When do we perform endodontics
When deciding on endodontic treatment, several factors play a role, such as the importance of the tooth, its condition or a biological factor, the extent of of the problem in the clinical crown of the tooth or the preservation of the so-called ferrule, i.e. a certain amount of healthy hard tooth tissue around the tooth root above the gum level. Important factors are the anatomy of the root and technical factors that might make treatment problematic, such as restrictions on mouth opening, damage to the jaw joint or some general diseases suffered of the client. We also assess whether the tooth will be able to serve as a pillar of a prosthetic replacement after treatment.
How does the endodontic treatment work
The purpose of endodontics is to preserve the tooth in the oral cavity and restore its function. To do this, the tooth root canal system must be treated well. During the procedure, we mechanically widen, chemically disinfect and fill the canals of the damaged tooth so that we can subsequently reconstruct the tooth and, if necessary, cure the inflammation of the bone bed of the tooth, if it is diagnosed.
According to the complexity of each case, we divide the endodontic examination into the suitable number of visits to the surgery. Each visit lasts approximately two hours. We perform endodontic procedures under local anesthesia, or in controlled analgesia, if it benefits the comfort of the client. We first insolate the treated tooth with a special elastic membrane (so-called rubber dam). In the event of severe damage to the tooth crown, we will perform an adhesive completion of the peripheral walls of the tooth crown before isolating it.
During the treatment, we use special devices and instruments and do X-ray tests. First, we remove the infected tissues of the crown part of the dental pulp and find the entrances to the root canals using an operating microscope. We mechanically widen the system of root canals with manual and rotary tools and apply disinfectant solutions, which eliminate germs.
The exact length of individual root canals is determined using an electronic apex locator. We fill the expanded and disinfected inner space of the tooth and hermetically seal it with gutta percha pins. If the root system is filled with residues of gangrenous or otherwise inflamed marrow, we apply a disinfectant pad with calcium hydroxide to the root system for 10 – 14 days on the first visit and the root canals are finally filled at the next visit. Then we complete the core of the crown part of the tooth so that the tooth is ready for possible prosthetic reconstruction.
What to expect after endodontics
Although the root canal system can be quite complex and may present anatomical complications, the modern operating microscope under which the entire treatment takes place allows our dentists to work very precisely and minimize the risk of complications during the procedure. After the treatment, you may notice an increased sensitivity of the treated teeth for several days, which gradually subsides. If necessary, we can suppress it with drugs with analgesic effect.
Complications and possible risks of endodontics
During the mechanical processing of the root canals, the root instrument may also separate or the tooth root may be perforated. It cannot be guaranteed that all root canals can be found, cleared, widened, disinfected and filled, that the obstruction(s) in the canal are removed or, for example, that the perforated root can be sealed, or that the dental bed inflammation is healed.
The risk of this method of treatment lies primarily in the higher risk of bending the instrument or perforation of the root canal wall, then the need to fill the canal with a substance that shrinks in the canal and does not guarantee a hermetic seal. Subsequently, reinfection of the canal may occur, which may result in the loss of a tooth, or the need for a time-consuming, technically and financially much more demanding procedure (reendodontic, i.e. re-treatment of the root canal). Any further treatment of the root canal is potentially dangerous because of the possible weakening of the tooth and its subsequent loss due to crown or root breakage.
During the procedure, activation of the chronic lesion with the subsequent outbreak of acute inflammation is also not ruled out. This could be solved by the administration of antibiotics or surgical treatment, depending on the situation. The success rate of the above procedures is high, but the individual anatomical proportions of the tooth do not guarantee that it will always be cured and preserved. Sometimes, even after successful filling of the root system, complete healing of the inflammatory deposit in the alveolar bone cannot be achieved. In this case, the primarily conservative root canal filling procedure must be supplemented by surgical intervention in the apex (root tip) to remove the inflammatory lesion and revise the periapical space. This procedure is also performed under the control of a microscope and aims to minimize the extent of surgical intervention.
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