The most complicated procedure in the field of therapeutic dentistry is the treatment of dental canals. The tooth channels are located inside the roots and are narrow passages. Only using a microscope allows the doctor to see their mouths. X-ray examination allows the specialist to get a slightly greater idea of the internal structure of the tooth. However, an x-ray can show only a lateral projection of the roots, not reflecting the possibility of their overlapping, bifurcation.
All methods of dental canal treatment are combined by specialists in a separate field of science - endodontics. She also studies the anatomical structure of teeth, especially the course of pathologies in the dental cavity. During endodontic therapy, specially designed tools are used for which special qualities are characteristic - strength and flexibility, allowing manipulations in curved and narrow spaces. Using computer technology, it is possible to obtain spatial images that allow you to examine in detail all the discrepancies and branches of the dental canal.
For the treatment of materials, the following are used:
- hardening (cements);
- non-hardening (pastes);
- solid materials (pins).
The filler has a complex set of tasks. It must simultaneously block the dental canal, be strong, and at the same time not cause irritation. In addition, it is good if it is permeable to x-rays in order to monitor the process and the result of therapy. Materials for sealing are selected by the doctor. Each variant of the filler has its own characteristics, so the doctor will evaluate the poles and minuses of each and offer a choice to the patient.
Indications
Endodontic tooth therapy is necessary in the following situations:
- Injury, accompanied by damage to the internal cavity of the tooth (pulp chamber).
- Any kind and form of periodontitis.
- Pulpitis with acute or chronic course.
Treatment of inflammation of the canal is carried out very often.
Contraindications
This type of therapy is contraindicated in the following cases:
- The bone tissue of the alveolar process is destroyed by more than two-thirds of the entire length of the tooth root, while the teeth have a third degree of mobility.
- The bottom of the tooth cavity is perforated or the root of the tooth is fractured (if the tooth has several roots, in some cases it is possible to remove the damaged root and treat the remaining ones).
- Canal obstruction resulting from obliteration or previous therapy.
- The penetration of the inflammatory process, localized in the periodontium, in the maxillary sinus.
- A pronounced inflammatory process on the dental roots, accompanied by periostatitis (swelling of the surrounding tissues), which prevents the creation of an outflow of purulent exudate through the channels.
- The inability to restore the dental crown by therapeutic treatment or by prosthetics.
If there is no possibility of filling and passage of the canals, depending on the diagnosis, tooth extraction or therapy with mummifying paste may be indicated.
Stages of Dental Canal Treatment
Endodontic therapy is carried out in several stages.
The first stage is preparation for dental canal treatment. It includes an examination, diagnosis, determining a treatment plan, anesthesia.
Anesthesia is a mandatory procedure if an initial autopsy is performed. Anesthesia on repeated use after application of the mummifying paste (arsenic), with a chronic form of periodontitis, with the application of the drug in the channels, as a rule, is not required.
The process of preparing the carious cavity consists in removing the softened dentin layer with the help of burs, opening the tooth cavity, creating full access to the cavity without overhanging the edges and with the possibility of a good view of the canal mouth.
In the treatment of pulpitis of teeth with many roots and causing severe pain, it is shown to finish the first dose by opening an inflamed pulp cavity. After opening, a special paste is applied to the pulp, and the carious area is temporarily filled.
Dental canal treatment is popular under the microscope. The microscope helps the doctor carefully examine the problematic unit, remove the caries and seal the canal. Without the use of high-precision equipment, the quality of treatment is significantly impaired.
Cavity opening
By opening the tooth cavity, dentists understand the removal of the arches of the pulp chamber. Disclosure is carried out using special endodontic burs, which have a longer working part. Getting access to the pulp has several features:
- When the carious cavity touches an insignificant portion of the pulp chamber protruding upwards (pulp horn), access can be expanded even with the capture of healthy dentin. This is done in order to eliminate the entire arch of the dental cavity.
- When the carious cavity is not located near the upper part of the tooth (for example, in the cervical cavity), it should be filled separately, the dental canal is treated using the standard method.
Crown pulp removal
Removal is carried out using boron in the process of opening the pulp cavity. Vital amputation (partial removal of undamaged pulp) can be performed with good anesthesia during pulpitis therapy. In the primary treatment of periodontitis, the doctor, as a rule, deals with pulp, which is already destroyed, or with open channels.
In the case when the pulp is removed at the second visit (after applying the devitalizing paste), a devital amputation can be performed, that is, the destroyed pulp can be removed. Such a process does not cause pain in the patient.
Finish the pulp extraction process with the help of such hand tools as a probe, an excavator. The stage of coronal pulp removal ends with the determination of the root canal mouths.
If pulp is detected in the canals, the dentist removes it with a pulp extractor. Then the file (thin instrument) is advanced along the entire length of the root canal to the apical opening. Processing should be carried out strictly before it in order to avoid the spread of infection to nearby tissues.
Channel processing
The processing of the channels can be medication or mechanical. Carry out the procedure using files that have length limiters. During cleaning, chemicals are introduced into the canals, which contribute to the washing out of the dentin particles from the channel and have an antiseptic effect.
The processing procedure is completed by drying the channels and re-determining their length, since it can change due to straightening with tools. After the channel is processed, it is hermetically sealed with a seal.
Channel processing is not always possible in one visit. In some cases, osteotropic, antiseptic, anti-inflammatory substances are temporarily introduced into the canal.
Indications for delayed therapy
Indications for delayed therapy are:
- The need for treatment of pus in the dental canal.
- Swelling in the area of the apex of the tooth, not accompanied by the appearance of a fistula.
- The chronic form of periodontitis, accompanied by inflammatory changes that can be detected on the radiograph.
Root canal filling
The most important stage in the treatment of a canal is filling. As a result, the dentist must ensure that the internal tooth cavity is completely filled with filling materials.
The most effective is considered to be the use of hardening pastes and gutta-percha pins. Gutta-percha does not decrease in volume, does not resolve, with its help you can completely obstruct the space inside the channel.
Endodontic therapy is completed by setting a gasket for isolation and restoration of the tooth crown.
Complications
The assessment of the success of channel therapy is determined during the year after the first treatment. With a good result, the patient does not experience pain. In this case, swelling, changes in the sinuses of the appendages, pathological abnormalities on the roentgenogram are absent, and the tooth function is preserved.
If the treatment was ineffective, there is a likelihood of developing the following complications:
- The appearance of perforation in the bottom or walls of the dental cavity. This complication develops in the presence of a large amount of softened dentin, a very deep introduction of the instrument when searching for the root canal.
- Inadequate filling of the canal, as a rule, is the result of incomplete passage through it. This can happen if the length of the channel is measured incorrectly, the channel is too narrow or it is obstructed.
- Perforation of the root wall. Often occurs if the work is carried out with curved channels, or the channels were previously sealed. It may also result from the installation of root pins.
- Blockage of the lumen of the channel with dentin sawdust, a broken instrument, pulp residues.
- Incomplete removal of content from root canals. It occurs with obstruction of the channel, if it has lateral branches, there are denticles, bleeding inside.
Causes of pain
Soreness after completion of treatment may develop due to:
- The development of inflammation on the upper part of the tooth.
- Individual intolerance to the components of the filling material.
- Excretion of fragments of tools at the top of the tooth, gutta-percha.
- Presence of pulp residues in hard to reach places.
- Contact with the tooth tip of the filling paste, products used in the processing of the channels, tissue decay products.
The occurrence of repeated pains and their preservation for a month indicates the need for repeated tooth therapy.
Dental canal treatment in Kazan costs from 700 rubles. There is an opportunity to visit the clinic, which works around the clock.