Human teeth require special care throughout life. After all, the he alth of our internal organs, in particular the intestines, depends on their condition. They can both keep us from infections and be a breeding ground for it. A bad tooth brings us special discomfort. We feel pain at the slightest contact with cold or hot food, sweet or s alty. When tooth pain begins, you should immediately contact a dental specialist, as obvious symptoms may indicate an advanced stage of the disease inside the tooth. In this case, special methods of therapy are used, one of which is endodontic treatment.
Dentistry Section - Endodontics
Endodontics is a direction of therapeutic dentistry, focused on the treatment of inflammatory diseases of the dental pulp and tissues surrounding the tops of the roots - periodontium. The term "endodontics" comes from two words: "endo" which means "inside" and "odont" which means "tooth".
What isendodontic intervention?
Endodontic treatment is a whole complex of successive stages of treatment aimed at preserving the tooth. In the case of such common complications of caries as pulpitis or periodontitis, it is necessary to work directly inside the tooth. The complexity of this treatment lies in the fact 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 even to simply detect it. If the roots are twisted, and the tooth is tilted, the opening of the mouth is limited for some reason, endodontics becomes the acme of modern dentistry. It requires vast experience and intuition from the dentist, possession of a variety of high-tech methods of diagnosis and treatment.
Endodontic treatment - indications
Indications for such treatment are:
- All types of pulpitis not subject to biological, conservative treatment.
- Acute and chronic periodontitis.
- Need for retreatment after previous endodontic treatment.
- Tooth preparation for prosthetics with stump tabs.
- Preparation for prosthetics with crowns that require significant grinding of hard tooth tissues (including with a significant inclination or protrusion of the tooth from the jaw).
- Endodontic treatment is also indicated when preparing a tooth for intracanal whitening.
- Treatment of a fractured tooth resulting in traumapulp or its death.
Are there any contraindications for this procedure?
Contraindications to endodontic root canal treatment can be divided into two groups: absolute and relative.
Absolute contraindications:
- periodontal disease preventing tooth retention;
- if the tooth is to be removed for other reasons (supernumerary, with an incorrect location in the dentition and not subject to orthodontic treatment, with an early extraction of the tooth for orthodontic indications, etc.);
- longitudinal fracture of the tooth root;
- presence of a cyst not subject to conservative or surgical treatment, or other formation in the area of the tooth root (osteomyelitis, oncology, etc.);
- The severe general condition of the patient is also a contraindication to such manipulations as endodontic root canal treatment.
Relative contraindications:
- significant root canal curvature;
- obstruction of the root canals (lack of lumen, the presence of hard-to-remove filling material);
- the presence of foreign objects in the lumen of the root canal, such as fragments of instruments;
- perforations of the root walls;
- conflict of the patient, his unwillingness to treat the tooth.
Goals pursued by the doctor during this manipulation
The challenges faced by the dentist during endodontic root canal treatment can be divided into the followingdestinations:
- Ensuring the sterility of the instruments and materials used.
- Isolation of a diseased tooth from saliva during work.
- Qualitative partial or complete removal of the inflamed pulp or complete elimination of its decay.
- Fight against pathogenic microflora inside the tooth and behind the tops of the roots.
- Quality and safe expansion of root canals.
- Full filling of root canals in their entirety, temporary or permanent.
- Quality control of treatment at all its stages.
Preparing for this treatment
In preparation for endodontic canal treatment, it is necessary to conduct a full examination: make a diagnosis and plan the stages of the upcoming intervention. It is mandatory to study the preliminary x-ray. The information received must be clearly communicated to the patient. After he understands all the important points of the upcoming treatment, the patient signs an informed consent document.
It is also important to make sure in advance that the patient has no contraindications to the various stages of the upcoming treatment, especially to anesthesia. In the absence of reliable information about the absence of allergy to anesthetics, it is necessary to conduct an allergy test by referring the patient to an allergist.
How is endodontic treatment carried out?
Treatment carried out inside the tooth should be carried outonly by doctors who have undergone specialized training, confirmed by the appropriate certificate. When choosing a method of anesthesia, the doctor must 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, etc.
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 diagnostics and therapy during treatment. The use of a visiograph or apex locator makes it possible to treat root canals with high quality, minimizing the risk of injury to the root walls and tissues around the root tips, under- or overfilling of canals, etc.
It is mandatory to warn the patient about the possibility of various complications and discomfort after treatment. It is desirable that these explanations be given before the procedure, this will help the patient decide on the appropriateness of the intervention and give more confidence in the actions of the doctor.
Treatment steps
All stages of endodontic treatment can be roughly divided into three steps:
- Preparing access to root canals. At this stage, anesthesia is carried out, all non-viable tissues of the carious cavity are excised, and constant antiseptic treatment is carried out.
- Working in 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 channels 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 inflammation is eliminated and various impurities are washed out, the root canals are sealed. The method of filling depends on the diagnosis and qualifications of the doctor. Upon completion of the work, a control x-ray should be taken. The choice of a method for further restoration of the outer part of the tooth is negotiated with the patient additionally.
Treatment of periodontitis
Endodontic treatment of periodontitis involves one more stage - post-apical therapy. After preparing the root canals for filling, a drug is temporarily placed in them, partially removed from the apical opening, which can effectively fight infection. Most often, preparations based on calcium hydroxide are used for this purpose.
In case of complications of periodontal inflammation with the formation of granulomas or cysts, the injection of the drug can be repeated. If necessary, in addition to endodontic treatment, surgical removal of the top of the tooth root and the walls of the cyst is carried out.
Complications during manipulation
The most common complications in endodontic treatment are:
- Fracture of the instrument in the lumen of the root canal.
- Perforation of the root wall.
- Not detecting an additional root canal.
- Insufficientpassage 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.
- Pain and/or swelling after treatment.
If complaints appear or if the listed complications are detected, repeated endodontic treatment is indicated. During the warranty period specified in the contract, retreatment is free of charge. Re-treatment can be carried out both in full and in part, with refilling only those canals in which deviations from the norm are found.
