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Root canal treatment

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Root canal treatment

What is a root canal?

A root canal is a treatment of the pulp of the tooth that is inflamed, infected, or dead. The dental pulp is a soft substance in the center of the tooth that consists of the nerve, blood vessels, and connective tissue. The pulp chamber is the hollow part in the center of the tooth that contains the pulp, and it continues down canals that extend through the roots of teeth and into the surrounding bone. Some roots have more than one root canal, but all have at least one canal.

How does an endodontist perform a root canal?

To confirm that a tooth does indeed require root canal treatment, the dentist will take an X-ray of the root and may perform a pulp vitality test. Most pulp tests involve placing a cold stimulus on the tooth to check for a healthy response. Many teeth will be tested to compare the responses. If the test confirms the need for root canal therapy, it will be completed in either one or two appointments. The dentist will determine whether the root canal will be treated in one or two appointments based on the size and duration of an abscess and other factors. A tooth is likely to be treated in two appointments if it is getting retreatment (being treated a second time). Patients are often curious how long a root canal takes to finish. They can generally expect one or two appointments of about 90 minutes each. An endodontist, and some general dentists, will often perform root canal treatment using a microscope that attaches to the wall and hangs over the patient’s mouth. This provides magnification that helps the treatment provider locate and treat all the necessary anatomy inside the tooth.

Endodontic treatment consists of several stages, and root canal filling is performed at the final stage. Its goals:

  • preservation of the biological condition of the tooth and extension of its service life (filled with filling materials, the root continues to serve as a support for the crown);
  • protection against infection of the root and adjacent tissues in case of recurrence of caries.

Root canal treatment

Indications for the treatment of dental canals

Root canal filling is performed in the following clinical indications:

  • inflammation of the pulp as a result of injury;
  • the defeat of the neurovascular bundle as a result of running or deep caries (with pulpitis, periodontitis);
  • if necessary, treatment of already depulped tooth (the formation of granulomas at the apex, re-infection);
  • for the purpose of disinfection and prevention of inflammation before prosthetics.

The main sign of damage to the pulp bundle – pain. However, to accurately determine the cause of pain, to determine the nature of the problem can only be a specialist during the examination, using methods of hardware diagnostics.

How is the treatment and filling of root canals?

In the treatment of pulpitis, the doctor performs many tasks that can be divided into three groups. These are the main stages of treatment of dental canals:

  • preparation;
  • cleaning;
  • sealing.

At the preparatory stage is:

  • examination, diagnosis;
  • anesthesia with anesthetics;
  • tooth crown preparation;
  • cleaning of a carious cavity;
  • formation of access to the pulp.

In the second stage, the doctor performs the following actions:

  • removal of the neurovascular bundle;
  • expansion and cleaning of channels;
  • irrigation, antiseptic treatment of channels.

At endodontic processing, the doctor uses a special tool and the device for cleaning of channels of a tooth.

The third stage (sealing) includes the following tasks:

  • temporary sealing to check the correctness and effectiveness of treatment;
  • during the second visit the channels are sealed;
  • in the end – tooth restoration;
  • control of treatment results.

Is anesthesia required for canal filling? Anesthesia is necessary at the stage of removal of nerves and blood vessels. Sealing is carried out during the second visit to the doctor. If the treatment is carried out correctly, then at the time of filling the patient has no signs of inflammation, and the procedure is performed without anesthesia.

Materials used to seal dental canals

Root canal treatment

Modern polymeric materials for dental fillings have excellent aesthetic and practical characteristics, but they are not suitable for sealing the root canals of the tooth, given their narrow passages and often complex anatomical structure.

So what fills the dental canals after endodontic treatment? Dentists use 3 types of materials:

  • harden dental cement;
  • non-hardening pastes;
  • materials for retrograde sealing.

All these materials are divided into the following types:

  • sealers;
  • filler pins.

Since a tooth that has had a root canal has been hollowed out to a certain degree, it is more prone to fracture. Getting a crown placed on the tooth will almost completely prevent this, but it can still happen. Sometimes there may have been an undetected crack at the time the root canal was performed, and the tooth may need to be extracted even though the tooth was treated with a perfect root canal.

In excessively curved roots, a file could break off inside the canal. Sometimes these files can be retrieved, but many times they cannot. If this happens, the tooth will be filled to the level of the file and monitored closely. If it was thoroughly cleaned before the file broke, the tooth may be unaffected. If not, it may need a surgical procedure to finish the root canal treatment.

Sometimes, if the pulp canal is difficult to find due to narrowing or calcification, the tooth may become perforated while attempting to locate the canal. The tooth is perforated when the dental drill starts from the inside of the tooth and communicates a hole through to the outside of the tooth instead of remaining centered. Many perforations can be repaired, but if severe, may cause the tooth to have to be extracted.

When should a tooth be extracted instead of getting a root canal?

Each tooth is evaluated on a case-by-case basis to determine the pros and cons of root canal treatment vs. extraction. Root canal treatment is performed in an effort to save a tooth, but just because a tooth can be treated with a root canal doesn’t mean it should. The following are some reasons a tooth may be better treated with extraction vs. root canal:

  • Root fracture: A tooth that has sustained a fracture down the root or through a significant portion of the crown of the tooth will continue to hurt or be infected even after a root canal is performed and is extracted instead.
  • Lack of remaining tooth structure: If there isn’t enough healthy tooth structure above the bone for a crown to attach to, root canal treatment is worthless. Sometimes, a crown lengthening procedure can be performed, which removes bone to expose more of the tooth. But careful examination must be performed by the restoring dentist to determine if such a procedure will have other disadvantages and should be avoided.
  • Third molars: Third molars, or wisdom teeth, are often not in a functional position and should be extracted rather than being preserved with root canal treatment.
  • Significant resorption: If a large amount of a tooth has dissolved away due to internal or external resorption, a root canal may not be able to save it. Many teeth in this situation must be extracted.
  • Multiple root canals: The percentage chance for success decreases every time root canal treatment is performed on a tooth after the first time. If a patient has already had a root canal and they later need re-treatment of the root canal on the same tooth, they must compare root canal treatment with other treatment options that would replace the tooth following extraction. In most instances, an implant-supported crown will have a better chance for success than a tooth that needs a third or fourth root canal. Ultimately, the patient must decide to what extent they will go to save the tooth, and how comfortable they feel with their treatment options. The dentist and endodontist are very valuable in helping maintain perspective regarding the condition of a tooth and the likelihood for success with different treatment options.

Conclusion

In endodontic treatment, all work is carried out out of sight, so for a favorable result of great importance is the accuracy of diagnosis and experience of the specialist. In some cases, the roots of the teeth have such a complex structure that traditional methods of treatment and filling are ineffective, and quality treatment is possible only with the use of a dental microscope.

Before entrusting such a procedure to the dentist, pay attention to the level of equipment of the clinic, find out what diagnostic methods they use, how the dental treatment is performed, what materials are used. Your health ultimately depends on the quality of the materials and the quality of the treatment.

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