Endodontic treatments

Endodontic treatments

Endodontic treatment is a process for the maintenance of the teeth, due to this treatment we can save decayed teeth of which pulp is infected. Through the caries the bacteria can enter the pulp chamber and cause inflammation that leads to toothache. We can ease the pain if we treat the teeth, i.e. if we perform an endodontic treatment. During this treatment the dentist removes the infected or necrosed pulp tissue and he profoundly cleans the cavity situated on the internal part of the tooth till the root apex. At our office we perform endodontic treatments using special rotatory instruments with incorporated apex locator that creates new possibilities as far as cleaning and preparation of the root canal are regarded. Due to the precision of the instruments these treatments are more successful than the traditional manual treatments. We put the root filling material into the cleaned canal using a new technique: we warm the filling material up (thermoplastic technique) and we insert it in the canal through vertical compaction, this way the filling material fills the space completely and exactly. The root filling will be precise and stable – these are the most important aspects of a successful treatment.

Advantages of the mechanical technique:

  • faster and more precise cleaning of the root canal
  • shorter treatment time
  • precise root filling, successful maintenance of the teeth
  • it can be used in the case of bent, curved canals

After the endodontic treatment:

  • Most of the treated teeth become asymptomatic because we have cleared the bacteria away and we have disinfected the canal
  • It can happen that after the treatment the tooth remains sensitive for 1-2 days or it becomes sensitive for a peiod of time when we bite on it. This sensitivity appears because the inflammation around the root apex does not disappear from one day to the next as it is a chronic inflammation that appears slowly, so for its disappearance we need months or years and there is also need for an appropriate immune response
  • We should protect those teeth in the case of which more surfaces have been endodontically treated, so it is recommended to apply a crown and we should enforce these teeth by introducing in the root canal of some fibreglass posts because these teeth are not alive, have no circulation and later they can become very fragile.

Root canal treatment of monoradicular and pluriradicular teeth and root canal obturation

The root canal treatment of the monoradicular and pluriradicular teeth require more time, so in most of the cases we need more sessions to perform this treatment because patients mostly see the dentist with this problem when they are already in pain. As at our office the sessions of the patients have been booked for several months, in these emergency situations we try to ease the pain or in case of pulpal inflammation we try to remove the pulp and to temporarily close the pulp chamber, in the case of a gangrenous tooth we try to open and drain the pulp chamber. In these cases we will perform the root canal obturation, the disinfection of the root canals and their hermetic closure at a later session. This does not lead to less successful treatments. The root canal treatments are performed with local anesthetization and after the filling of the root canal – according to the possibilities – we prepare a radiogram about that tooth in order to check the results.

Removal of old or incomplete root canal obturations

Usually this treatment takes place after we realize – due to a radiogram made in order to perform a complex oral rehabilitation or in order to identify problems in case of an emergency – that the existing root canal obturations do not completely fill the root canal out, so the pulp tissue remained in the canal becomes infected and the toxin of these bacteria enter the periapical space through the root apex and cause chronic inflammation. In these cases during the treatment we remove the inadequate root obturation or eventually we remove the sticked post and then we continue the treatment according to the phases mentioned at the description of the root canal treatment. Often after the root canal obturation – in order to enforce the weak and thin dental tissue – we stick a fibreglass post in the root canal and we cover it by a crown.

Reinforcement of the endodontically treated tooth with fibreglass post

In some cases the crown of the natural tooth is so injured that it cannot be restored through a simple obturation or through the application of a crown. In this case we need to enforce the root using a post cemented to the root. Through this method we can save those dental roots that can be endodontically treated and in the case of which the margin of the dental tissue is at least 2 mm above the gingiva. At our office we perform dental restoration with post using some fibreglass posts that are much more elastic and flexible than the traditional metal posts, this way the tension in the root – that can lead to root fracture – will be more reduced.

Closing false dental routes

False dental routes are some non-anatomical routes that appear in the root after endodontic treatments. It is necessary to close these because the bacteria can cause chronic inflammation. Usually these false routes appear after the removal of the old root canal obturations because – according to old root canal obturation techniques – a large part of the root canal hasn’t been filled with gutta-percha used today (root canal filling material coming from gum-trees), but with hard cement. Gutta-percha is a plastic material that is soluble in a certain dissolvent and it can be easily removed. In many cases the removal of the cement is absolutely impossible even if we use a miscroscope. In these cases – due to the cement existing in the cavity – the instrument used for the expansion of the canal will not expand the internal part of it, but it will perforate its wall and this leads to the appearance of false routes. False routes can also appear when we expand some canals that are too curved, bent and the instrument cannot turn off, the needle creates an edge, a border in the wall of the canal and as we continue the expansion we reach the dento-periodontal space through the inappropriate route. We close these routes using a special filling material (MTA) that does not have side-effects and it is just as hard as the root canal cement.

Removal of broken instruments from root canals using a microscope

During root canal treatment because of the extreme curvature of the canals or because of the too narrow canals it can happen that even the extremely flexible Ni-Ti instruments break. Probably this thing could be avoided if we used instruments only once, but the low Romanian salaries do not make it possible. These can be removed only when we use a microscope and some extremely thin instruments and adequate techniques. Their removal is important because the broken instrument in the root canal hinders its cleaning, sterilization and hermetic closure through a tridimensional root canal obturation. In the lack of this intervention chronic inflammations can appear around the root apex because of the bacteria. When we don’t manage to remove these instruments, it may be necessary to remove that part of the root if it does not endanger the stability of the tooth, and also the retrograde closure of the root canal may be required using an MTA filling material.