Endodontics

Endodontics is a science that studies the endodontic anatomy, as well as detects and treats pathologies associated with changes in the tooth pulp and periodontal ligament, injuries in the dental cavity. Treatment of dental canals is provided within this section of dentistry.

The goals of endodontic treatment

Endodontic treatment has the following objectives:

• To remove the infected tissues (dentin substance and tooth pulp) from the periapical tissues and root canal.
• To prepare the root canal for tooth filling.
• To fill the root canal.

Endodontic treatment can be primary and secondary. Primary treatment implies root canal filling and chemomechanical cleaning. Then, the rebuilding procedure of the dental crown is carried out with the help of filling material or a post-and-core inlay. When the filling takes about 2/3 of the dental crown, the crown has to be replaced. Secondary endodontic treatment implies retreatment of the root canals which have already been treated unsuccessfully. A doctor removes old root canal fillers, cleans the canal thoroughly, then inserts the filling again. All actions are carried out in order to reduce inflammation and chronic toothache, as well as to preserve the tooth. Secondary treatment can be called more difficult, since not always a successful result is long term. It is necessary to be followed up by a dentist in order to react and take the necessary measures in case of infection development.

Dental injuries can be nonreversible and lead to teeth loss if they are not treated in due time. Only dental prosthetics and implantation can help in neglected cases.

Indications and contraindications for endodontic treatment

Root canal treatment is indicated in the following cases:

• Different forms of periodontitis are inflammation of the surrounding tissues of the tooth root. As a result, a pus pocket appears in the root. A specific symptom of this disease is a sharp pain in the tooth. Causes of periodontitis can be infectious, traumatic, medicamental and allergic ones.
• Acute pulpitis is a disease characterized by the inflammation of the tooth pulp which comes to be called the nerve. In most cases, this is the infectious inflammation which arises from the penetration of bacteria through the carious canal. Initially, the patient may feel dull pain that becomes acute. There may be the enamel darkening of the affected tooth, swelling of the surrounding tissues, slight dental bleeding.
• Chronic pulpitis is the inflammation of the tooth pulp which is the chronical one. In the case of this health problem, there are episodes of toothache from time to time in response to mechanical and/or thermal (hot most of all) influence. The causes of the disease may be different from the acute periodontitis and parodontitis to low-quality tooth treatment provided earlier.

There are contraindications for endodontic treatment as well. They are as follows: vertical root fracture, periodontal disease, impossibility to treat root canal of the tooth, inability to restore the tooth.

How is the treatment provided?

Endodontic treatment is a staged process that requires a correct approach and compliance with the following plan of actions:

• Diagnostics. Each patient who seeks endodontic treatment must be diagnosed. Except for the examination and clinical procedures, the tooth vitality is tested, and the marginal periodontium is explored (to determine the vertical tooth fracture). CT scan might be performed.
• Assessment of the tooth health and prognosis of treatment options, decision making. A doctor analyzes the results of the diagnostic testing in order to perform afore-named actions. If the patient has a dental core or a crown on the affected tooth, such dentures should be removed.
• Preparation for endodontic treatment. It may involve the following procedures:
  treatment of periodontal diseases;
• filling of tooth cavities affected by caries (unrelated to the endodontic access);
• restoration of missing parts of the tooth;
• in the case of excessive salivation, the patient gets atropine in the form of collutory 30 minutes before the initiation of endodontic treatment.
• Endodontic treatment. At first, it is necessary to give the patient anesthetic and then initiate the procedure. In a certain manner, a dentist opens the carious cavity to get easy endodontic access. Then he removes the pulp cavity and gets access to the pulp canal. Next step is to remove the tooth pulp and foreign substance. A doctor applies apex locator and X-ray in order to know the length of the root canal (it is very important and helps to avoid complications). Then, the doctor treats the root canal with special tools and medications. If there is the inflammation in the periodontal ligament, it is reduced. Then, the dentist fills the root canal.
• Rebuilding procedure of the coronal part should be completed no later than 2 weeks after the endodontic treatment.
• Follow-up. It is impossible to assess the result of treatment at once, so the patient has to do first medical check-up via computer tomography in 6 months. Then it should be done in 1 year, 2 and 4 years.
• In the case of apical pathology enhancement, apical surgery is indicated. It includes surgical revision and obligatory control of the result.

A noteworthy detail is that it is not recommended to complete endodontic treatment in one visit. It can last for several days or even weeks.

When treatment is completed, it is necessary to restore the anatomy and function of the tooth. Filling materials or dental prostheses can be used for this.

Certus clinic provides endodontic treatment with the help of modern hardware. There are manual endodontic instruments, rotating systems, X-smart equipment for rotary dental instruments, thermaprep (equipment designed to heat up gutta-percha and it is used during root canal filling as well), apex locator. Treatment is provided under x-ray control on a mandatory basis. Due to the modern equipment, the high-quality instruments, as well as innovative materials, our experts cope even with complicated endodontic cases successfully.