Endodontics

Doctor, my teeth are turning black in colour after an accident

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. The procedure involves removing the damaged area of the tooth (the pulp) and cleaning and disinfecting it, then filling and sealing it. The common causes affecting the pulp are a cracked tooth, a deep cavity, repeated dental treatment to the tooth, or trauma to it. The term “root canal” comes from cleaning of the canals inside the tooth’s root. The hand instruments were very effective however tedious when contrasted with rotational instrumentation. Hence nowadays we use Rotary endodontics for root canal therapy. There was a time when RCT was painful and a long process. Nowadays with effective anesthetics, root canal therapies are basically a single visit therapy.Successful endodontic treatment depends upon localization, proper chemo-mechanical preparation of the root canal system, debridement, shaping, disinfection, and three-dimensional obturation of the canal system. Thus multiple sitting endodontic therapies were advocated and followed. Single-visit endodontic treatment had various drawbacks mainly concerning post-operative pain and failure of the treatment outcome. With the advent of newer technology, elimination of these various drawbacks of single-visit endodontic therapy could be made possible in many scenarios. So with recent advances, single-visit endodontics has been shown to be an effective treatment modality when compared with multiple visit therapy and it does not deviate from achieving the objective.

The general sequence of a root canal procedure is as follows:

Step 1
Local anesthesia is administered via injections to numb the tooth to be treated and the surrounding tissues. If the pulp in a tooth is acutely inflamed, and therefore very painful, it may take a while to get it numb, but your dentist will not start the treatment until it is.

Step 2
A small access hole is drilled through the biting surface of an affected back tooth or from behind a front tooth, allowing access to the pulp chamber and root canals for treatment.

Step 3
The diseased and dead pulp tissue is removed from the tooth with specially designed instruments used to clean out the root canals and pulp chamber. This is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain. The canals are disinfected with antiseptic and antibacterial solutions.

Step 4
The canals are then shaped with tiny flexible instruments to allow them to receive root canal fillings and sealers. The canals are washed and cleaned again to remove root canal debris prior to sealing them.

Step 5
Root canal fillings are selected that will exactly fit into the freshly prepared canals. Usually, a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“Thermo” – heat; “plastic” – to shape), which literally is heated and then compressed into and against the walls of the root canals to seal them. Together with adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria.

Step 6
A temporary or permanent filling material will then be placed to seal the access hole that was made to treat the canals, and the dental dam is removed. If the tooth lacks sufficient structure to hold a restoration (filling) in place, the dentist or endodontist may place a post (either metal or a very strong plastic) in one of the canals inside the tooth to help retain it.

Step 7
After the procedure, an antibiotic may be prescribed to treat or prevent infection. Be sure to follow the instructions of your dentist or endodontist carefully. After-effects of treatment are minimal, generally lasting from a couple of days to about a week. It is normal to have some minor discomfort after treatment including slight soreness that can usually be managed with over-the-counter (aspirin, ibuprofen) medications or prescription (codeine-type) drugs, or a combination of the two.

Step 8
Your tooth will need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal to the top of the tooth. Your endodontist will send you back to your general dentist to determine which type of restoration is best for you. This step is of particular importance since many studies show that if the filled root canals are decontaminated with bacteria from the mouth, there could be a recurrence of infection around the tooth.