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What is Endodontics?

In order to understand endodontics, first of all, it is necessary to know the dental anatomy briefly. The part of the tooth visible in the mouth, which remains on the gum, is called the crown; while the part invisible in the mouth, which remains in the bone, is called the root. The teeth consist of several layers. The outermost layer is the enamel layer visible above the gingival border. Under the enamel layer, there is a structure called dentine. Under the enamel and dentine, the outer tissues of the tooth, there is pulp tissue that is a soft connective tissue forming the living part of the tooth, also colloquially known as the “nerve of the tooth.” The task of the pulp is to nourish the tooth during its growth and development. When a tooth is fully developed, the pulp tissue transmits the pain to inform that the tooth is damaged or inflamed.

Endodontics is a branch of dentistry dealing with and treating problems that have progressed up to the dental pulp.

A specialist physician who have completed his/her dental education, have had his/her practical and theoretical education in the department of root canal treatment, and have completed his/her doctorate, is called endodontist.

What is Root Canal Treatment?

The procedures performed to treat inflammation of the soft blood vessel-nerve extension (pulp) inside the tooth, under the enamel and dentin layers, are called canal treatment. Dental canals are very small and thin tunnels that extends from the crown part of the tooth to the root end. It is the procedure for removing the pulp.

In the past years, tooth extraction was the only form of treatment for teeth with inflamed pulp, but today, thanks to canal treatment, dentists can keep the teeth in the mouth and enable them to serve for a long time.

Why Root Canal Treatment Should Be Performed?

When damaged and inflamed, the pulp dies because it is not capable of healing itself. Pulp death occurs mostly in a traumatized or broken tooth, or due to a deep decay. In both cases, bacteria reach the pulp and cause inflammation. In such a case, stimuli such as chewing, pressure or hot and cold temperatures can cause extreme sensitivity and pain. In addition, inflammation of the pulp can lead to a pain that starts spontaneously and cannot be relieved with painkillers.

Medications--especially antibiotics--you take without consulting the dentist can only postpone your pain for a temporary period of time. Long-term use of antibiotics makes inflammation more resistant and makes it more difficult to treat the tooth.

If the inflammation of the pulp is not treated, “pus-filled sacs” called abscess develop as a result of accumulation of inflammation in the root ends and jawbone. These abscesses developing at the root end can expand and destroy the bone tissue around the root. If the inflamed pulp is not removed, pain and swelling are observed. If a treatment is not performed for a long time, tooth extraction may become necessary.

How is root canal treatment performed?

When your dentist recommends canal treatment after identifying the condition of the tooth, an endodontist starts the treatment and the tooth is treated in one or more sessions depending on its condition.

First, the area to be treated is anesthetized so that you do not feel pain. If there is decay, it is cleaned off, and then the tooth is opened from its crown part to access the area where the nerves of the tooth are located.

Radiography (X-ray) is taken to determine the length of the channel.

The contents of the root canals (pulp tissue) are removed and cleaned off; and then the root canals are shaped using various hand tools and rotary tools.

The root canals are disinfected, i.e., they are purified from bacteria, and then the canals are filled with a material compatible with the surrounding tissues.

The treatment may take 1 to 3 sessions depending on the condition of the tooth.

Especially in cases where the tooth is dead and there is inflammation in the root end, drugs can be put in the root canals with intent to destroy the bacteria. In order to ensure its efficacy, this drug should remain in the canal for a period of at least 5-7 days for effective use. During this time, the tooth is closed with a temporary filling material.

In cases of severe inflammation, the dentist may also recommend taking oral medication.

Following the treatment, complaints of mild pain and tenderness may occur in the tooth, but this condition is temporary. In such a case, the best solution is to not use the side, where that tooth is located, for a period of several days. After a short time, the sensitivity will be observed to disappear.

A tooth treated with canal treatment can serve for years, like a tooth that has never been treated. As in any tooth, decays or fractures may occur in teeth treated with canal treatment, and they can be problematic in terms of gums. After root canal treatment, strict attention should be paid to oral hygiene.

You should brush your teeth, use dental floss, and visit your doctor for checkups, on a regular basis.

What is the Success Rate in Root Canal Treatment?

The success rate of endodontic therapy increases in parallel with advancements in technology. The success of a root canal treatment performed properly in accordance with the rules has such a high percentage as 90% to 95% on average. In different studies, endodontic success rates have been reported to be between 53 and 94%.

The anatomy of the root canal plays an important role in the success of a treatment. Cleaning and shaping is more difficult in teeth with complex canal shapes.

Endodontic failures may be encountered due to inadequacy in cleaning, shaping and plugging; tool breakage in the root canal; overlooked canals; fracture formations in the inter-root area; the falling out of the tooth treated with root canal treatment and bacteria reproduction due to the resultant exposure of the tooth to the external environment, and re-inflammation of the root canal system.

In case of failure, the solution is usually achieved by renewing the canal treatment and correcting the mistakes, if any. The old canal filler is removed, and then the canal of the tooth is reshaped, cleaned off, and refilled. If a good result cannot be achieved with this procedure, a surgical intervention called “root-end resection” is performed. During this process, the tooth root is reached and the area together with its surroundings are surgically cleaned off and covered. If a solution cannot be achieved with surgical intervention, extraction of that tooth can be considered applicable.

Is There Any Alternative to Root Canal Treatment?

There is no treatment option that can be an alternative to canal treatment.

When the repetition of the root canal treatment is unsuccessful or in cases of teeth where a second root canal treatment is inapplicable—for example, if there is a restoration on the tooth treated with canal treatment, performed by creating a support through the canal, or if there is a broken tool in the canal—, surgical intervention can be performed on the root end of the tooth.

Extraction should be considered in cases where the repetition of the canal treatment and surgical intervention are not successful, or where teeth have excessive substance loss that makes it impossible to apply filling or crown restoration.

The cavity that will occur after tooth extraction can be treated with bridge or implant applications.

However, it is always preferable to preserve the natural tooth. Lack of one or more teeth may lead to dislocation and deteriorated posture of the neighboring teeth. In addition, preserving natural teeth does not require expensive and prolonged treatments such as implant and bridge procedures.

What Dental Diseases Are within the Scope of Endodontic Treatment?

Canal treatment should be performed when the pulp is damaged or inflamed for any reason.

The main cause that requires canal treatment is conditions where deep and widely-spread decays reach the pulp.

Especially in young children, the pulp may be damaged with fractures caused by falls, injuries or any impact on the teeth. In such cases, regular checks should be carried out to see whether the tooth is still alive. Canal treatment is required in teeth that have lost their vitality.

In case of inflammation due to poor and incorrect canal treatments, the first option is the renewal of canal treatment. The old canal filling is removed, the inflammation is cleaned off, and then the canal treatment is repeated.

Root canal treatment is the first procedure to perform for also cases of swelling and purulent discharge caused by inflamed teeth that have not been treated for a long time.