Endodontics

Endodontics

Endodontics (from the Greek endo "inside"; and odons "tooth") deals with the tooth pulp and the tissues surrounding the root of a tooth. Endodontists perform a variety of procedures including root canal therapy, endodontic retreatment, surgery, treating cracked teeth, and treating dental trauma. If the pulp (containing nerves, arterioles, venules, lymphatic tissue, and fibrous tissue) becomes diseased or injured, endodontic treatment is required to save the tooth.

·         Root Canal treatment - (Single and Multiple Sittings)

Root Canal therapy refers to the process by which a dentist treats the inner aspects of a tooth, specifically that area inside a tooth that is occupied by its "pulp tissue." Most people would probably refer to a tooth's pulp tissue as its "nerve." While a tooth's pulp tissue does contain nerve fibers it is also composed of arteries, veins, lymph vessels, and connective tissue. The Root Canal Therapy is generally done to improve the health of your damaged tooth. During the treatment, the pulp is removed from your root canals through a small opening in the crown. Then the canals are cleaned and disinfected. The canals are then sealed with an inert material that occupies the space vacated by the removal of the pulp. Treatment may take one or more visits.
After the inside of your tooth has been treated, the outside will be restored to protect your tooth's underlying structures and to bring the tooth back into function. The dentist will usually cover the tooth with a ceramic crown. After root canal therapy, your tooth continues to be nourished by the surrounding gums and bone.

·         Apexification - (Multiple sittings)

Apexification is a method of inducing the development of root apex in an immature pulpless tooth by formation of osteocementum or other bone like tissue. Apexification procedure should induce root end closure at the apices of immature roots, as evidenced by periodic radiographic evaluation.

An immature tooth with an open apex, ensuring maturogenesis is the treatment of choice.  Until the tooth is fully mature, the apex is open and the root canal walls are thin.  Closure of the apex is needed in the root development of immature teeth, but continued root development and dentin formation are also needed.  We want to allow not just apexogenesis—the closure of the apex—but maturogenesis—the continued maturation of the tooth, the normal process of root and apex formation with eventual closure of the apex, and continued dentin formation along the root walls to increase their thickness and length.  Canal walls need thickness and an appropriate internal shape if the mature tooth is to be strong.  The thin canal walls and open apex make root-canal therapy on an immature tooth extremely difficult.  Keeping the pulp alive and allowing the tooth to mature is preferred because the mature tooth is a much better candidate for successful root-canal therapy.

Post treatment, adverse clinical signs or symptoms such as a prolonged sensitivity, pain, or swelling should not be evident.

There should be no evidence of abnormal canal calcification or internal or external root resorption, lateral root pathosis, or breakdown of periradicular supporting tissues during or following treatment of Apexification. 

In this procedure, necrotic tissue is removed, and apex closure is induced.  The desired effect of apexification is a calcified barrier across the open apex to allow for obturation with gutta-percha.  However, apexification does not allow for the development of the root-canal walls.  To achieve apexification, the canal must be free of infection.  Calcium hydroxide is used to promote apical closure by stimulating the formation of a calcified barrier.  The successful formation of the hard-tissue barrier is usually determined by tactile sensation. 

·         Apexogenesis - (Multiple sittings)

Apexogenesis is a good option for young patients with immature teeth with carious exposures or pulp exposures due to trauma. The goal is to remove the unhealthy pulp tissue which means that pulpal amputation can extend only a few millimeters or you may be doing a very deep pulpotomy depending on the situation. A small endodontic spoon or a round diamond bur can be used to remove the tissue. Traditionally, calcium hydroxide has been the material of choice but now MTA (Mineral Trioxide Aggregate) is also a viable material.

If apexogenesis is successful, root will continue to form (oftentimes irregularly) and this will give additional support for the tooth. This procedure can take months to years depending on the case, and when this is done root canal treatment is normally recommended because canals can continue to calcify and make the canals nonnegotiable when endodontic treatment is required at a future time.