Human teeth require special care throughout life. Indeed, the health of our internal organs, in particular the intestines, depends on their condition. They can both save us from infections and be a hotbed of it. Special discomfort brings us a bad tooth. We feel pain at the slightest contact with cold or hot food, sweet or salty. When tooth pain begins, you should immediately consult a dentist, as obvious symptoms may indicate an advanced stage of the disease inside the tooth. In this case, special treatment methods are used, one of which is endodontic treatment.
Dentistry Section - Endodontics
Endodontics is a field of therapeutic dentistry that focuses on the treatment of inflammatory diseases of the tooth pulp and tissues surrounding the tops of the roots - periodontium. The term "endodontics" comes from two words: "endo", which means "inside", and "odont" - "tooth".
What is endodontic intervention?
Endodontic treatment is a whole complex of successive stages of treatment aimed at preserving the tooth. In the event of such common caries complications as pulpitis or periodontitis, work is necessary directly inside the tooth. The complexity of this treatment is that the internal volume of the tooth can be extremely small, the lumen of the root canals is often so narrow that it is difficult to even detect. If the roots are bent, and the tooth is tilted, the opening of the mouth for some reason is limited, endodontics becomes the aerobatics of modern dentistry. It requires the dentist great experience and intuition, possession of a variety of high-tech diagnostic and treatment methods.
Endodontic dentistry - indications
Indications for such treatment are:
- All types of pulpitis not subject to biological, conservative treatment.
- Acute and chronic periodontitis.
- The need for retreatment after a previous endodontic treatment.
- Preparing a tooth for prosthetics with stump inserts.
- Preparation for prosthetics with crowns requiring significant grinding of the hard tissues of the teeth (including with a significant tilt or extension of the tooth from the jaw).
- Endodontic treatment is also indicated when preparing a tooth for intracanal whitening.
- Treatment of a tooth fracture leading to pulp injury or death.
Are there any contraindications to this procedure?
Contraindications to endodontic treatment of root canals can be divided into two groups: absolute and relative.
Absolute contraindications:
- periodontal damage, not allowing to save the tooth;
- if the tooth is to be removed for other reasons (supernumerary, with improper location in the dentition and not subject to orthodontic treatment, when the tooth is removed soon due to orthodontic indications, etc.);
- longitudinal fracture of the tooth root ;
- the presence of a cyst not subject to conservative or surgical treatment, or other formation in the area of the root of the tooth (osteomyelitis, oncology, etc.);
- The patient’s severe general condition is also a contraindication to such manipulations as endodontic treatment of canals.
Relative contraindications:
- significant curvature of the root canals;
- obstruction of the root canals (lack of clearance, the presence of hard-to-recover filling material);
- the presence in the lumen of the root canal of foreign objects, such as fragments of tools;
- perforation of the walls of the root;
- the conflict of the patient, his unwillingness to treat a tooth.
The goals that the doctor pursues during this manipulation
The tasks facing the dentist while he carries out endodontic treatment of root canals can be divided into the following areas:
- Ensuring the sterility of the tools and materials used.
- Isolation of a diseased tooth from saliva during work.
- Qualitative partial or complete removal of inflamed pulp or the complete elimination of its decay.
- The fight against pathogenic microflora inside the tooth and at the tops of the roots.
- High-quality and safe expansion of the root canals.
- Full filling of the root canals in their entire volume, temporary or permanent.
- Quality control of treatment at all stages.
Preparation for such treatment
In preparation for endodontic treatment of the canals, it is necessary to conduct a full examination: make a diagnosis and plan the stages of the upcoming intervention. Mandatory is the study of a preliminary x-ray. The information received should be clearly communicated to the patient. After he understands all the important points of the upcoming treatment, the patient signs a document of informed consent.
It is also important to make sure in advance that the patient does not have contraindications to the various stages of the upcoming treatment, especially for pain relief. In the absence of reliable information about the absence of allergies to anesthetics, it is necessary to conduct an allergy test, referring the patient to an allergist.
How is endodontic treatment carried out?
The treatment carried out inside the tooth should be carried out exclusively by doctors who have undergone specialized training, confirmed by an appropriate certificate. When choosing a method of anesthesia, the doctor is obliged to choose the most effective drug, taking into account the possible characteristics of the patient's body - the presence of pregnancy or diseases of the cardiovascular system, allergies to specific medications, and more.
During treatment, the doctor continuously monitors the general condition of the patient, he must be ready at any time to interrupt the main treatment for emergency care.
It is very important to use additional methods of diagnosis and therapy during treatment. The use of a visiograph or apex locator allows the root canals to be treated with high quality, minimizing the risk of injury to the root walls and tissues around the root tips, under- or over-filling of the canals, etc.
It is mandatory to warn the patient about the possibility of various complications and discomfort after treatment. It is advisable that these explanations be given prior to the procedure, this will help the patient decide on the advisability of the intervention and will give more confidence to the actions of the doctor.
Stages of treatment
All stages of endodontic treatment can be divided into three steps:
- Preparing access to root canals. At this stage, anesthesia is performed, excision of all non-viable tissues of the carious cavity is carried out, a constant antiseptic treatment is performed.
- Work in the root canals, preparing them for permanent filling. The doctor finds the entrance to the root canals, removes their contents, including the infected layer from the walls, increases the lumen of the canals for the possibility of further filling. The constant presence of an antiseptic solution in the lumen of the root canals during endodontic treatment is strictly necessary!
- After the elimination of inflammation and leaching of various contaminants, the root canals are filled. The method of filling depends on the diagnosis and qualifications of the doctor. At the end of the work, a control x-ray should be taken. The choice of a method for further restoration of the external part of the tooth is discussed with the patient additionally.
Periodontitis treatment
Endodontic treatment of periodontitis involves another step - apapical therapy. After preparing the root canals for filling, a medication is temporarily placed in them, partially removed from the apical hole, which can effectively fight the infection. Most often, calcium hydroxide preparations are used for this purpose.
In the case of complications of periodontal inflammation by the formation of granulomas or cysts, the investment of medicine can be repeated. If necessary, in addition to endodontic treatment, surgical removal of the apex of the tooth root and cyst walls is carried out.
Complications during the manipulation
The most common complications of endodontic treatment are as follows:
- Fracture of the instrument in the lumen of the root canal.
- Perforation of the root wall.
- Failure to detect additional root canal.
- Inadequate passage of the root canal.
- Underfilling of the root canal or excessive removal of the filling material beyond the root.
- Incomplete filling of the lumen of the root canal, leading to resorption of the root filling.
- The appearance of pain and / or swelling after treatment.
If there are complaints or in case of detection of the listed complications, repeated endodontic treatment is indicated. In the warranty period specified in the contract, retreatment is free of charge. Repeated treatment can be carried out both in full or in part, with re-filling only those channels in which deviations from the norm are detected.