Root canal treatment is an invasive surgery that allows you to repair teeth that have been seriously compromised by deep caries or serious dental trauma, which have irreversibly damaged the dental pulp .
Devitalization, which saves the tooth from an inevitable extraction , is performed in three main steps:
- Removal of diseased and infected dental pulp
- Replacing the dental pulp with a special amalgam (biocompatible material + cement)
- Tooth reconstruction
Despite being almost painless, root canal treatment continues to terrify the vast majority of patients forced to undergo the surgery. Let us therefore try to describe precisely all the steps necessary to devitalize a sick tooth. The detailed description of the procedure can be useful for relieving tensions and anxieties that – inevitably – arise in the patient before root canal treatment.
Execution
Root canals are mainly performed to save a tooth from being extracted. The surgery, performed on an outpatient basis, is usually completed in two sessions.
The devitalization is carried out in several steps, always after a careful dental visit which also includes an X-ray of the diseased tooth.
All the phases of the intervention are described below:
- Local anesthesia of the tooth
- Positioning of the dam on the tooth to be devitalized. The dam is a small latexhandkerchief which, fixed on a tooth, protects the others from any fragments of dentin or waste that could be created during the operation
- Drilling the crown of the tooth (to allow access to the damaged or infected pulp using a special instrument, called root canal file)
- Removal of dental pulp and any bacterial residues in the root canal
- Root canal disinfection
- Filling the root canal with a sterile and inert material called gutta-percha: it is a natural resin capable of transforming itself into calcium hydroxide . Gutta-percha is generally mixed with adhesive cement, a further guarantee that ensures complete isolation of the root canal.
- Seal of the tooth with a special TEMPORARY filling(useful device to prevent any entry of bacteria in situ.
From Wikipedia: the various stages of dental root canal treatment. A) Diseased or damaged tooth. B) Drilling and cleaning. C) Elimination of vessels and nerves up to the apex of the tooth with root canal files (“files” endodontic). D) filling with gutta-percha and covering with prosthetic crown (capsule)
After the surgery…
After devitalization, the tooth must be reconstructed or, if necessary, also encapsulated (with the possibility of inserting a pin). The temporary filling must be removed before proceeding with the reconstruction of the tooth (for this reason, it is referred to as a “temporary filling”). A carbon or metal post should be positioned on the tooth canal, useful for supporting the reconstruction.
The last step consists in covering the tooth with a capsule, useful for minimizing the risk of future dental fractures . In fact, let us remember that a devitalized tooth is more fragile than a “live” tooth (with pulp).
Devitalization or extraction
Devitalization is the ideal expedient to escape the extraction of a diseased tooth. Caries , as well as serious trauma and pulpitis in an advanced stage, can seriously compromise the health of the tooth, up to irreversibly damaging it . In similar circumstances, toothache is relentless, and is punctually accentuated by taking excessively hot or too cold foods, chewing crunchy foods or simply brushing the tooth with the tongue. These painful symptoms push the unfortunate person to request a consultation with the dentist, who, in the presence of irreversible damage, will propose devitalization of the tooth as a valid alternative to extraction. Root canalization offers many advantages:
- Tooth rescue
- Almost painless operation
- Treatment of infection
- Removal of pain
Risks
Like any treatment, root canal treatment can also involve some risks. First of all, this procedure must be performed by doctors who are experts in endodontics (the branch of dentistry specializing in the diagnosis and treatment of infections or traumas affecting the pulp of the tooth).
The risks of devitalization can be:
- Tooth fall in case of badly performed devitalization
- Possible damage to the tooth if crunchy foods are eaten immediately after the first root canal treatment (before tooth reconstruction)
- Dental hypersensitivityin the 15-20 days following root canal and reconstruction of the tooth
- Possible alteration of the natural color of the tooth (which takes on a more intense color than white)
- Necessity to resort to tooth extraction in case of unsuccessful devitalization
Considerations
Today, in the majority of patients, root canal treatment has a very high percentage of success, and the risk of complications is extremely low. Furthermore, unlike some time ago, the improvement of surgical techniques guarantees a painless intervention; the pain that can appear when the anesthesia wears off can be easily managed with analgesic drugs ( NSAIDs ), such as ibuprofen or naproxen .
Root canal treatment is indicated for all types of teeth, including encapsulated ones.
To prevent devitalization – which, despite being painless, is still an unwelcome intervention – correct and systemic dental hygiene is necessarydaily home care, supported by professional dental hygiene interventions ( “tooth cleaning” or scaling ) every 6-12 months.