Endodontics (root treatment) takes a fundamental part in dentistry, something like foundation of a house. It studies filling of canals which are in teeth roots. It is primarily concerned with "work in the dark" , which makes it manipulatively delicate, and often undervalued from patients, because only endodontics lack final visual result. It is said that it is the most responsible branch of dental science since complications due to incorrect treatment are hard to identify, and often are severely damaging for the recipient patient. This is possible due to the fact that in root treatment dentists are in direct contact with internal organism, they perform treatment in this delicate area of common sites of a battles ( with microbe infections) and leaves permanent mark ( filling of canals.). Therefore the specialist uses not only manual sense and good knowledge of canal anatomy, but also x-ray scans of teeth and electric- metrical equipment called apex locator.
When a dentist is sure that a nerve can be recovered without its extraction, treatment finishes with biological "bandage" on open pulp by calcium-hydroxide cream, as we stick with photopolymeric method, since its more durable and does not dissolve as time passes, which could lead to holes in the filling. Self-destruction is possible but making an attempt to recover the treated tooth is important.
When root treatment of pulpitis teeth is required, most modern method is vitality extirpation – where dentist remove teeth pulp(nerve) under an anesthesia. In a lot of countries putting arsenic or killing tooth nerves is forbidden, because it is possible for intoxication, allergic reaction and local infection of periapex to occur. Afterwards the tooth canal is expanded by manual or mechanical items and is flushed with boiling substances to enable extraction of blood and tooth tissue. This mechanical and chemical treatment is performed under x-ray control, where a small scan picture is taken in order for working distance to be measured. This method helps creating so called apical hook, vital for accurate filling. This method also uses canals filling cream on spiral aggregate, and then are placed plastic pins for better sealing of side horizontal micro canals.This methodology with active canal filling items is old dated and even forbidden in some countries ( USA, Western Europe), but is widely performed in Bulgaria, because if the procedure is not done professionally there is no tooth pain. Epoxide resins that are used by dentists are inert and does not dissolve. After fillings it is mandatory to be performed and x-ray scan, so it can be determined if the apical hook is reached, which is not to be undermined by dentists, because it can lead to pain and/or difficult recovery.If tooth pulp is completely dead, disintegrated, often followed by unpleasant smell, but the process is not damaged the bone beyond treatment yet, "old school" dentists and patients refer to it as tooth gangrene. Treatment is analogical to the mentioned before with the only exception of not killing/extracting of nerves, because spontaneous self-killing is occurred, where more persistent flushing of every tooth root and canal is required.
Chronic periodontics - granulomas
This represents small inflames around top of teeth roots, which can only be discovered by x-ray and analysis. Most common causes are dead, broken/remaining roots. This is the worst dental disease because it affects the whole body. Bones surrounding teeth roots are heavily blood streamed and it is ease for infections to spread and infect vital organs ( heart, brain, kidneys, liver etc.). This disease often does not have symptoms following it up which makes it insidious, therefore regular prophylactic check ups at dentist office are vital in early treatment. The only difference with pulpitis treatment is in the bigger expanding of canal, where the microbe infection depot is, and also in osculant medical inputs and/or physiotherapy.
Worsened periodontitis - abscesses
They occur because of early mentioned granuloma and cause huge pain, and later lead to abscess with pus. These cases require emergency interventions – trepanation ( drilling hole at the tooth"s top) at first phase or incision of abscess(second phase) in order isolate the pus. Following treatment is same as granuloma treatment
In cases of prolonged avoiding of granuloma treatment a bigger defect can occur shaped and sized like peanut – cyst. Treatment in this case is: standard root treatment, if this does not work, endodontic-surgery manipulation takes place - apical osteotomy; in worst cases extraction is required.
Special attention is reserved for incorrectly treated or filled teeth, because they are most common cause for complications. In such situations the dentist uses equipment that softens the filling cream.If there is broken instrument, its extraction is required, and in worst cases scenario – tooth extraction. With single-rooted teeth this means removal, but with multi-rooted ones only infected root is treated – hemisection.