About endodontics.

The term “endodontics” comes from the Greek word ‘endo,’ meaning “inside,” and “odonto,” meaning “tooth.” Endodontics thus refers to the part of dentistry that deals with the inside of the tooth. Its aim is to prevent and treat diseases of the dental pulp (the inside of the tooth) and the periapical tissues (the tissues around the root of the teeth).

To understand endodontic treatment, it is important to know dental anatomy. Inside the tooth, there is the pulp, which consists of cells, blood vessels, and nerves. It extends from the crown down to the tip of the roots, where it connects to the surrounding tissues. It ensures the “vitality” of the tooth.

Recognized as a specialty since 1963 in the United States, endodontics encompasses all procedures aimed at preventing and curing the spread of infection from the tooth to the surrounding tissues (bone, sinuses, etc.).

An endodontic treatment is necessary when the dental pulp is inflamed, infected, or has suffered trauma. The main cause of pulp inflammation is dental caries.

Caries is a progressive lesion of the enamel and/or dentin. As it progresses, it causes reversible inflammation of the pulp, resulting in sensitivities to cold, heat, and sweets. If left untreated, this pulp inflammation becomes irreversible and leads to severe spontaneous pain: this is toothache. At this stage, an endodontic treatment (root canal treatment) becomes essential.

Pulp inflammation can also occur if a filling leaks or if a tooth develops a fracture.

A tooth crack or fracture can result from several causes:

• Parafunction (e.g., teeth grinding or clenching, nail-biting, chewing on hard foods like almonds, or using teeth to cut plastic).
• A dental filling (amalgam).
• Loss of a significant part of the tooth due to caries.
• A traumatic impact or injury.

If you grind your teeth or clench them at night or during the day due to stress, talk to your dentist about getting a night guard for protection.

There are different types of cracks, classified by their size and location. Typically, a superficial crack in the enamel is asymptomatic. The deeper the crack, the more likely it is to cause pulp inflammation and sensitivities to cold, heat, and sweet foods. These sensitivities are accompanied by pain during chewing.

A crack is a progressive condition, and it’s important to diagnose and treat it before it’s too late and the tooth fractures.

Unfortunately, the presence of a crack reduces the long-term prognosis for the tooth.

After confirming the diagnosis, local anesthesia is applied to ensure the treatment is pain-free. A dental dam (rubber dam) is placed around the tooth to isolate it from the rest of the mouth. The dental dam serves two purposes:

• To protect the patient (tongue, cheek, lips) from the instruments and materials used.
• To protect the tooth from saliva, which contains millions of bacteria.

Once the dam is in place, we clean the roots by removing the inflamed or infected tissue and disinfecting the inside of the tooth.

Next, the roots are sealed (closed) permanently, and a temporary dressing is placed over the crown of the tooth to protect the treatment.

A follow-up appointment with your dentist is necessary after our treatment. Your dentist can then protect the treated tooth with a crown or overlay to prevent future cracks.

We recommend you familiarize yourself with post-treatment guidelines.

Depending on the case, a follow-up appointment will be scheduled one year later to evaluate the healing of the tooth.

Sometimes, a tooth that has already undergone an endodontic treatment (root canal) can become reinfected for several reasons:

• The initial treatment was not optimal.
• One of the roots was not disinfected.
• An obstacle or calcification prevents cleaning one of the roots.
• Loss of the crown restoration or its seal leads to new contamination.
• A devitalized tooth can decay again.
• A crack can lead to contamination.

In these cases, we need to assess whether the tooth’s structure allows us to retain it and proceed with a root canal retreatment (re-root canal). In some cases, this type of retreatment may not be possible, and surgical retreatment will be necessary.

When conventional retreatment (called orthograde) is not recommended (due to significant prosthetic work, correcting anatomical issues, obstacles, or the need to complement previous treatments), surgical endodontic treatment is required.

The goal remains the same: to disinfect the root(s) causing the problem. A CBCT (Cone Beam Computed Tomography, 3D radiology) is mandatory in this case, as it helps anticipate underlying anatomical structures.

All steps and information regarding surgical endodontic treatment will be explained during a preoperative consultation.