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Endodontics

Endodontics is the specialty that deals with the endodontium, the tri-dimensional space that contains dental pulp, made of nerves and blood vessels.
The pulp chamber is a sterile space but if sterility fails due to the presence of bacteria (such as dental caries, crown or root fractures, dental fissures, massive parodontal infections) or if the pulp is stressed by prothesis setting or a trauma, dental nerves and vessels become inflammated (hyperaemic). The hyperaemia soon turns into acute pulpitis that make the tooth extremely sensitive to cold, causing unbearable pain to the patient; this is a clear signs of evolution towards pulp necrosis (vitality loss). If the endodontic treatment is provided at this stage, acute pain will be immediately relieved. If no endodontic therapy is provided, the evolution will inevitably be pulp necrosis. Pulp putrefaction products cause a periapical infection that, if acute, progresses to a periapical abscess (acute periapical parodontitis). We talk about granuloma when the periapical infection becomes chronic; more often, granuloma doesnʼt turn up, but itʼs revealed by x-ray check ups underneath teeth whose care has been neglected or that have been treated with out-of-date canalar techniques.
Modern endodontical techniques make use of nickel-titanum root canalar instruments that, if used at an appropriate speed, optimize the characteristics of super elasticity of its alloy. Those instruments can follow even the most extreme canal curves and so to give the canals the right conical shape to be properly sealed. Whether instruments are too big to reach the complex apical canalar system, with its side canals and several passages, irrigant substances (sodium hypochlorite or EDTA) dissolve the organic and non-organic material left. Rubber dam, electronic apex revealer and dental loupes are vital instruments in modern endodontics.


The best way to seal treated root canals is heat-softened gutta-percha driven by a carrier or pressed down to the root apex, lessening the the living space for bacterial growth.
4 to 6 months after the procedure, x-rays allows to assess the succesful results of the treatment.
However, practitionerʼs expertise becomes evident in the re-treatment of previous canalar therapy, maybe outdated or inappropriate, not suitable for prothesic treatment or have resulted in granulomas. The main difficult lies in overcoming the obstacle where previous treatment has stopped, overcome it and seal wherever the early anatomy of the root canal has been altered. Whenever the infection heals, mantaining a natural element as the original tooth is always preferable rather than replacing it with an implant