Endodontics

Tooth treatment is essentially an endodontic procedure, commonly known as “nerve removal”. Endodontic therapy literally means therapy of the tooth’s interior (Latin: endo – inside, dont – tooth).

Although the first associations with this term suggest discomfort and pain, the fact is that today the “nerve removal” procedure is performed completely painlessly under anesthesia. Endodontic treatment actually means “saving” the tooth, as a properly performed procedure leads to the preservation of the tooth’s function, which would otherwise be lost.

A tooth consists of hard outer structures, such as enamel, dentin, and cementum, as well as soft tissue – the pulp, which is located in the inner cavity. In the dental pulp, in addition to nerves (commonly referred to as the “nerve”), there are blood and lymphatic vessels, as well as connective tissue.

Each nerve enters the tooth through the tip of its root. From the point of entry, the nerve extends through the central part of the root (root canal) and enters the wider space within the tooth’s crown, known as the pulp chamber.

The dental nerve plays an important role in the tooth’s growth and development, but once the tooth erupts and completes its development, its most pronounced function is sensory—the ability of the tooth to respond to stimuli such as hot or cold sensations.

How is an endodontic treatment performed?

Root canal treatment involves mechanical cleaning and flushing of bacteria, decayed organic material, and bacterial toxins that remain after the deterioration of the dental nerve. All of these factors can lead to inflammation of the surrounding tissue, resulting in pain, swelling, and other symptoms commonly associated with infections.

After cleaning and flushing the root canal, it is then filled with special pastes and gutta-percha points to ensure that the internal space of the tooth remains hermetically sealed. This prevents bacteria from re-entering the tooth and eliminates the risk of recurrent infection and inflammation along with its potential complications.

Types of Endodontic Treatments

If there is a periapical lesion, there are two treatment options:

Conservative treatment – Root canal therapy using various medications (this treatment is performed over several visits to the dentist).
Surgical treatment – Apicoectomy, or root resection (a procedure where the gums are lifted, and the infected tissue or cyst in the bone is removed).

The success of endodontic treatment primarily depends on timely intervention as well as the anatomical characteristics of the tooth itself. Teeth treated in the early stages of infection have a higher chance of success compared to those with severe tissue damage or abscesses.

Molars require a high level of skill, precision, and expertise from the dentist, as they typically have multiple root canals. These canals are not always straight and uniform—they may branch out, curve, or even be completely obstructed, all of which can complicate root canal treatment.

At the start of the procedure, the dentist usually informs the patient if multiple sessions will be required. Single-rooted teeth can sometimes be treated in one visit, provided there is no bone infection or an infected pulp requiring additional precautions.

Once endodontic therapy is successfully completed, the next step is to assess the future of the tooth.

If the tooth is not severely damaged, it can be restored with a composite filling, sometimes reinforced with fiberglass fibers or an FRC post.
If the tooth is significantly weakened, a post is placed inside the root to strengthen it, and the crown portion is restored with either a metal-free crown or a metal-ceramic crown.
A special type of crown, called an endocrown, made using CAD/CAM technology, is also an option for endodontically treated teeth.

Since these procedures are complex and multi-stage, they may take a month or longer to complete. However, preserving a natural tooth is invaluable and is usually highly rewarding for both the patient and the dentist.

It’s important to remember that endodontically treated teeth are structurally weaker than vital teeth. Over time, they lose the elasticity of the hard tissue, making them prone to fractures.

If a fracture occurs, the crack can extend into the root, making it impossible to restore the tooth. In such cases, the tooth must be extracted, and the missing tooth can be replaced with either a dental implant or a bridge, which often requires modifying healthy adjacent teeth to support the restoration.

This highlights the importance of carefully planning the post-treatment restoration, ensuring the most suitable and long-lasting solution is chosen based on the patient’s needs and possibilities.