Endodontics

A root canal, also called "root canal treatment" (or popularly "killing the nerve") is the removal of the nerve that is lodged inside the root of the tooth. This is done in cases where decay bacteria reach this nerve (known as "dental pulp") and infect it. It may also be necessary in those situations in which due to trauma, fracture or other causes, the tooth loses its vitality, and therefore, it is necessary to remove the nerve so that an infectious process is not generated.

Once the canal has been cleaned of nerve remnants and shaped in a specific way, it is filled with gutta-percha, a sterile material for sealing it. The tooth is then reconstructed and sometimes prepared for an inlay or another type of prosthesis (crown, bridge...).

To perform an endodontic treatment the tooth does not necessarily have to hurt. There are cases in which the pulp necroses or dies asymptomatically, that is to say, without any type of symptom. To check the vitality of the nerve, what is called a "pulp vitality test" can be carried out by which, by means of cold, heat, electrical impulse and other tests, the sensitivity of the tooth is checked.

Endodontics should be performed by an endodontist, that is, a specialist in this type of treatment, with specialized training in this field.

The price of endodontics depends on the time it takes to perform the treatment and the cost of the material used. The cost of endodontic treatment in Madrid ranges between 180 and 350 euros. Teeth can have one, two, three, four or even more canals, so the greater the number of canals to be treated, the higher the cost. That is, an upper lateral incisor usually has only one canal (uniradicular tooth), so the treatment time and cost will be less than a molar, which is a multi-radicular tooth, which usually has 4 canals.

Re-endodontics, which is the re-treatment of previously endodontic teeth, is somewhat more expensive as it takes more time to remove the endodontic material that the tooth has, so the price of re-endodontics in Madrid starts at 200 euros.

Endodontics or root canal treatment can be classified according to the number of canals to be treated:

• Unirradicular: teeth with one canal, such as central incisors, lateral incisors or canines, both upper and lower.
• Birradicular: teeth with two canals, such as upper first premolars.
• Multiradicular: teeth with three or more canals, such as molars, both upper and lower, which usually have four canals.

Occasionally, this may vary, as there are incisors or canines that sometimes have two canals.

The duration of endodontic treatment depends on the tooth to be treated, that is, the number of canals that have the root of the tooth.

Thus, root canal treatment of teeth with one root canal (incisors and canines) can last around 60 minutes; if it is of biradicular teeth, such as the first upper premolars, it can last between 60-90 minutes and if it is of multirooted teeth (molars), around 90-120 minutes. These times are variable and depend on the complexity of the case. In very complex situations or in those teeth with a significant infection, two treatment sessions may be necessary, that is, performing the root canal on two different days. The procedure will always be carried out with the patient's best interest in mind.

Re-endodontic treatment usually takes longer than endodontic treatment, since the sealing material that was already in place must be removed before the canal is cleaned and resealed.

The steps to perform a root canal are as follows:

1st Anesthesia: local anesthesia of the tooth is performed so that nothing is noticeable during the root canal.

2nd Instrumentation of the canal and conductometry: the canal through which the nerve passes is completely cleaned by using manual and mechanical files of different diameters and disinfected by sodium hypochlorite 1-5% and other products. In addition, its length is measured by means of an apex locator and the entire canal is given a specific shape to favor its sealing.

3rd Canal obturation: the clean and shaped canal is sealed with a material called gutta-percha, usually by means of the hot gutta-percha system. Throughout the endodontic treatment some x-rays will be taken to evaluate the anatomy of the root and the canal, to confirm that the length of the canal we are shaping and that its sealing is adequate.

4th Sealing of the tooth and reconstruction: once the endodontics is finished, it is necessary to guarantee an adequate sealing and reconstruction of the tooth. The rehabilitation of the tooth can range from a filling (commonly called a filling) or a resin reconstruction to an inlay or a crown, depending on how weakened the tooth is. The weaker the tooth, the more necessary a treatment that strengthens the tooth well, such as an inlay or a crown (commonly called a "cap").