Endodontics

Endodontics, also known as “killing the nerve” or “root canal treatment”, is the elimination of the nerve, arteria and vena that exist inside the teeth (dental pulp). Generally, a root canal treatment is indicated when there is an acute nerve lesion caused by the microorganisms from a caries. In this case the patient may feel a lot of pain; or may be when the lesion has progressed too much that the nerve has been slowly altered until developing a necrosis which may even cause a bone lesion at the end of the root, cursing with or without pain. When the conducts inside the teeth are completely contaminated, more bacteria and toxins may go inside the bone, and this can end up developing a granuloma, a fistula, a cyst or even a big abscess. Endodontics is a very complex specialty of dentistry, due to the difficulty of the techniques. Work is done on a very reduced space, and the anatomy of the dental roots, even though following a pattern, are unique for every tooth. It is a very time-consuming procedure that is not very visual but that is paramount to be able to save teeth affected with big carious lesions, trauma, endodontic lesions that may develop from periodontal affectations, root resorptions… Besides, the endodontist works on the main conduct, but really the nerve has many secondary branches, and for this reason the complete elimination of the nerve tissues in the conducts is not easy. During all the phase of elimination of the nerve, disinfectants are constantly used with the objective to eliminate all the tissues and microbiota. It is a procedure that, even though optical magnification can be used, either with magnifying glasses or microscopes, cannot be visually controlled. All the handicaps included in endodontics have caused a great evolution of this specialty in every one of the aspects involved. In this regard, in diagnosis we use CBCT to detect all the anatomical anomalies that may exist, preventing each problem before starting treatment. In Clinica Dental Padrós-Creus Muntaner we can perform the CBCT in the clinic, as we have the NewTom machine which allows us to obtain very precise and helpful images. To make sure that we have reached exactly the extreme of the root with the necessary instruments to remove the nerve tissues, we have apex locators and radiovisiography (Digora). But the real innovation in endodontics is the use of rotatory instrumentation with NiTi devices which are very flexible, and the use of thermal treatments. We have gone from the strictly manual work to a more mechanical one, enhancing precision and speed. Once inside the root canals are clean and widened, they will have to be hermetically sealed. This is also a procedure that needs precision, dexterity, patience and, obviously, knowledge of the different available techniques. A correct sealing is of great importance to control all the bacteria that live in the dentinal tubuli, because there are around 30.000 per mm2, with a 2-4 micron diameter, with bacteria that have a size of 1 micron. Again, innovation with condensing 3D systems and new generation biomaterials. Investigation and evolution keep moving. We have entered the era of pulpal revascularisation, pulpal regeneration, autotransplants, re-implants, 3D planning… In fact, the whole endodontic procedure can be compared to a microsurgical complex treatment, but at the same tame is very challenging. If an endodontic treatment fails, we can still give the affected tooth a new chance. We need to evaluate the option of performing a re-endodontic procedure, or if there is a lesion in the end of the root, we can reach it surgically directly, practicing an apicectomy. In Clínica Dental Padrós-Creus Muntaner we have the best equipment to reach success in our endodontic treatments. We have the Zeiss operative microscopic; magnifying lenses, radiovisiography, ozone therapy, thermoplastic filling systems, superelastic instruments made of Nickel-titanium, electronic apex locaters, devices programmed to perform determined movements, with predetermined torques. Clínica Dental Padrós is the author of an original system which applies dentinal adhesives. It is an original method in endodontics, which allows an exceptional sealing of the internal fillings. This system has been awarded twice.