Endodontics (from the
Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
roots ''endo-'' "inside" and ''odont-'' "tooth") is the
dental specialty concerned with the study and treatment of the
dental pulp
The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.
Anatomy
The pulp is the neurovascular bundle centr ...
.
Overview
Endodontics encompasses the study (practice) of the basic and clinical sciences of normal dental pulp, the
etiology, diagnosis, prevention, and treatment of diseases and injuries of the dental pulp along with associated
periradicular conditions.
In clinical terms, endodontics involves either preserving part, or all of the dental pulp in health, or removing all of the pulp in irreversible disease. This includes teeth with irreversibly inflamed and infected pulpal tissue. Not only does endodontics involve treatment when a dental pulp is present, but also includes preserving teeth which have failed to respond to non-surgical endodontic treatment, or for teeth that have developed new lesions, e.g., when root canal re-treatment is required, or
periradicular surgery
In the dental specialty of endodontics, periradicular surgery is surgery to the external root surface. Examples of periradicular surgery include apicoectomy, root resection, repair of root perforation or resorption defects, removal of broken fra ...
.
Endodontic treatment is one of the most common procedures. If the
dental pulp
The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.
Anatomy
The pulp is the neurovascular bundle centr ...
(containing
nerves,
arteriole
An arteriole is a small-diameter blood vessel in the microcirculation that extends and branches out from an artery and leads to capillaries.
Arterioles have muscular walls (usually only one to two layers of smooth muscle cells) and are the primar ...
s,
venule
A venule is a very small blood vessel in the microcirculation that allows blood to return from the capillary beds to drain into the larger blood vessels, the veins. Venules range from 7μm to 1mm in diameter. Veins contain approximately 70% of t ...
s,
lymphatic tissue
The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphatic or lymphoid o ...
, and fibrous tissue) becomes diseased or injured, endodontic treatment is required to save the tooth.
Procedures
Root canal treatment
Root canal treatment is a dental procedure used to treat infected tooth pulp which would be otherwise extracted. The pulp is the soft tissue core of the tooth which contains nerves, blood supply and connective tissue necessary for tooth health.
This is usually caused when bacteria enter the pulp through a deep cavity or failed filling.
Root canal treatment is required when the dental pulp is irreversibly damaged and involves both coronal and apical pulp.
Root canal treatment can also be carried out on teeth with doubtful pulpal state before placing post-retained crowns and overdentures. Root canal therapy is not only performed when pain relief from an infected or inflamed pulp is required. It is also done to prevent adverse signs and symptoms from the surrounding sequelae and promote the healing and repair of the surrounding periradicular tissues. An example of which is if there is trauma to a front tooth which has caused it to be avulsed from the bony socket; endodontic treatment is required following re-implantation to preserve the aesthetics and function of the tooth, even though there may be no adverse symptoms of the dental pulp, or pain present at the time.
Prior to root canal treatment, clinical examination and radiographic examinations are carried out to diagnose and plan treatment. Local anaesthesia is delivered to make the procedure pain free. The tooth to be treated is then isolated using a rubber dam, which prevents saliva entering the tooth during treatment and protects the airway from the fine files and strong chemicals used. The root canal treatment procedure is often carried out over single
or multiple appointments.
Root canal treatment involves:
* Removing the damaged and infected pulp
* Shaping the entire root canal system
* Cleaning and disinfecting the entire root canal system
* Filling and sealing the root canal system
* Placing a direct restoration such as composite filling or indirect restoration such as a crown
Instrument fractures are common procedural mishaps in root canal treatment. It is essential to prevent instrument fractures. The success of removing of broken instrument depends on the location, direction and type of instrument.
A sodium hypochlorite accident can result in long-term functional and aesthetic complications. Extrusion of sodium hypochlorite irrigating solution during a root canal procedure can cause a severe inflammatory reaction and tissue damage. Treatment is provided based on the severity of the injury. Tooth discolouration as a result of root canal treatment can occur if the pulpal tissue remnants are not completely removed or if a root canal sealer material containing silver is used.
Periradicular surgery
Periradicular surgeries involve the root surface. These include apicoectomy (removal of a root end),
root resection (removal of an entire root), repair of an injured root due to perforation or
resorption
Resorption is the absorption of cells or tissue into the circulatory system, usually by osteoclasts.
