What is an endodontist and what does he do?

An endodontist is a dentist with further University education (2 years or more) who specializes in the prevention, diagnosis and treatment of pulp and periapical tissues. This treatment is called endodontic treatment or root canal treatment.

More specifically, the endodontist deals with the differential diagnosis of pain of dental or non-dental etiology, endodontic treatments of teeth with live or dead pulp, the repetition of root canal treatments, the treatment of traumatic dental injuries, endodontic microsurgery, as well as the whitening of endodontically treated teeth.

The endodontist has at his disposal high tech specialized equipment in order to provide successful and as comfortable as possible endodontic treatment for the patient. Endodontists with their advanced training, specialized techniques and superior technologies can perform a successful root canal treatment when a general dentist decides to refer the patient due to anatomical variation of the tooth or technical difficulties. The endodontist is always in close cooperation with the referring general dentist in order to achieve the best and most effective treatment for the patient.

Tooth anatomy

The tooth consists of two parts, the crown which is the part visible in the mouth and root which is the part inside the jaws. There are teeth that have only one root (single root) and teeth that have more than one root (multi root).

Though the teeth are the hardest substances of the human body the inside of them is filled with a soft tissue that contains nerves and blood vessels and is called the dental pulp. The inside of the root that hosts the pulp is called the root canal.

The hard parts of the tooth include:

  • Enamel, the hardest, semitransparent outer part of the tooth at the crown, which is mostly made of hydroxyapatite crystals (calcium phosphate)
  • Dentin, the substance that forms the bulk of the tooth, covered by enamel at the crown and cementum at the root. It contains the dentinal tubules which are microscopic channels that travel from the inside of the tooth (where the pulp is) out through the dentin, ending right beneath the enamel.
  • Cementum, a calcified substance, the surface layer of the root, it covers the dentin at the root, and is specially designed to attach the tooth to the alveolar bone of the jaws.
Pulp inflammation

When the pulp of the tooth is infected, an inflammatory reaction starts, which can be reversed in the early stage of the inflammation (reversible pulpitis). When the inflammation is more advanced (irreversible pulpitis), it cannot be reversed and the tooth has to be treated. The pulp can be inflamed in different ways but the most common are bacteria that reach the pulp through various gates (caries, cracks, failure of restorations etc.). In some cases of intense inflammation symptoms are developed such as sensitivity to chewing, intense pain and swelling. After the end of endodontic treatment, the symptoms completely disappear and the tooth becomes fully functional.

What is endodontic treatment, when should it be done, when should it be repeated, and why does it fail?

Endodontic treatment is the process of cleaning and shaping the root canals and then filling them with the appropriate materials per case. The endodontist has at his disposal modern technological equipment (magnification means, rotary root canal preparation instruments, modern root canal obturation techniques, etc.) to achieve the best possible therapeutic result.

In cases where the procedure does not an effectively eliminate the bacterial load, the treatment may fail and it should be repeated. Causes of failure are the complex root canal anatomy, the existence of narrow root canals, iatrogenic incidents or even the delayed placement of the final tooth restorations (fillings, crowns, etc.).

Other causes of long-term failure (failure after a significant period of time) are development of caries under the prosthetic restoration, a tooth fracture or poor restoration. All these reasons can lead an otherwise successful endodontic treatment to failure and require endodontic retreatment.

It is important to emphasize that an endodontic treatment, especially if done by a specialized dentist, the success rate reaches 95%. Modern endodontic techniques and the constantly evolving technology in dental equipment and materials result in high rates of successful treatments.

The tooth restoration

The proper restoration of endodontically treated teeth is of equal importance as the endodontic treatment. The immediate restoration of the tooth after the endodontic treatment is very important because in this way the success of endodontic treatment is ensured and at the same time the functionality of the tooth is restored. Delayed placement of the proper restoration has as a result the reinfection of the endodontic treatment. Most of these treated teeth suffer from extensive loss of dental substance. The type of restoration depends on the tooth type, the extent of dental substance loss and should be in harmony with the periapical tissues and the aesthetics of the patient.

Surgical Endodontics - What is Apicoectomy?

The goal of conservative endodontic treatment is to achieve a sterile or aseptic pulp cavity, which is then obturated. When this cannot be achieved, we apply Surgical Endodontics.

Nowadays, the surgical endodontic procedure is assisted by modern equipment such as the surgical microscope, ultrasound devices and modern obturation materials, achieving minimal intervention in the involved tissues, essentially establishing the term microsurgical endodontics.

Apicoectomy is the most well-known technique in surgical endodontics. The surgical intervention is done through the soft tissues and the bone surrounding the tooth root, so that the root apex and infected tissues are revealed. In addition to removing pathological periapical tissues, a part of the root tip, about 2-3mm long, is cut off and removed. Then a retrograde filling of biocompatible materials in placed and the incision is sutured.

Traumatic tooth injuries

Traumatic tooth injuries are common, especially in children. They may affect the hard tooth tissues and are classified into cracks, crown fractures with or without involvement of the pulp, horizontal, oblique or vertical root fractures, but they may involve injury to the tooth-supporting structures which are classified as concussion (abnormal loosening or displacement of the tooth), subluxation, luxation either extrusive with partial displacement of the tooth out of its socket, or lateral with displacement of the tooth in a direction other than axially, or intrusive with displacement of the tooth into the alveolar bone and finally avulsion (exarticulation) with complete displacement of the tooth out of its socket.

Long-term manifestations of tooth injury are pulp necrosis, internal or external root resorption of the injured tooth and complete calcification of the pulp cavity and root canal.

It is of vital importance to know that in case the tooth is completely displaced out of its socket (avulsion), it should be immediately transferred to the nearest medical site, ideally within an hour. The transfer should be done in cold milk or special commercial solutions.

The treatment of traumatic tooth injuries depends on the type and severity of the damage, the delay time until treatment, the age of the patient and especially the stage of tooth development in young individuals. The treatment covers a wide range and includes:

  • Monitoring of the case with recalls at certain intervals with radiographic and clinical assessment mainly for any color changes of the tooth crown, pulp vitality, calcifications or resorptions
  • Pulpotomy, allowing time for the complete conformation of the root
  • Endodontic treatment of tooth with incomplete root formation and open foramina with classic or modern techniques (use of MTA, regeneration of pulp tissue)
  • Orthodontic or surgical eruption of an intruded tooth
  • Tooth replantation
  • Immobilization as indicated per case
  • Recall examination