Endo-dontic Nitty-Gritties--TOOTHSOME TALK-Blog-Carol Lee Skerpan DMD

Endo-dontic Nitty-Gritties

12/1/2018

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TO LAST BLOG---11-10-2018--'Endo-dontics to the "Rescue"!

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MUSCLES:
' It's pretty incredible that humans discovered
"endo-dontic" treatment which enables the
tooth to continue surviving & functioning in
the bone and jaws---don't ya' think??!! Can
you please "dig" into the Basic Nitty-Gritties
of this "endo-dontic" treatment which rids the
tooth of it's dead-pulp, infection & abscess?
I mean HOW the actual procedure is done? '

Dr Skerpan:
MUSCLES, you're absolutely "right-on-the-nose"!
When the concept and procedure of this treatment is
understood, it becomes clear that it is quite amazing
that such a "rescue" technique was ever discovered for
the tooth's continued viability in the bone! Let's "dig a
little deeper" into the actual procedure, but first some
review. Since it is critical to remove the "nidus" of the
infection, one must remove EITHER the tooth OR the
internal dead-pulp-debris. With either choice the
dead-pulp-debris will be removed, the "reason" for the
infection will be removed, and any infected areas can
finally resolve and heal.

An abscess IN the bone occurs FROM the INSIDE pulp infection at the root's apex.

To also review from the last blog---as long as there is no infection remaining in
TOOTH OR BONE, with "endo-dontic" treatment the tooth still can function in and
with the bone! The tooth's external root surface continues to interact with it's
surrounding healthy "PERIO- DONTAL STRUCTURES"--AND the TOOTH-to-BONE
relationship survives!!

Depending on the LOCATION & EXTENT of decay, fracture or trauma--the tooth may be IMPOSSIBLE to save with endo-dontics!

Fractures which extend INTO the ROOT destroy the tooth's EXTERNAL ROOT surface. The "PERIO-DONTAL STRUCTURES" CAN'T sustain the TOOTH-to-BONE relationship--& the BONE-SUPPORT for the tooth fails.

IN GENERAL AND IF POSSIBLE, "endo-dontic" treatment is the more conservative
and healthier choice over an extraction in most cases. Previously we had discussed
the importance of the teeth for oral-chewing & speaking, as well as for the bone's
survival and function! "Endo-dontic" treatment serves to "rescue" the tooth from
extraction for survival of the dental-bone, oral-functioning, facial-structure AND
overall body-health!

MUSCLES: 'Got it so far! The Basic Nitty-Gritties on the treatment itself please!!'

Dr Skerpan:   "ENDO-DONTIC" TREATMENT
aims to rid the tooth of it's internal dead-
pulp-debris in it's pulp-chamber and root-
  canals. However, the tooth still can have
sensation even if the pulp is "partially-dead"
because the pulp does not all "die-off" at
one time. Each tooth has it's own unique
anatomy.  In addition to the expected main
  canals on a given tooth, often there are ad-
ditional unexpected main canals & acces-
sory canals all "dying-off" at different rates.

TEETH vary depending on LOCATION & FORMATION in the mouth. Canals greatly vary in number, shape, width & length.

Each tooth has it's unique anatomy depending on it's location and formation in the
mouth. Generally, the number of main root-canals vary from 1 to 4 canals depend-
ing on whether the tooth is located towards the front or back of the mouth (altho'
these numbers commonly vary). To add to the challenge of every tooth, each main
canal is unique in it's shape, width & length. Often the root-canals are not easily
accessible--and rarely are they straight in shape and may be very narrow. In addi-
tion, the tooth itself may be difficult to access depending on it's location & position.

The BASIC NITTY-GRITTIES of
"ENDO-DONTIC" TREATMENT:

1. Locate all main root-canal openings,
entering thru' the TOP crown-of-the-tooth.
2. Thoroughly clean the full-length & shape of
all canals with files & irrigation.
3. Fill all the canal-spaces where the pulp-
tissue used to be with a "filling & sealing-
material".
4. Seal all root apex-openings to the bone.

A molar's pulp-chamber is cleaned to reveal 3 openings into the tooth's 3 canals (legs).

Importantly and in general, the success of "endo-dontic" treatment requires that
all main root-canals be carefully & fully cleaned of all debris in full-length, width &
shape. Each cleaned canal-space should be filled & sealed of any voids---and the
opening of the root's apex to the bone must be sealed.

During ENDO-DONTIC TREATMENT the full-length & shape of every MAIN root-canal is CLEANED with files.......

.......and the canal-spaces are FILLED with a "filling & sealing-material". The infection resolves AND the external TOOTH-to-BONE relationship can "carry-on"!

A Final Doggy-Summary--

In the two previous dental blogs, we had discussed WHY the tooth's pulp "dies-off"
AND WHY "endo-dontic" treatment allows a nonvital tooth to continue functioning.
In this dental blog we discussed the basics of HOW "endo-dontic" treatment is ac-
complished. The Nitty-Gritties for a successful treatment comes down to 4 Steps:
location of ALL main root-canals--carefully & fully cleaning ALL dead-pulp-debris
from the pulp-chamber & ALL main root-canals--filling ALL canal-spaces where
the pulp-tissue used to be--AND sealing ALL the root apex-openings to the bone.
With the treatment completed, the "inside-of-the-tooth" and the jaw-bone have no
remaining dead-pulp-debris or infection to "feed" from anymore. Any previous in-
fection or abscess will resolve with all dead-pulp-debris removed and the canal-
spaces filled & sealed to the root's apex. Internally the tooth is "dead", with no
living-functioning-pulp connected at the apex with the bone anymore. The whole
tooth becomes brittle, but everything has become "infection-free" again---AND
the external tooth relationship to the bone remains "alive"!! It's as if the tooth
serves as a "cleaned-up-place-holder" within the bone--and the external TOOTH-
to-BONE relationship can continue to function and "carry-on"!!! If the tooth is a
candidate for "endo-dontic" treatment, it can be "rescued" from extraction with
careful attention to and execution of the "endo-dontic" Nitty-Gritties!!