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ENDODONTICS
Endodontics – what is it?
Endodontics, or colloquially “root canal therapy”, is the field of dentistry that is experiencing its prime today. In the past, teeth with deep caries and infected dental pulp (“nerve” of the tooth) were qualified for removal, especially if they were multi-root teeth in the depths of the mouth (molars). Currently, dentists have extremely precise tools that allow cleaning even the most inaccessible and narrow channels, and when working with the use of a microscope, they are able to guarantee the perfection of the treatment.
Endodontics – types of treatments
Endodontic treatment is carried out in both deciduous and permanent teeth. In the case of permanent teeth that have not completed the development of the root (in the case of anterior teeth up to 9-10 years, in the case of lateral – even up to 16 years) can be done so-called biological treatment, which is partial cleaning of the canals and the use of materials that are intended to ensure the proper further development of the tooth. In mature teeth, the optimal method of treatment is partial dental pulp amputation performed under local anesthesia.
Nowadays, we are moving away from devitalization methods (so-called tooth poisoning) due to the high probability of leaving remains of dead pulp in the lateral channels of the tooth, impossible to clean with mechanical tools. The basis of endodontics is mechanical and chemical treatment, ie cleaning of canals and their widening with simultaneous rinsing with disinfectants.
There are entire systems of endodontic machine tools available on the market, improved over the years to meet even the most demanding channels and allow their treatment in a few minutes. Of course, we use such systems in our office.
Endodontics – the course of the procedure
The treatment starts with providing comfort to the patient and the doctor, and therefore local anesthesia is performed, followed by the use of a cofferdam. The use of rubber dam in endodontics is necessary for several reasons. It not only facilitates the doctor’s work, but also prevents small, precise canal tools from falling into the mouth and throat of the patient, and protects the mucous membrane against irritation by disinfectants used to rinse channels. After this preparation of the patient, the doctor cleans the cavity to gain initial access to the channels, and then sets the treatment microscope over the treated tooth. From this moment, the treatment is carried out at an enlarged scale, thanks to which the endodontist finds all the canals without any problems and proceeds to their purification and elaboration. A qualified dental assistant cooperates with the doctor all the time, which allows him to work with the microscope continuously and guarantees exceptional precision and accuracy of the procedure.
Depending on the physician’s decision, temporary or final filling is used. The channels are finally filled with the best available material – biologically compatible liquid gutta-percha, which is introduced using a special dispenser (“gun”) and ensures an extremely tight filling. In the case of temporary filling, another visit is required to check and execute the final filling.
During endodontic therapy, X-ray examinations are necessary, which allow first to assess the number and course of the canals, and then verify the correctness of the performed procedure (tight filling of all channels). Photographs are taken in our clinic, maintaining the highest safety standards and using the latest equipment (so-called digital radiovisiography), which allows us to get pictures in excellent quality with the minimum radiation dose (for comparison – the dose affecting the patient during 1 x-ray image corresponds to the amount radiation that each of us receives naturally during the week – so-called background radiation, completely harmless to health).
Endodontics – indications and contraindications
Endodontic treatment may be carried out in all teeth in which root canals have been infected. The symptom of such an infection is usually acute pain, especially intensifying under the influence of cold dishes or drinks. If these symptoms are ignored, the pain may slowly regress spontaneously, intensifying with warm dishes. Sometimes an unpleasant odor appears. This is not a sign of self-curing, on the contrary – it is evidence of pulp necrosis and is an absolute indication for root canal treatment. Endodontics is the last resort to removing a tooth. Negligence of treatment leads to irreversible changes in the bone surrounding the roots of the teeth and then only the extraction remains.
Endodontic treatment is not always recommended, especially when the channels are excessively narrowed (we call it obliteration) or the root is cracked longitudinally. A contraindication is also the significant destruction of the tooth, when its maintenance in the mouth is doubtful, a high degree of looseness or pathological changes in the bone surrounding the roots. Root canal treatment is not recommended in patients with undergoing immunosuppression (eg after transplantation) as well as in some heart conditions. The final decision is always made by the dentist in consultation with the physician administering the patient.
All the above situations are an indication for surgical treatment. In the case of single-rooted teeth, the only option is extraction, while in multi-root teeth, it is possible to remove only the infected root or its fragment, leaving the larger part of the tooth if it does not show any pathological changes. Sometimes in the lower molar teeth you can perform the so-called premolarisation – “cutting the tooth in half”, to thoroughly clean the space between the roots. Such 2 new teeth, well-endodontically treated and rebuilt, can still function in the oral cavity for a long time.
Endodontics – frequently asked questions
How long does the treatment last?
In the past, root canal treatment was considered one of the most long-term procedures in dentistry and required great patience from both the doctor and the patient. However, modern methods have completely changed the face of endodontics. Currently, in our office we use all possible facilities that greatly improve and speed up the work of the doctor. Cofferdam and microscope ensure comfort of work, machine development of the canals takes a dozen or so minutes, filling the canals with the use of liquid gutta-percha is equally fast. The whole visit in terms of time is not different from any other visit to the dental office.
Is the treatment painful?
Each endodontic treatment starts with local anesthesia, which excludes any pain during the procedure. The patient can only feel the movement of the tools in the canal, which is short and does not cause significant discomfort.
Is the tooth after root canal treatment as durable as before?
A tooth after endodontic treatment, in addition to the fact that it does not respond to thermal stimulation (hot or cold food), is a fully functional tooth. An important issue in its strength is the correct reconstruction of the crown, conservatively (filling) or prosthetically (crown), which guarantees its resistance to occlusal forces. Studies show that a tooth treated canalically becomes more brittle and vulnerable to fractures than the living teeth. However, if it is not overly loaded (eg in the case of numerous missing teeth) and with proper hygiene, it can successfully serve the patient for the rest of his life.
