Welcome. The purpose of this page is to include general information that answers the most frequently asked questions by those patients who are interested in our specialty. Surely you have heard sometime that a tooth needs a "root canal treatment". Many people fear this treatment because they are not properly informed about it. Our goal is to provide the best possible treatment according to the newest cientific knoweledge and advances in technology, techniques and materials.

  What is endodontics?

Endodontics refers to the interior (Endo) of the teeth (Dontia). Thedental pulp is the tissue located inside the teeth and it is composed of nerves, blood vessels and specialized cells; among others. It's main function is to form the teeth (during the formation period of these structures) and secondly to perceive external stimuli. Endodontics is the dental specialty dedicated to prevent, diagnose and treat the illnesses of the dental pulp and the tissues that surround it.

  Why does the dental pulp become ill?

The most frequent reasons for the dental pulp to become ill are:

  • Dental caries (deep cavities).
  • The cumulative effect of numerous dental procedures performed on a tooth.
  • Traumatic injuries (accidents).

On the other hand, the conditions under which a tooth might need a root canal for the first time can be divided in two big groups:

  • When there is an irreversible inflammation in the dental pulp (called pulpitis).

When there is necrosis of the dental pulp (the pulp dies).

As a consequence of the action of different irritants, the dental pulp becomes ill (it gets inflamed) although it can still be vital (alive) inside the tooth. In some occasions the injury is so intense that the pulp is irreversibly affected (this becomes apparent with symptoms like sensitivity to hot or cold or a spontaneous toothache). This condition of irreversible injury can only be solved with a root canal treatment.

If this situation is not diagnosed on time (maybe because it does not hurt), the dental pulp may become necrosed (dead). In this case the tooth has no sensitivity at all to termical changes. The necrosed dental tissue (decomposed pulp with bacteria) comes out of the tooth usually towards the area of the root tip, affecting the surrounding tissues (dental abscess). At this point the most frequent symptoms are sensitivity or pain on pressure and-or mastication and even inflammation of the surrounding tissues (gums, face, etc). As this progresses, the dental radiograph shows a dark area at the root tips. If this situation is not attended promptly, the whole bone around the area can become affected leading to the loss of the tooth.

  What is a root canal treatment?

The treatment of choice for the inflammatory conditions and necrosis of the dental pulp is basically the same, a root canal treatment. This form of therapy consists in completely removing the pulpal nervous tissues and other contents (in the case of infections or necrosis) from inside the roots. Afterwards, the remaining spaces are disinfected and filled with an inert material. The purpose of this treatment is to create a clean environment inside the roots so the inflammation subsides and the surrounding tissues can heal so the tooth can function normally without any symptoms.

  How long does it take to perform a root canal treatment?

In our case, 95% of the cases are treated endodontically in only one appointment. Today's knowledge and technology permit this to happen. Traditionally these treatments where performed in various appointments (usually 2 to 4 visits). The results where satisfactory but there is a lot of wasted time.

  Is this treatment painful?

Usually not. The procedure is performed under local anesthesia so the patient does not feel any discomfort.

  What about after treatment?

In most cases after the procedure is completed, you can expect mild discomfort. In other less frequent occasions there might be some more discomfort. But the truth is that in the majority of cases you will not feel anything at all. If you feel anything this can be very easily treated for a few days with an over the counter analgesic.

  Are there other types of endodontic treatments?

Yes, You might have heard about re-treatments of previous root canal treatments or even the term Periapical surgery. Both of these procedures are performed on teeth that already have a root canal treatment. This could be due to an unsuccessful previous treatment or because there is a lesion in the root tip or tips of the tooth.

Once the treatment is executed, the response of the tooth is measured in terms of the healing response around the treated tooth. Although the percentages speak highly about the success of the endodontic treatments (around 92 percent when the procedure is performed correctly), there are no total guarantees because it all depends on the particular biological response and healing capacities of each individual case. As a matter of fact, some teeth that have received successful endodontic treatment many years ago can sometimes develop problems. These problems depend of many different variables like new caries or periodontal (gum) infections. The other variable that has not received a lot of recognition until recently is the quality of the restoration that is placed over a tooth with a root canal treatment. A restoration that is not adapted properly to the tooth can generate a pathway for microleakage of saliva and bacteria that can affect the endodontic treatment.

