Conservative endodontic treatment and endodontic surgery
In modern world dental practice, endodontics or treatment of root canal and tissues surrounding the tooth root is aimed at removing the infection from inside a tooth applying a conservative or surgical treatment.
Over the past 20 years, a scientific, evidence-based approach has made it possible to improve methods and materials for treating root canals, and the success rate of the long-term treatment in the world now stands at around 83% and 92% for retreatment and initial treatment, respectively.
The popular presumption that the size of periodontitis foci larger than usual indicates a cyst and requires surgery is now considered obsolete. Today, the treatment of pulpitis (inflammation of dental pulp tissue) and periodontitis (inflammation of tissues surrounding root tips) in most cases is conservative and is done within a short
space of time.
We follow several basic principles for effective endodontic treatment.
1. Dental microscope. How about using optical imaging systems or having the ability to see the canal from inside? Is it better to work manually? It seemed unreal, but today the choice is obvious. In addition to the apparent advantages, one of the reasons why a microscope is necessary is that accessory canals could sometimes be quite difficult to detect without a microscope. For example, it was considered that the upper first molars (“sixes”) most often have three canals, however, later it was found that they usually have four canals. The fourth canal is simply very difficult to locate and process without proper visual inspection.
2. Irrigation and mechanical pre-treatment protocols. Years of medical research proved that high-quality root canal treatment is impossible without proper pre-treatment and rinsing. Basic treatment includes the ultrasonic-activated canal passage, enlargement and thorough irrigation (rinsing) applying visual and x-ray image control.
3. The root canal treatment in our clinic is performed using cofferdam, a membrane used to isolate the tooth from the oral cavity, which prevents saliva and rinsing liquids from washing mucous.
4. Electronic determination of root canal length. An electronic apex locator gives 100% accuracy compared to the X-ray length determination. The root apex, visible in the image, rarely coincides with the point to be reached, since the projection of the image is evaluated subjectively.
5. Three-dimensional obturation of the root canal system. The ultimate goal of endodontic treatment is obturation or filling of cleaned root canals and their junctions with sealing material. We do not use any toxic materials or filling materials with hormonal agents, as we are interested in long-term tooth rehabilitation, and not in a temporary solution. An inert AH Plus sealers with gutta-percha which in the liquid phase fill all the anatomical areas of the root canals assuring maximum sealing and better forecast are applied for three-dimensional obturation.
6. Digital radiography. We use a digital X-ray machine installed directly in the office. A digital X-ray machine exposure to radiation is 5 times less than that of an X-ray film machine and has greater advantages.
In some cases, the periodontitis process can be defined as irreversible due to significant accumulation of microorganisms in inaccessible root tissues. In this situation, endodontic surgery can be applied when root apex is removed through special access to create conditions for fast bone regeneration.
The situations described above present dental follicular cysts that cannot be adequately addressed with conservative endodontic treatment, therefore, surgical procedures to remove inflamed tissue around the apex of a tooth are to be considered to preserve teeth with such a diagnosis.