The most difficult procedure in the field of therapeutic dentistry is root canal treatment. The canals of the tooth are located inside the roots and are narrow passages. Only the use of a microscope allows the doctor to see their mouths. X-ray examination allows the specialist to get a little more insight into the internal structure of the tooth. However, an x-ray can only show a lateral projection of the roots, not reflecting the possibility of their overlapping, bifurcation.
All methods of root canal treatment are united by specialists in a separate field of science - endodontics. She also studies the anatomical structure of the teeth, the features of the course of pathologies in the dental cavity. In endodontic therapy, instruments specially designed for this purpose are used, which are characterized by special qualities - strength and flexibility, which allow manipulations in curved and narrow spaces. With the help of computer technology, it is possible to obtainspatial images that allow you to examine in detail all the divergences and branches of the dental canal.
The following materials are used for treatment:
- hardening (cements);
- non-hardening (pastes);
- hard materials (pins).
The filler has a complex set of tasks. At the same time, it should block the dental canal, be durable, and at the same time not cause irritation. In addition, it is good if it is transparent to x-rays in order to monitor the process and result of therapy. Filling materials are selected by the doctor. Each filling option has its own characteristics, so the doctor will evaluate the pros and cons of each and offer a choice to the patient.
Indications
Endodontic therapy of a tooth is necessary in the following situations:
- Injury, accompanied by damage to the internal cavity of the tooth (pulp chamber).
- Any variety and form of periodontitis.
- Pulpitis with acute or chronic course.
Tooth canal inflammation is treated 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 broken (if the tooth has several roots, in some cases it is possible to remove the damaged rootand treatment of the remaining).
- Obstruction of canals due to obliteration or previous therapy.
- Penetration of the inflammatory process localized in the periodontium into the maxillary sinus.
- Severe inflammatory process on the dental roots, accompanied by peristatitis (swelling of the surrounding tissues), which prevents the creation of an outflow of purulent exudate through the channels.
- Unable to restore the dental crown through therapeutic treatment or through prosthetics.
If there is no possibility of filling and passage of channels, depending on the diagnosis, tooth extraction or therapy with mummifying paste may be indicated.
Steps of root canal treatment
Endodontic therapy is carried out in several stages.
The first stage is preparation for the treatment of the dental canal. It includes examination, diagnosis, determination of the treatment plan, anesthesia.
Pain relief is a mandatory procedure if the primary opening of the dental cavity is performed. Anesthesia at a second appointment after the use of mummifying paste (arsenic), with a chronic form of periodontitis, when applying the drug to the channels, as a rule, is not required.
The process of preparing a carious cavity consists in removing the softened layer of dentin with the help of burs, opening the tooth cavity, creating a full access to the cavity without overhanging edges and with the possibility of a good view of the mouthchannels.
When treating pulpitis of teeth that have many roots and cause severe pain, it is shown to complete the first appointment by opening the inflamed pulp cavity. After opening, a special paste is applied to the pulp, and the carious area is temporarily sealed.
Popular root canal treatment under a microscope. The microscope helps the doctor to carefully examine the problem unit, remove caries and seal the canal. Without the use of high-precision equipment, the quality of treatment deteriorates significantly.
Cavity opening
Under the disclosure of the dental cavity, dentists understand the removal of the arches of the pulp chamber. Opening 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 affects a small area of the pulp chamber protruding upwards (pulpal horn), access can be extended even with the capture of he althy dentin. This is done in order to eliminate the entire vault 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 root canal is treated by the standard method.
Removal of crown pulp
Removal is carried out with the help of boron in the process of opening the pulp cavity. It is possible to carry out vital amputation (partially extract an intact pulp) under the condition of good anesthesia during the treatment of pulpitis. At primaryIn the treatment of periodontitis, the doctor, as a rule, deals with the 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 is removed. This process does not cause pain in the patient.
Finish the pulp extraction process with hand tools such as probe, excavator. The stage of removal of the coronal pulp ends with the determination of the orifices of the root canals.
If pulp is found 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 foramen. Processing should be carried out strictly before it in order to avoid the spread of infection to nearby tissues.
Channel processing
The root canal treatment can be medical or mechanical. The procedure is carried out using files on which length limiters are set. During cleaning, chemicals are introduced into the canals, which contribute to the leaching of dentin particles from the canal and have an antiseptic effect.
Finish the processing procedure by drying the canals and re-determining their length, since it can change due to straightening with tools. After the canal is processed, it is hermetically sealed with a seal.
Processing a channel is not always possible in one visit. In some cases, osteotropic, antiseptic, anti-inflammatory substances are temporarily injected into the canal.
Indications for delayed therapy
Indications for delayed therapy are:
- Need to treat pus in the root canal.
- Swelling in the area of the top of the tooth, not accompanied by the occurrence of a fistula.
- Chronic form of periodontitis, accompanied by inflammatory changes that can be detected on x-ray.
Root canal filling
The most important step in the treatment of a dental canal is filling. As a result, the dentist must achieve complete filling of the internal tooth cavity 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 dissolve, it can be used to completely obturate the space inside the canal.
Finish endodontic therapy with isolation pad and crown restoration.
Complications
Evaluation of the success of canal therapy is determined throughout the year after the first treatment. With a good result, the patient does not experience pain. At the same time, swelling, changes in the sinuses of the appendages, pathological abnormalities on the radiograph are absent, and the function of the tooth is preserved.
If the treatment was ineffective, there is a possibility of the following complications:
- The appearance of perforation in the bottom or walls of the tooth cavity. This complication develops in the presence of a large number ofsoftened dentin, very deep insertion of the instrument when searching for a root canal.
- Insufficient filling of the canal, as a rule, is the result of incomplete passage through it. This can happen if the length of the canal is not measured correctly, the canal is too narrow, or it is obturated.
- Perforation of the root wall. It often occurs if the work is carried out with curved canals, or the canals were previously sealed. May also result from the installation of root pins.
- Clogging of the canal lumen with dentine filings, broken instrument, pulp remnants.
- Incomplete removal of content from root canals. Occurs when the canal is obstructed, if it has lateral branches, there are denticles inside, bleeding.
Causes of soreness
Soreness after completion of treatment may develop due to:
- Development of the process of inflammation on the top of the tooth.
- Individual intolerance to the components of the filling material.
- Removing fragments of instruments, gutta-percha beyond the top of the tooth.
- Presence of pulp residues in hard-to-reach places.
- Fitting the top of the tooth with filling paste, products used in root canal treatment, tissue decay products.
The occurrence of repeated pains and their persistence for a month indicates the need for repeated tooth therapy.
Treatment of dental canals in Kazan costs from 700 rubles. There is a possibilityvisit a 24/7 clinic.