Many factors can determine the development or the recurrence of a pathology associated with a tooth that has a root canal treatment. These factors can even preclude healing in this tooth. If the condition of the actual root canal treatment is not favorable, a decision has to be made in order to keep the tooth functioning. Once the choice is to maintain the tooth, the two available options are re-treating the canals or performing Periapical surgery.

  Re-treating previous root canal treatments (Root canal retreatment)

This is always the first choice when a previous root canal treatment has failed. The treatment consists in removing the material inside the canals, a thorough cleaning and disinfecting process along (if possible) with the identification of the reason(s) for the failure. The canals are then re-sealed again.

In many of the cases, the cause of the previous failure is corrected (e.g. some canals were not treated or were treated incompletely). In this way, surgery can be avoided. On the other hand, it may also happen that lesions do not heal after this so the case has to be resolved using surgery. If this is the case, it is always advisable to get to this stage with the best possible root canal treatment, as this will enhance the results of the surgical procedure.

  Periapical surgery

Periapical surgery is the treatment of choice when everything else has failed or in those cases where a re-treatment is not feasible (e.g. when canals are not accessible due to obstructions, unremovable cemented posts, etc)

Instead of approaching the problem through the tooth, this type of surgery approaches the root tip directly entering from the gum and bone. During the procedure, the tip of the root is identified eliminating a very small piece of it (the last 3 millimeters) together with the lesion. This procedure is called "apicectomy". Afterwards, a small hole is prepared in the tip of the root, which is then sealed with a material that precludes the microfiltration of contaminant elements from the tooth to the surrounding supporting tissues. More information about this procedure can be found in the web site of the American Association of Endodontics.

  New technologies in endodontics

The practice of endodontics has dramatically changed in the past decade. This is directly related to the development of new equipment and new designs in the instruments. In this same manner, dental professionals dedicate extensive hours to continuing education in this field and some of them even undertake specialty courses lasting a couple of years becoming certified "specialists in endodontics". Some of the recent advances in endodontics are:

  • Computerized radiographs: These new types of radiographs are taken with a special sensing device that substitutes the x-ray film. Images can be viewed immediately in the computer screen without the need for development of the film. The real advantage for the patient is the reduction of the levels of radiation because for this new type of image only 1/8 of the usual radiation is needed.
  • Nickel-titanium instruments: The files are instruments that are used for cleaning and shaping the root canals. Until recently, these instruments had limited flexibility because they were made out of stainless steel. Many of them fractured inside the tooth during its use. Nickel-titanium is a material that is 450 times more flexible than stainless steel and permits easy preparation of even the most curved root canals.
  • Rotary (Mechanical) instrumentation: The use of dental files adapted to rotatory instruments is a breakthrough and it is possible because of the added flexibility of the new types of files. This technique makes it easier and faster to clean and shape the root canals before sealing them.
  • Electronic apical-foramen (apex) locators: This technology permits the rapid electronic determination of the exact place where the root canal ends inside the root tip. In the past, this was done by radiograph observation and visual approximation. Several radiographs needed to be taken and the procedure was inexact and took a longer time.
  • Ultrasonic equipment: They allow the controlled vibration of certain instruments that clean and shape the root canals. They also help in the removal of obstructions and objects (e.g. cemented posts) from the roots. This type of equipment has even revolutionized the way of preparing the root tips during the apicectomy procedures in Periapical surgery, making it a very reliable technique with excellent results.
  • Clinical microscopes: Because the working area in endodontics is so small (a root canal can have one millimeter in diameter) magnification of the viewing field is very important. For these reasons different types of loupes, telescopic loupes and lately microscopes have been developed. Although many cases can be solved without these magnifying aids, they are extremely helpful because the human eye has important limitations when these types of treatments are performed. This is especially true when re-treating canals or during periapical surgeries.

Everything has to be performed under strict disinfecting and sterilization. Many of the materials that are used are disposable and many of those that are re-usable are sterilized and disinfected and afterwards are protected with disposable protective shields.

 
If you wish to learn more about this and other dental fileds, please visit:

http://www.ceo.com.ve

 

If you have any question please e-mail us at carlosboveda@carlosboveda.com , or feel free to contac-us through our guest book.

 

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 Carlos Bóveda Z. May 1999 - Rev: October 2003