Depulped tooth

A depulped tooth is a tooth from which the soft tissue containing nerves and blood vessels (the pulp) has been removed. A depulped tooth is also called a “dead” tooth.

Pulp removal is performed as part of endodontic treatment, which belongs to tooth-preserving technologies. That is, after pulp removal, the tooth retains its external structure but loses sensitivity.

The main reasons for depulpation include:

• deep caries that has reached the pulp;
• dental injuries leading to pulp rupture or inflammation;
• infections such as pulpitis or periodontitis.

• Pain elimination (pulp removal eliminates the source of pain, providing the patient with immediate relief).
• Tooth preservation (depulpation allows preserving the natural tooth, avoiding the need for extraction. This is important for maintaining jaw structure, normal chewing function, and smile aesthetics).
• Prevention of infection spread (removal of the infected pulp prevents further spread of infection to surrounding tissues).
• Tooth stabilization (after depulpation, the tooth becomes more stable and less prone to inflammatory processes).

• Loss of sensitivity (after pulp removal, the tooth becomes insensitive to pain and other stimuli, which may complicate detection of future problems).
• Vulnerability to cracks and fractures (without a living pulp, the tooth loses part of its natural strength and elasticity, making it more prone to cracks and fractures).
• Need for additional reinforcement (in some cases, a depulped tooth requires installation of a crown or another type of restoration to ensure its strength).
• Tooth discoloration (sometimes a depulped tooth may change color).
• Risk of complications.

The main goal of removing the nerve from a patient’s tooth is an attempt to preserve the tooth. This may involve preserving the tooth with or without its crown part.

The crown part of the tooth can be preserved in case of:

• Minimal caries damage.

If caries has damaged only the pulp and a small part of the dentin, while the main crown structure remains intact, the crown part can be preserved. This refers to destruction of less than 30%.

• Absence of significant cracks and fractures.

If the crown part has no deep cracks or fractures that could weaken the structure, it can be preserved.

• Absence of inflammatory processes in surrounding tissues.

If inflammation is limited to the pulp only and does not spread to surrounding tissues (periodontium), the crown part can be preserved after removal of the infected pulp.

Stages of endodontic treatment with crown preservation:

1. Diagnosis and planning.
2. Anesthesia.
3. Tooth isolation (installation of a rubber dam to isolate the tooth from saliva and ensure sterility of the surgical field).
4. Opening the tooth cavity (creating access to root canals through an opening in the crown part; in case of caries, this also involves removal of affected tissues).
5. Pulp removal (tissue removal using special instruments — endodontic files).
6. Root canal disinfection (treatment of canals with antiseptic solutions to remove remnants of infected tissue and prevent further spread of infection).
7. Root canal shaping (expansion and giving the correct shape to root canals for their subsequent filling).
8. Root canal filling (filling the canals with filling material).
9. Crown restoration (filling of the crown part).

In a number of cases, significant damage or destruction of the crown part of the tooth is observed, but the tooth root remains undamaged and can continue to perform some functions. This opens the possibility for endodontic treatment with preservation of only the root part of the tooth. In such cases, the crown part of the tooth is completely removed, creating better opportunities for root depulpation.

Factors that make crown preservation impossible:

• Significant crown destruction.

If caries or trauma has led to significant destruction of the crown part of the tooth — more than 30%.

• Horizontal crown fractures.

In injuries causing horizontal fractures of the crown part of the tooth, the root often remains undamaged.

• Significant thinning of the crown part.

If the tooth crown is severely thinned and cannot withstand chewing load, but the root remains healthy and strong, the damaged crown can be removed and the root used for fixing a new construction.

• Failed previous restorations.

In cases where previous restorations (for example, fillings or crowns) were unsuccessful and led to destruction of the crown part, but the tooth root remained intact, it is possible to preserve the root and perform re-prosthetics.

• Internal crown resorption.

Internal resorption affecting only the crown part of the tooth leaves the root healthy and suitable for further treatment.

After endodontic treatment without crown preservation, there is a need for further prosthetics. This involves installation of a post and core and an artificial crown.

A post and core is a construction consisting of one or several posts and a tooth stump. The posts are integrated into the tooth roots for their reinforcement — providing greater strength. The stump serves as the base on which the artificial crown is installed.

Endodontic treatment involves removal of nerve tissues, so a depulped tooth cannot hurt. However, many patients find that pain in a depulped tooth is still present. This raises a logical question: why and due to what does a depulped tooth hurt?

Answering this question in the most general terms, pain can occur immediately after treatment. The patient feels that the tooth hurts after depulpation, but in reality, so-called “indivisible discomfort” is observed — a slight pain in the treatment area that gradually decreases over time. During this period, increased tissue sensitivity in the treatment area may also be observed. It can be quite difficult for patients to differentiate between pain sensations — a persistent impression arises that the depulped tooth hurts.

In case of indivisible discomfort, there are no particular reasons for concern, but we recommend not self-diagnosing and consulting a doctor even with minor doubts. This is important not only for the patient’s psychological comfort but also because pain after endodontic treatment may also indicate the occurrence of complications.

Pain after endodontic treatment can signal that the patient is developing complications, signs of which may include:

• acute, pulsating, intensifying pain;
• reaction to cold or hot food;
• inflammation and swelling of soft tissues;
• elevated body temperature.

If at least one of these signs is present, you should immediately consult a doctor. Professional help should also be sought if:

• a depulped tooth under a crown hurts;
• a depulped tooth hurts when pressed;
• a depulped tooth hurts when tapped;
• a depulped tooth hurts when biting.

Complications during tooth depulpation