A several critical factors are taken into account for an assessment of the indication: for example, the importance of the tooth, a biological factor, the extent of disability clinical crown of the tooth, preserving of so called Ferrule (certain amount of healthy dental hard tissues around the circumference of the root of the tooth above the gums), the ability of the tooth after treatment to serve as a pillar of the prosthetic, the root anatomy, technical factors that may impede the treatment (eg. the restriction on opening the mouth, impairment of TMJ, some overall patient’s disease, etc.). When indicating endodontic treatment, the patient’s desire to preserve tooth is important, but not decisive. Conversely, the lack of interest of the patient for treatment or social (financial) reasons are straightforward criterion for non-commencement of treatment.
How does endodontic treatment goes
The treatment is normally performed under local anesthesia. In order to prevent the spread of infection and leakage of disinfectant substances in the oral cavity, the tooth is isolate by using a special elastic membrane (ie. kofferdam). In large damage of the tooth crown we provide an adhesive finishing of the external walls of the crown before insulation.
According to the complexity of each case is the treatment divided into several visits to the dentist’s office, each of approximately two hours. During the treatment there are used a special equipment and instruments and made X-ray images for checking.
First, we remove infected tissue coronal portion of pulp and find entrances to the root canals using an operating microscope. Root canal system is mechanically expanded with hand and rotary instruments in order to apply disinfectant solutions, which helps the tooth to get rid of freed from germs.
The exact length of each root canal is determined by using an electronic apex locator devices. Widespread and disinfected the interior of the tooth is then filled, and hermetically sealed gutta-percha pins by lateral or vertical condensation. In case that the root system is filled residues gangrenous or otherwise inflamed pulp in the first visit to the root system is applied disinfecting insert with calcium hydroxide for 10 to 14 days and the final filling of the root canals is performed at the second visit. After completion of the core is fabricated crown part of a tooth so that the tooth is prepared for an potential prosthetic reconstruction.
Complications and possible risks of endodontics
Possible complications can arise because of substantial anatomical complexity of the root canal system and the technical difficulty of endodontic treatment, but due to the use of the most advanced instrumentation and zooming techniques (operating microscope) is reasonable to assume a low incidence of complications during treatment at our clinic. The mechanical treatment of root canals may also cause separation of the root tool or perforation of the tooth root. We cannot guarantee that all root canals will be found, passable, expand, disinfect and fill, all the obstacle in canals removed or, for example, perforated seal root or achieved healing inflammation of the tooth socket.
The risk of this treatment lies in the inconsistent structure (i.e. higher risk of tool break or perforation of the wall of the root canal), the necessity of filling the channel with material, which shrinks and does not guarantee a hermetic seal in the canal. Afterwards the reinfection of the canal, which ends with the loss of a tooth or necessity of a time-consuming, economically and technically much more demanding performance (re-endodontic, ie. re-treatment of root canal). Any further treatment of the root canal is potentially dangerous weakening of the tooth and it can cause a subsequent loss due to breakage of the crown or root.
During the treatment is also not ruled out an activation of chronic deposit with subsequent outbreaks of acute inflammation, which is a situation resolved with antibiotics or surgery.
Success of the above procedures is high, but the individual anatomy of the tooth does not guarantee that it will always be able to heal and preserve the tooth in the oral cavity. Sometimes, even after a successful treatment and filling of the root system, it fails to achieve the complete healing of an inflammatory foci in the bone alveoli. In this case the primarily conservative surgery of the root canal filling must be supplemented by a surgical intervention in the area of apex (a root tip) to remove the inflammatory foci and revising the periapical space. This procedure is also done under the control of the microscope, and it aims to minimize the extent of surgical intervention.
Restrictions and recommendations in the way of life after endodontics
After the above-described medical procedure, the patient may perceive several days increased sensitivity of the treated tooth, which gradually recedes and can be reduced if needed by drugs with analgesic effect. The change of health eligibility is unlikely.
MD. Velková Lina, head physician of DENT MEDICO
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