Endodontology

Endodonty (root treatment) involves cleaning and then filling the root canals. After treatment the tooth is devitalised (a dead tooth).

Such intervention is only necessary if a tooth is dying, if decay has reached the pulp cavity (nerve cavity), or if the nerve of the tooth is inflamed. The patient is not always aware of these phenomena, but often there is acute or chronic dull pain, particularly if there is inflammation of the nerve fibre.

During root treatment the dentist removes the nerve fibre from the root canals ensuring hygienic isolation of the tooth using a rubber dam, sterile instruments and high-precision measuring devices. The cleaned canals are then either sealed immediately with a root filling paste or, if there is inflammation, initially treated with a disinfecting medicament and then filled at a later session.

Root treatments involve demanding procedures, not infrequently associated with complications. If the roots of the tooth and their corresponding canals are very bent or narrow it is difficult for the dentist to clean and fill right down to the tip of the root. These teeth are then always at risk because the part of the root which cannot be reached remains unsterile and thus very susceptible to new inflammation. In this case a root tip resection or root amputation (shortening or complete removal of the root) may help. Other complications can arise because of instrument fractures, especially in the case of very narrow canals because the fine spiral-shaped cleaning needles used can become lodged in the canal and snap off. If the broken-off instrument cannot be removed the outlook is considered to be much poorer.

Following root treatment the corresponding teeth have to stabilised with a solid prosthesis. Otherwise teeth that have had the nerve removed have a tendency to break because of the inevitable drying that occurs and the unstable, hollow interior.

If a root filling is successful and properly sealed, the devitalised teeth can last just as long as vital teeth.