An endodontist is a dental specialist who completes two to three additional years of post-dental school training focused on the internal structures of the tooth. This specialization centers on the dental pulp, which is the soft tissue containing nerves, blood vessels, and connective tissue, and the tissues surrounding the tooth root. Endodontists diagnose and treat complex causes of tooth pain and disease affecting this inner core. Their primary professional goal is to preserve the natural tooth structure and function, managing intricate cases often referred by general dentists.
Treating the Infected Pulp: Standard Root Canal Therapy
Standard root canal therapy (RCT) is the most common procedure performed by endodontists, intended to save a tooth when the pulp tissue becomes irreversibly inflamed or necrotic. This condition results from deep decay, trauma, or a crack that allows bacteria to invade the pulp chamber and root canals. The procedure begins with the endodontist creating a small access opening in the crown to reach the infected pulp space.
The next step involves cleaning and shaping the root canals using specialized, flexible instruments called endodontic files. These files work alongside antibacterial irrigation solutions to ensure all infected tissue and bacteria are removed from the canal system. Endodontists frequently use high-powered operating microscopes and three-dimensional imaging, such as Cone Beam Computed Tomography (CBCT), to visualize the narrow and complex anatomy of the root system.
Once the canals are disinfected and shaped, they are filled and sealed with gutta-percha, a rubber-like material, often combined with a bioceramic sealer. This filling material prevents future bacterial re-entry. The access opening is closed with a temporary filling, and the patient is referred back to their general dentist for a permanent restoration, typically a crown, to protect the treated tooth.
Preserving the Injured Pulp: Vital Pulp Treatments
When the pulp is injured but not fully infected, endodontists may perform vital pulp treatments to maintain the living tissue. These procedures differ from standard root canals because they aim to keep the pulp alive. They are often performed in teeth with deep decay or minor traumatic exposure, especially in younger patients whose roots are still developing.
Indirect pulp capping involves removing most deep decay but leaving a small amount over the pulp to avoid exposure. A protective, bioactive material, such as calcium silicate cement, is placed over this layer to encourage the tooth to form reparative dentin. Direct pulp capping is used when a small, clean exposure of the pulp occurs, placing the bioactive material directly on the exposed tissue.
A pulpotomy involves removing only the infected portion of the pulp, typically the part in the crown, while preserving the healthy tissue within the root canals. Sealing the remaining vital root pulp with a biocompatible material stimulates the tooth’s natural healing. These preservation techniques allow immature teeth to complete their root development, a process known as apexogenesis, which strengthens the tooth structure.
Correcting Complex Issues: Retreatment and Endodontic Surgery
When a tooth previously treated with root canal therapy becomes reinfected or fails to heal, endodontists perform non-surgical retreatment. This is necessary if the initial treatment missed a canal, if new decay compromised the seal, or if a delayed crown allowed bacteria to enter. During retreatment, the endodontist reopens the tooth, removes the existing filling material, and cleans any missed or newly infected areas.
If non-surgical retreatment fails, endodontic surgery may be recommended; the most common procedure is an apicoectomy. This microsurgical procedure addresses problems at the root tip that cannot be accessed through the crown. The endodontist makes a small incision in the gum tissue to expose the underlying bone and root end.
The infected tissue surrounding the root tip is removed, along with the last few millimeters of the root itself. A small filling is placed to seal the root canal from the bottom, preventing bacteria from re-entering the tooth from the bone side. This surgical approach saves the tooth by removing the source of infection and bypassing obstructions that prevented successful conventional treatment.