Endodontics

Devitalization of a tooth?

How the dentist saves your tooth

What is devitalization of a tooth? Does it hurt? Is it really necessary?

The ‘innumerable amount of information on the web is often a source of doubt and perplexity for the curious patient who goes to inquire before embarking on treatment, but misinterpretation and the choice of unreliable and scientifically unaccredited sources can mislead the patient toward the most risky choice, non-treatment.

What happens to the nerve of the tooth?

The tooth is a complex organ that nature has endowed with receptors, natural “sensors” that are deputed to protect it. In fact, the tooth is innervated both internally and externally by different nerve endings. Inside the tooth is the innervated dental pulp so that in case of tooth breakage or decay the body has a signal to indicate the problem and limit chewing on the diseased tooth.

The tooth is then innervated from all external and adjacent areas by the supporting tissue of the tooth. Devitalization affects only the internal innervation; in fact, the tooth remains alive and sensitive. This will allow the patient, for example, to feel any hard food and modulate chewing force.

What is devitalization? When does it become necessary?

Current conservative techniques have limited the indications for endodontic therapy to a minimum, but it is necessary in some cases to save healthy tooth tissue and avert tooth extraction and subsequent prosthetic solution.

However, devitalization is necessary when, for example, dental caries is so destructive that it creates a communication with the dental pulp (the nerve) with the entry of bacteria, which at this point are also free to go into the bloodstream and create more or less serious infections.

Pain is often not present despite the entry of bacteria due to the establishment of a type of inflammation that is chronic but can flare up over time. In addition, often the decay is so severe that it has destroyed much of the tooth, and the inflammation, which normally creates swelling has a rash that does not allow the pulp to have enough increased pressure inside the tooth to create pain. Another occurrence is necrosis of the infected nerve due to bacterial damage frequently totally asymptomatic.

Devitalization is nothing more than the removal of necrotic or infected pulp material and the scrupulous cleansing of the canals contained in the roots of the tooth within which the nerve branches flow; these operations should be carried out along the entire length of the tooth without neglecting gaps that can create problems in the long run. Properly prepared and cleansed canals using sophisticated diagnostic and therapeutic instrumentation are then filled with highly biocompatible materials.

During these phases, a deep local anesthesia will allow the session to take place in a totally painless manner.

State-of-the-art, ultra-low-dose endoral radiographs may be required for control during the course of the session. The rubber dam, latex sheet that is inserted around the tooth also will allow isolation of the tooth from the rest of the mouth, and the disinfectants used inside the tooth will be free to act without risk of accidental ingestion and will ensure the most comfortable session possible.

Devitalization of lower central incisors with lesion, follow-up at 3 months. Case of Dr. Caschetto

Isn’t it better to replace the tooth with an implant?

The average life expectancy has lengthened quite a bit, and the current trend in modern dentistry is to take all conservative routes before proceeding to prostheses. This extends the life of the tooth to postpone tooth extraction as long as possible. It is, of course, desirable in the quest for greater predictability of results to have a specialized approach to endodontics, with a quest for excellence through attention to detail and precision, which is achieved with the right expertise and training and dedication during the session that extends a little over time to ensure extra years of life for the tooth.