Many advancements in recent years help dentists treat patients with a root canal infection.
A tooth has a layer each of enamel and dentin. Inside those layers, there are canals extending through the roots, which are filled with dental pulp, protected by the root dentin and tooth enamel. Dental pulp is composed of tissue, nerves, and blood vessels. When pulp becomes infected through tooth decay, an endodontic treatment, or treatment for the inside of the tooth, is required to save the tooth.
The good news is that modern science has paved the way for minimally invasive endodontics and made improvements to the root canal treatment. Technology and materials have improved diagnostics and endodontic imaging, how the root canal is prepared, disinfected, and filled during the treatment. Regenerative endodontic procedures are currently being studied, but more research is needed on these.
Imaging
With better imaging, dentists can diagnose, locate, and treat calcified canals and canal infections faster and more accurately. It also allows for records to track a patient's history.
Digital imaging technological advancements have helped significantly by enabling multiple images to quickly and easily be taken and recorded. High quality images can be captured, for better accuracy and proper diagnosis. In addition, the imaging procedure doesn't involve the levels of radiation that older x-rays used to produce.
The latest technology in digital dental radiographs allow for faster imaging with lower exposure to x-rays. 3D CBCT Imaging, or three-dimensional Cone Beam Computed Tomography, is another newer technology that gives clearer, better information for endodontists to assess and treat teeth with three dimensional imaging.
Preparation of Root Canals
As part of the root canal treatment, a dentist will create a tiny hole in the tooth, and clear out the infected pulp. Improvements to the tools used in root canal procedures increase how successful they are.
Discovery of more flexible alloys, such as nickel titanium, helps the dentist reach all of the areas of the canal better. The infection can be cleared out thoroughly with less impact on the rest of the tooth. This allows endodontists to access the tooth through smaller holes and minimally enlarged root canals.
The latest technology in operating microscopes, such as Xenon illumination, allows for micro-endodontically treated teeth. Endodontic procedures completed at the microscopic level enables better precision.
New laser technology can help a dentist to create the tiny hole to access the root canal, remove the pulp, disinfect, shape, and fill it. Lasers are more precise so have less impact on the healthy tooth and cause less discomfort.
Disinfection
After clearing out the infection and diseased or dead pulp tissues, endodontists disinfect the area. Finding better antimicrobial disinfectants and ways to help the liquid wash through and clean the area better through advances in fluid dynamics are some ways this step has been improved.
Irrigation
Endodontists irrigate, or wash out, the area to disinfect it. A new procedure known as GentleWave® helps them do this. It delivers the cleaning liquid into the root canal with pressure and uses acoustic waves which are delivered through a handpiece. Suction helps remove the liquid as it flows out. This helps the liquid flow through the entire root canal system for better cleaning. It is minimally invasive and helps preserve the natural tooth structure better. As many as 96.6% of patients have also reported no pain or only mild pain after this procedure. Because the tooth is sealed with rubber, and the technique involves suction, the cleaning fluid is prevented from washing outside of the root canal system, so it won't irritate any tissues outside of the treated tooth.
Antimicrobial Fillings
Disinfection is done through an irrigating wash, but adding antimicrobial substances to the materials used to fill root canals afterwards also helps prevent infection. Antibacterial nanoparticles, or microscopic particles, have been found that are broad spectrum and less likely to develop microbial resistance. These are effective when added into the filler, and diffuse the antibacterial component into the dentin.
Potential Future Disinfecting Techniques
There are new disinfection treatments being studied, which need more research before being used generally.
Antimicrobial photodynamic therapy involves applying a photosensitizer and then using light on the sensitized tissue to kill off infection. This would likely be an additional step instead of replacing irrigation.
Photon-induced photoacoustic streaming is a laser system delivered in a short pulse duration which creates enhanced bubble dynamics and improves the irrigant flow dynamics within the root canal.
Root Canal Sealers
A key part of root canal treatments is filling the hole after the infected pulp has been removed and the root canal space cleaned. Gutta percha has traditionally been used to fill the hole, and adding antimicrobials into this has shown promise. Glass ionomer fillings have been tried, but gutta percha remains the most popular choice, as it creates an excellent seal to protect the tooth, it's biocompatible, and it's easy to apply or remove if necessary.
Research is being done on replacing with tissue similar to pulp, but this is ongoing.
Regenerative Endodontics
For growing, immature teeth, having infection and death of the dental pulp means the tooth will stop growing, for additional complications and concerns. Advancements in regenerative endodontics are improving our understanding of the regeneration and repair of pulp and dentin, but practical applications of this need further research.
At Waterloo West Dental, we offer treatment of infected root canals. If you are experiencing symptoms of a root canal infection, such as severe pain, temperature sensitivity, swelling, redness, or pus in the area, don't delay treatment.
Since commencing his practice in 2017, Dr. Darroch has honed his expertise in various specialties within dentistry, including Endodontics, Oral Surgery, Dentures, Periodontics, Crowns, and Pediatric Dentistry. His commitment to patient comfort and safety is evident through his certifications in IV sedation and Nitrous Oxide Sedation, ensuring a seamless and pain-free experience for all his patients.
Beyond the confines of his dental clinic, Andrew is an avid traveler, often found embarking on scenic road trips with his beloved wife and their playful labradoodle. A cinephile at heart, he relishes the magic of movies and unwinds with a good book, reflecting his diverse interests.
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