Conservative endodontic treatment and endodontic surgery
The idea behind endodontic treatment (root canals trreatment) is to eliminate infection from the root canal system and prevent repeated infection. In simpler terms, the infection first needs to be removed, then by obturating (filling) root canals and creating adequate restoration “cleanliness” in canals needs to be preserved. The key principles for root canal treatment which we adhere to in our clinic are as follows:
1. When boring (dilating) canals, we use titanic files which allow to thoroughly irrigate (rinse canals). The irrigant to canals is injected by a syringe.
2. As a key irrigant, we use a warmed 5% solution of sodium hypochlorite, which apart from being disinfectant, is able to lyse (dissolve) organic particles.
3. In our work, we use optics (dental microscope) (photo 1). Optics allow adeaquate access and prevent tooth over-preparation. And the more tissues the tooth has remaining the more robust and hermetical the permanent restoration will be (photo 2).
Dental microscope: optics provide high accuracy, control and a smaller amount of tissue preparation
Tooth under microscope or 20-fold increase of the tooth durig endodontic treatment
4. To determine the working length of the canal, an apexlocator is used (device to measure canal length), since the x-ray method of root canal treatment is less accurate.
5. When treating root canals, we only use cofferdam. This enables to have an adequate irrigation (rinsing). Also, the use of cofferdam ensures proper insulation of the root canal system from oral infections.
6. As a filling material, we use epoxy АН+ with hot gutta-percha. When treating root canals we do not use resorcinol-formaldehyde paste like Foredent and Endometazon as RF makes teeth fragile and accumulating in tissues of internal organs can be toxic and carcinogenic.
A fragment of a dental instrument was left in an upper side tooth by a dentist who treated the patient in a different clinic. According to an X-ray image, the instrument entered the root canal of the tooth. While the patient did not suffer any discomfort due to this issue, it was decided that the fragment should be removed as it would inevitably corrode and it is possible that the tooth may become painful at any time
Tool fragment was removed. X-ray image taken prior to the filling of the root canal
After removing the fragment and using a dental microscope, the treatment was completed by filling of the root canal and indirect restorations (crowns)
Endodontic surgery is used for preservation of teeth with periapical tissue problems (radicular cysts, cystogranulomas, cysts in the area of teeth bifurcation), not responding to therapeutic treatment. Tooth-preserving operations are used together with osteoplastic materials with a success rate of approximately 80%.
Images, shown above, demonstrate radicular cysts that cannot be treated with a conservative endodontic treatment. Therefore, in order to save teeth in such cases it is necessary to resort to the surgical removal of the inflammatory area around the root of the tooth.