Types of resorption include:
* Bone resorption
* Herniated Disc Resorption
* Tooth resorption
* Fetal resorption
* Blood resorption
See also ...
, removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.
Apicoectomy
An apicoectomy is a surgical procedure through which the apex of a root is resected, and a root-end filling is placed, preventing bacterial leakage into the root canal system from the
periradicular tissues.
A microsurgical technique is used to carry out apicectomy, which improves post-operative healing.
An apicoectomy can be carried out when a previous root canal treatment fails, and re-root canal treatment is not possible.
This may be as a result of anatomical features, such as root dilaceration, which can compromise the completion of cleaning and obturating the root canal system. Procedural errors including ledges or perforations, may also be indications for an apicectomy.
Local anaesthetic is utilised to achieve anaesthesia as well as
haemostasis
In biology, hemostasis American and British English spelling differences#ae and oe, or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is Bleeding, hemorrhage). ...
for improved visualisation. A
flap
Flap may refer to:
Arts, entertainment, and media
* ''Flap'' (film), a 1970 American film
* Flap, a boss character in the arcade game ''Gaiapolis''
* Flap, a minor character in the film '' Little Nemo: Adventures in Slumberland''
Biology and he ...
in the gum is designed, and then raised to allow for exposure of the periapical lesion.
Bone removal (
osteotomy
An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is ...
) is carried out to enable access to root apex, and diseased tissue is removed at this point through
curettage
Curettage ( or ), in medical procedures, is the use of a curette (French, meaning scoop Mosby's Medical, Nursing & Allied Health Dictionary, Fourth Edition, Mosby-Year Book 1994, p. 422) to remove tissue by scraping or scooping.
Curettages are ...
.
The root end resection is carried out, removing 3mm apically. The canal(s) is then obturated, and the flap is sutured. There are a number of root-end filling materials available, including
zinc oxide eugenol cements, and
mineral trioxide aggregate
Mineral trioxide aggregate (MTA) was developed for use as a dental root repair material by Mahmoud Torabinejad. It is formulated from commercial Portland cement, combined with bismuth oxide powder for radio-opacity. MTA is used for creating apical ...
.
Complications that may arise include:
* pain: anti-inflammatory agents or analgesics should be taken
* swelling: intermittent ice will aid in eradicating this. Swelling resolves usually within 24–48 hours.
*
ecchymosis
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...
(discolouration): this will often occur distant from the surgical site
*
paraesthesia
Paresthesia is an abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause. Paresthesia may be transient or chronic, and may have any of dozens of possible underlying causes. Paresthesias ar ...
: usually transient as a result of inflammatory swelling, and sensation will return to normal in 4 weeks
* serious infection is rare, but can be treated with antibiotics, which should be administered with caution to avoid bacterial resistance
*
maxillary sinus
The pyramid-shaped maxillary sinus (or antrum of Highmore) is the largest of the paranasal sinuses, and drains into the middle meatus of the nose through the osteomeatal complex.Human Anatomy, Jacobs, Elsevier, 2008, page 209-210
Structure
It i ...
perforation
Other procedures
Other non-surgical endodontic procedures include
pulp capping
Pulp capping is a technique used in dental restorations to prevent the dental pulp from necrosis, after being exposed, or nearly exposed during a cavity preparation, from a traumatic injury, or by a deep cavity that reaches the center of the too ...
,
pulpotomy
Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved unders ...
,
apexification Apexification is a method of dental treatment to induce a calcific barrier in a root with incomplete formation or open apex of a tooth with necrotic pulp. Pulpal involvement usually occurs as a consequence of trauma or caries involvement of young ...
, and
pulpal regeneration.
Hemisection, where a root and its overlying portion of the crown are separated from the rest of the tooth and optionally removed, is another (non-periradicular) endodontic surgery.
Tools
Microsurgical endodontics Microsurgical endodontics is that aspect of endodontics
Endodontics (from the Greek roots ''endo-'' "inside" and ''odont-'' "tooth") is the dental specialty concerned with the study and treatment of the dental pulp.
Overview
Endodontics en ...
