Types of treatment, which affect the interior of the tooth and the area around the root tip, are collectively termed endodontics (endodontic treatment).
Endodontologists are dentists specialised in endodontics. Endodontics is a section of conservative dentistry and therefore always supports tooth conservation. This includes (direct) pulp capping of exposed pulp area, apicectomies but mainly root canal treatment. Endodontic treatment is indicated with irreversible pulpitis, destruction of the pulp due to accidents or infection as well as persistent or re-occurring bacterial colonisation of root canals that have already been treated or filled (revision).
Access to the pulp chamber
The initial aim (practical) is the complete elimination of diseased tissue, foreign material (e.g. existing root canal filler material) and pathogens from the root canal system. The chemical methods include antibacterial and/or tissue-dissolving solutions (e.g. chlorhexidine, EDTA, sodium hypochlorite, hydrogen peroxide). Machine or manually operated steel or nickel titanium root canal instruments are used for mechanical preparation, i.e. excavation, smoothing, cleaning and extension of the (main) root canals. Both methods in combination form chemomechanical preparation. Medical temporary fillings (e.g. with calcium hydroxide or chlorophenol camphor menthol) can be used for further reduction of bacteria. Finally, the prepared main root canals are obturated, i.e. using a root canal filling (e.g. consisting of gutta percha posts and root canal cement) filled, sealed and covered using an adhesive filling and/or a crown.
Filled root canals 25, 26, 27
Master point - The first guttapercha point
In the final outcome the treated tooth should heal long term without any discomfort/symptoms and there should be no pathological changes of the apical alveolar bone (detectable on the X-ray). The probability of success of endodontic treatment has greatly increased in the past two decades, particularly due to the increased use of operating microscopes and microsurgical techniques and is generally given as 90%. In addition, successes have been achieved in the coverage (including iatrogenic) of perforations or the removal of fractured instruments or cemented posts from the root canal system.