Anatomy of the tooth
To understand why you need endodontic treatment, it helps to know something about the anatomy of the tooth. Teeth are composed of three layers, the outer enamel, the inner dentin and the innermost layer, the pulp. The enamel is the outer insulating layer of the tooth that is devoid of nerve supply. The next layer, the dentin is innervated and is the sensitve tooth structure. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development. The pulp is housed in the canal system within the tooth, which comprises of the pulp chamber in the crown and the root canals in the roots. The pulp connects to the tissues surrounding the root through the apex or the tip of the roots.
Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can be due to a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth or traumatic injury to the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abcess.
Signs of pulp damage include throbbing pain, prolonged sensitivity to heat or cold, discoloration of the tooth, swelling and tenderness in the nearby gums. Sometimes, there are no symptoms.
Endodontic Procedure:
Endodontic treatment can often be performed in one or two visits depending on the complexity of the canal system and the severity of the infection. It involves the following steps:
1) The endodontist examines and performs several tests to determine the pulpal status, x-ray the tooth, then administers local anesthesia. After the tooth is numb, the endodontist places a small protective sheet called a "dental dam" over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2) The endodontist makes an opening in the crown of the tooth to acess the pulp chamber and locates the root canals. Anterior teeth and lower bicuspids usually have one canal, upper bicuspids usually have two canals and the molars have 3-5 canals. Very small instruments called files are used seqentially to clean and shape the canal system to receive the canal filling.
3) The endodontist makes an opening in the crown of the tooth to acess the pulp chamber and locates the root canals. Anterior teeth and lower bicuspids usually have one canal, upper bicuspids usually have two canals and the molars have 3-5 canals. Very small instruments called files are used seqentially to clean and shape the canal system to receive the canal filling.
2) The endodontist makes an opening in the crown of the tooth to acess the pulp chamber and locates the root canals. Anterior teeth and lower bicuspids usually have one canal, upper bicuspids usually have two canals and the molars have 3-5 canals. Very small instruments called files are used seqentially to clean and shape the canal system to receive the canal filling.
2) The endodontist makes an opening in the crown of the tooth to acess the pulp chamber and locates the root canals. Anterior teeth and lower bicuspids usually have one canal, upper bicuspids usually have two canals and the molars have 3-5 canals. Very small instruments called files are used seqentially to clean and shape the canal system to receive the canal filling.
Although initial root canal treatment was successfully completed the tooth may sometimes fail to heal. The tooth may become painful or diseased months or even years after successful treatment due to various reasons:
When this happens the endodontist can try to save the tooth by retreating the canal system . It involves removing the existing canal filling , exploring for new or untreated canals. This is usually done using an operating microscope, ultrasonics and digital imaging and will involve more time and effort in doing the procedure. The canals are then sealed with the canal filling . Sometimes retreatments are done in conjunction with endodontic surgery .Your endodontist will discuss your options and recommend appropriate treatment.
Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. But if symptoms persist even after successful non-surgical endodontic treatment your endodntist may advise surgery to save your tooth. Sometimes calcium deposits make a canal too narrow for the instruments used in root canal treatment requiring a surgical procedure to treat an infection or inflammation in the bony area around the end of your tooth. Surgery will aid in diagnosis and treatment. Surgery allows your endodontist to examine the root of your tooth, find the problem, and provide treatment.
Most common surgical procedure rendered is called Apicoectomy or Root end resection
Apicoectomy
In this surgical procedure your endodontist reflects the gum tissue near the root end of the tooth ,examines the underlying bone, gains acess to the root end ,removes infected tissue and resects the root end. He then seals the root end with an inert filling material and sutures the gum tissue back. Over a period of months the bone heals around the resected root end.
Reimplantation
According to the American Dental Association, the difference between saving and losing a knocked out tooth, is the thirty minutes following the incident.
To save the tooth, follow these steps:
If the tooth can be reimplanted into its socket within 30 minutes following the incident then your endodontist will delay the root canal treatment for 2 weeks in order to stabilise the tooth. If more than an hour has elaspse root canal treatment will be performed prior to reimpantation. However the prognosis is such cases is guarded due to future root resorption and eventual loss of the tooth.
Other surgeries endodontists might perform include dividing a tooth in half in order to elimimate a furcation involvement, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.
In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.
These procedures are designed to help you save your tooth.
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