preparation to obtain access to root canal
Root canal preparation including enlargement
Root canal debridement & Cleaning - (Surgical excision
of dead, devitalized, or contaminated tissue and removal of
foreign matter from a wound).
Flap preparation incision of soft tissue to prepare a flap
and expose the bone
Cutting bone to prepare a window access to the apex (apices)
of the roots
Apicoectomy - removal of the tip of the root.
Root end preparation for retrofill
Removal of pathological tissues and hyperplastic tissue (An
abnormal increase in the number of cells in an organ or a tissue
with consequent enlargement).
Dentistry
has now been introduced to a new root canal treatment using
the Er,Cr:YSGG (erbium, chromium:yttrium scandium gallium garnet)
laser to provide additional important benefits to our patients.
This new system should help reduce patient fear and improve
their general attitude towards dentistry. The device that provides
such a treatment is the Waterlase Hydrokinetic Hard and Soft
tissue laser (Biolase Technology, Inc), the only laser system
to receive FDA clearance for complete endodontic therapy involving
enamel, dentin, pulp and other root canal procedures. This laser
uses specialized fibers of various diameters and lengths that
provide access to effectively remove pulpal tissues and tooth
structure from the root canal walls, and prepared the canal
for opturation.
From
my experience with the Waterlase Hydrokinetic system on patients,
the most important benefit of this revolutionary technology
for endodontic treatments is the ease of using the system and
the great degree of patient comfort during and after the procedure.
Also, I have found a reduced need-and in some cases no need
to all-for prescription pain medication. Furthermore, postoperative
complications such as inflammation, swelling, and pain were
significantly reduced. In addition, the possibility exists that
more root canal therapy can be performed without any anesthesia.
Also, due to the antibacterial effect of the YSGG laser, it
is my opinion that this will lead to a reduction in the need
for postoperative antibiotics. All of these factors help to
improve patients attitude towards dentistry.
