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The endodontist makes an opening through the enamel and dentin tissues of the tooth, usually using a dental drill fitted with a dental burr.
There have been a number of progressive iterations to the mechanical preparation of the root canal for endodontic therapy.
Root canals, and their associated pulp chamber, are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities. Endodontic therapy involves the removal of these structures, the subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions, and the obturation (filling) of the decontaminated canals.
Filling of the cleaned and decontaminated canals is done with an inert filling such as gutta-percha and typically a eugenol-based cement.
There is a "hybrid" procedure combining "step back" and "crown down": after the canal's patency check, the coronal third is prepared with hand or Gates Glidden drills, then the working length is determined and finally the apical portion is shaped using step back techniques.
Subsequent refinements have been numerous, and are usually described as techniques.Treatment options for an irreversibly inflamed pulp (irreversible pulpitis) include either extraction of the tooth, or removal of the pulp (tooth).Removing the infected/inflamed pulpal tissue enables the endodontist to help preserve the longevity and function of the tooth.Usually, some inflammation and/or infection is already present within or below the tooth.To cure the infection and save the tooth, the dentist drills into the pulp chamber and removes the infected pulp and then drills the nerve out of the root canal(s) with long needle-shaped hand instruments known as files (H files and K files).