Endodontics is a specialized field focusing on the inner structures of the teeth, including pulp, nerves, and tissues. The aim of endodontics is to restore natural teeth and prevent the need for artificial replacements.
Signs that you might need endodontic treatment include gum inflammation, sensitivity to hot or cold, pain when chewing, tooth discoloration, and unexplained pain in nearby lymph nodes.
Cracked and fractured teeth are common and often painful dental issues. With people keeping their natural teeth longer, the risk of cracks increases due to biting hard objects, trauma, grinding, and clenching.
Cracks cause intermittent pain, especially during biting. The crack exposes the tooth pulp, leading to irritation and potential infection if untreated. Symptoms include:
Unexplained pain while eating
Sensitivity to hot and cold
Pain without an obvious cause
Difficulty pinpointing pain location
There are different types of cracks. Crazes are tiny surface cracks that are usually harmless and often treated for cosmetic reasons. Oblique supragingival cracks affect only the crown and cause minimal pain, while oblique subgingival cracks extend below the gum line and may require surgery and restorative treatment. Vertical furcation cracks separate tooth roots, often affecting the nerve but can be treated with root canal and a crown. Oblique root cracks occur below the gum line and often require extraction. Vertical apical root cracks occur at the root tip, causing severe pain and often leading to extraction.
Treatment varies based on the severity of the crack. Mild cracks can be treated with root canal therapy and a crown or filling to stabilize the tooth. Severe cracks may require extraction and replacement with bridges, implants, or partial dentures to restore function.
Root amputation is a dental procedure where one root is removed from a multi-root tooth, typically molars. This saves the tooth from extraction, making it fully functional with a crown or filling. Root amputation is less expensive and quicker than implants or bridgework, usually completed in 1-3 visits. Root amputation is only possible on a healthy tooth with a solid surface, strong bone support, and healthy gums. It's required for:
Broken, fractured, or injured teeth and roots
Embedded bacteria within the root structure
Severe bone loss from periodontitis
Concentrated tooth decay
The procedure requires prior root canal treatment to remove pulp, blood vessels, and nerves. Under local anesthesia, an incision exposes the roots, and the affected root is sectioned and removed. The area is cleansed with saline, and sutures seal the incision. A temporary crown or filling secures the tooth. Painkillers, antibiotics, and antimicrobial mouthwash may be prescribed. After 7-10 days, stitches are removed, and the permanent crown or filling is placed.
In rare cases, root canal therapy may not work as expected, leading to the need for root canal retreatment. The procedure is similar to the original root canal treatment, with a success rate of around 75%. Root canal therapy might fail due to:
Cracked crown leaking filling material
Untreated curved or narrow canals
Delay in placing restorative devices
New tooth decay or fracture
Saliva entering the restorative structure
Undetected complex canal structures
Under local anesthesia, the affected tooth is isolated with a rubber dam to protect it from bacteria and saliva. The crown is removed along with any obstructions blocking the root canals using an ultrasonic handpiece, which loosens unwanted material. Tiny instruments clean and reshape the canals, with X-rays ensuring thorough cleaning. If needed, medicated packing material is applied for further cleansing in a subsequent visit. Once clean, the canals are packed with gutta-percha to prevent bacterial invasion. A temporary crown or filling is applied, and a permanent, colour-matched crown is placed later.