, the use of magnification devices such as microscopes, and dental loupes, has been widely accepted among endodontists and practitioners;
its use is believed to increase accuracy and visualization in the operating field. However, a Cochrane review in 2015 found no evidence to determine whether there is a difference in the outcome of a procedure done by magnification devices or a conventional procedure done with no magnification. The
American Association of Endodontists
The American Association of Endodontists, or AAE, is a not-for-profit organization of endodontists and other professionals with an interest in endodontics founded in 1943.
The current Board of Directors is published on the Association'website
H ...
strongly encourages its members to pursue the use of an oral microscope to ensure the highest level of excellence.
The use of a
CBCT is also becoming the standard of care.
Training
Endodontists are specialist dentists with additional training, experience and formal qualifications in endodontic treatment, apicectomies, microsurgery, and dental emergency and trauma management.
Endodontics is recognized as a specialty by many national dental organizations including the Dental Board of Australia, British
General Dental Council
The General Dental Council (GDC) is an organisation which regulates dental professionals in the United Kingdom. It keeps an up-to-date register of all qualified dentists and other dental care professionals such as: dental hygienists, dental ther ...
,
American Dental Association,
Royal College of Dentists of Canada
The Royal College of Dentists of Canada (RCDC; french: Collège royal des chirurgiens dentistes du Canada) is a regulatory college which administers examinations for qualified dental specialists as part of the dentistry profession in Canada. Its h ...
,
Indian Dental Association, and
Royal Australasian College of Dental Surgeons
The Royal Australasian College of Dental Surgeons (RACDS) is a postgraduate professional education body established in 1965 to provide a broad range of activities to enhance the professional development of both general and specialist dentists thr ...
.
Australia
In
Australia, endodontics is recognized as one of the thirteen registered dental specialties. In addition to a dental degree, Endodontists have an additional three years of postgraduate University training in the area of Endodontics to be recognized and registered by the Dental Board of Australia. A general dentist is permitted by law to perform endodontic treatment, but must be competent in the skills required for the endodontic treatment, and refer complex cases for specialist management.
United States
In the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
after finishing a
dental degree, a dentist must undergo 2–3 additional years of postgraduate training to become an Endodontist.
American Dental Association (CODA) accredited programs are a minimum of two years in length. Following successful completion of this training, the dentist becomes Board eligible to sit for the
American Board Of Endodontology examination. Successful completion of board certification results in Diplomate status in the American Board of Endodontics.
Although general dentists can perform endodontic treatment, there are several things which set endodontists apart. Endodontists use
microscope
A microscope () is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic means being invisi ...
s during treatment to better treat the small internal
anatomy of teeth without taking away too much tooth structure, or causing
iatrogenic
Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...
damage. Also, endodontists use
CBCT (3D imaging) to assess case difficulty and for diagnosis and treatment planning of endodontic cases.
See also
*
American Association of Endodontists
The American Association of Endodontists, or AAE, is a not-for-profit organization of endodontists and other professionals with an interest in endodontics founded in 1943.
The current Board of Directors is published on the Association'website
H ...
*
Dental implant
A dental implant (also known as an endosseous implant or fixture) is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodo ...
*
Endodontic therapy
Root canal treatment (also known as endodontic therapy, endodontic treatment, or root canal therapy) is a treatment sequence for the infected pulp of a tooth which is intended to result in the elimination of infection and the protection o ...
*
Journal of Endodontics
*
Oral and maxillofacial surgery
*
Ralph Frederick Sommer Ralph Frederick Sommer (1898 – 1971) is known as one of the two leading pioneers in the development of endodontics. He is also noted as a pioneer in the treatment of root canal infections and the development of the root canal operation.
At the U ...
, an early developer of endodontics
*
Regenerative endodontics
Regenerative endodontic procedures is defined as biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex. This new treatment modality aims to promote normal function ...
*
Root canal
A root canal is the naturally occurring anatomic space within the root of a tooth. It consists of the pulp chamber (within the coronal part of the tooth), the main canal(s), and more intricate anatomical branches that may connect the root ...
References
External links
Organizations
American Association of EndodontistsAmerican Board of EndodonticsBritish Endodontic SocietyCanadian Academy of EndodonticsEuropean Society of EndodontologyIndian Association of Conservative Dentistry and EndodonticsInternational Federation of Endodontic Associations
Publications
Journal of Endodontics Research (JofER)International Endodontic Journal
{{Dentistry