ENDODONTICS: Treatment of the pulp (nerves and blood vessels) of the tooth. Located inside the tooth. Five basic types of endodontic therapy: Standard root canal therapy Surgical root canal therapy Direct pulp capping or vital pulpotomy Indirect pulp capping Apexification Two of these procedures are performed commonly in veterinary dentistry A) Standard Root Canal Therapy Used in patients with dead or diseased teeth. Most commonly due to fractured (broken) teeth. For patients with mature teeth (usually greater than 13 months of age). Not an emergency B) Direct Pulp Capping or Vital Pulpotomy 1. Performed in cases where the pulp is exposed, but may be still healthy and further maturation of the tooth is desired. Especially used in patients under 18 months of age. Emergency (within a day or two preferably) procedure. 2. Performed when the height of the crown (part of the tooth you can see) needs to be reduced either for an orthodontic problem or for disarming a vicious dog or cat. These procedures are detailed on their own pages The other three are performed very rarely in veterinary dentistry C) Surgical Root Canal Therapy 1. Very rarely done, usually only when conventional root canal therapy fails or when the canal is blocked by a pulp stone or other impediment. 2. Requires an incision in the gingival (gum) tissue and removal of some jaw bone to expose the tip of the tooth root (apex). The tip is removed, and the canal filled from the bottom.  D) Indirect Pulp Capping 1. Used commonly in human dentistry but rarely in animals due to the fact that animals rarely get bacterial caries.  2. Performed when the defect in the tooth gets close to the pulp but not into it. 3. A medicinal layer called calcium hydroxide is placed over the bottom of the defect. This will serve to insulate the pulp, as well as stimulate the pulp to lay down more tooth structure.  4. A standard restorative is placed over the lining E) Apexification 1. Performed in a dead, immature (has not closed at the bottom) tooth which is very valuable. 2. The tooth is cleaned as in the standard root canal therapy. Then the canal is filled with calcium hydroxide to stimulate the tooth to complete the development of the bottom (apex) of the tooth. 3. The patient is rechecked at 6-month intervals to determine if closure of the apex has occurred. If it has, then standard root canal therapy is performed. If there is not a complete apex, then the calcium hydroxide is removed and replaced. This process is repeated until there is an apex. 4. This is a long, expensive, tedious process which does not have a very good prognosis. Numerous anesthetics are required, as well as replacing the mendicants. However, if done right, it can save the tooth.

Endodontics Images: Fracture with pulp exposure of the mandibular right canine tooth. Completed root canal therapy using a engine driven rotary file system and thermoplasticised (warmed) gutta percha.  Completed access site closure and restoration Endodontics in cats: Fracture of the left maxillary canine in a cat. The pulp is exposed and non-vital.  X-rays show a distinct lucency at the root apex. Endodontics is a good option for this patient.