Dental Procedure Blog series
The following series of blogs will cover the different areas of dentistry. The aim is to simplify and explain the jargon that patients encounter in the normal course of dental visit. It is based on the Ontario Dental Association’s procedure categories and descriptions.
Endodontics is the treatment of the inside (endo) of the tooth. The pulp is inside and is commonly called the ‘nerve’, but it is far more complex with nerves, blood vessels and connective tissues.
The anatomy is comparable to a building with a large central (the pulp chamber) room and several corridors (the root canals in each root) leading away from it. The number of root canals varies depending on the type of tooth – incisor, bicuspid, or molar.
If the tooth is traumatized, fractured, or decayed the pulp will become inflamed. If treatment is timely, the tooth may settle. If it does not, the pulp becomes non-vital and the usual consequences may include pain, swelling and possibly a draining abscess.
Should this occur, the diseased pulp tissue is treated in one of the following ways.
Pulpotomy is the judicious removal of the pulp in the chamber and then sealing off the tissues in the root canals. The tooth may then remain functional. This is usually a procedure done on children’s teeth that are badly decayed to keep them in place as space maintainers until their time to fall out.
Pulpectomy is the removal of the diseased pulp tissues from the entire length of the root tips to the chamber. This may be done separately as an emergency to ease pain or as part of the entire root canal therapy.
Root canal therapy is comprised of removing the diseased tissues in all of the canals to the root tips; cleaning and shaping the canals and then sealing them from the chamber to the root tip with a biocompatible material. The therapy must ultimately be completed by restoring the tooth with a core and filling. Depending on the extent of tooth damage, a crown may be appropriate to prevent future fracture of the tooth.
Apexification is a therapy for young adult teeth that do not have completely formed root tips. The tooth is either traumatized (sports usually – wear your mouth guards!) or very badly decayed. Once the diseased tissues have been removed, medication is inserted into the canal to stimulate the closure of the root tip. Once this has taken place, conventional root canal therapy can be completed.
Apicoectomy; apical curettage and retrofilling are further therapies to retain root canal treated teeth. Sometimes, for any number of reasons, the tooth may become re-infected even after having had root canal therapy. To better seal the root tip; root tip surgery (apicoectomy) is performed, the area is cleaned out (curettage) and the root tips are sealed with filling material (retrofilling).
Amputations –hemisections are interventions that will remove one of multi-rooted molar teeth roots if the root canal therapy has been unsuccessful on that root. The remaining root and restoration will keep the tooth functional and useful.