Endodontist Rūta Žongolavičiūtė answers the questions about a root canal treatment.
A tooth consists of 3 main tissues: enamel, dentin and the pulp (with nerves and blood vessels) inside the tooth. Endodontology is the study of the interior of the tooth and about a canal system of tooth roots.
1. Kada reikalingas endodontinis dantų gydymas?
- If there is pain, indicating the inflammation of the pulp or the apical bone.
- If the deep decay violates not only the enamel, dentin, but the tooth pulp as well. In this case pain may not be felt.
- If pustules-track (fistula) form in gums and lead to an infected apex of tooth root.
- A recent dental trauma, when the tooth crown crashed to the pulp.
- Old dental trauma when the pulp lost its vitality, the darkening of the tooth crown. Pain may not be felt.
- X-ray shows bone destruction around the root tops.
- Narrow or curved channels that have not been filled at the time of pre-treatment.
- Porous or insufficiently fused filler material monitored in channels when tooth prosthesis is planned
- Teeth were left with the temporary crown filling or open for longer than 2 weeks.
- Prosthesis of the tooth is planned and the tooth crown restoration has not been hermetically sealed for a long time.
2. Kokia endodontinio gydymo eiga?
Endodontiniam gydymui atlikti reikia 1-3 paciento vizitų pas gydytoją endodontologą. Vieno vizito trukmė 0,5-2 val., priklausomai nuo gydymo sudėtingumo. Kiekvienas klinikinis endodontinio pergydymo atvejis yra unikali procedūra, reikalaujanti individualios gydymo taktikos parinkimo, kuri priklauso nuo esamos danties vainiko restauracijos, užpildo medžiagos tipo danties šaknų kanaluose ir kt.
- Prior to endodontic treatment, and during the treatment, a sufficient number of X-ray images are made. Tell your doctor if you are pregnant.
- Local anaesthesia is performed before the procedure. Warn your doctor if you are allergic to certain local anaesthetics.
- During the treatment, the special protective film from latex rubber is used. Warn your doctor if you are allergic to latex. Then the film made of other materials will be selected.
- During the therapy the doctor may use a visible image increasing tool – a microscope, through which the doctor evaluates the tooth root canals, possible degradation of a tooth and other small structures.
- During treatment, root canals, which may be 1-2 channels in front teeth and 3-5 channels in molars, are localized. The channels are broadened with small endodontic instruments and washing agents.
- Between visits, channels are stuffed with specific medication and tooth crown is reversed with temporary filler.
- During the final visit, channels are filled with gutta-percha and sealer. In some cases, channels or their parts may be filled with MTA cement.
3. Can procedures change in the course of the treatment?
Depending on the procedure, the required number of visits for endodontic treatment can vary.
Sometimes an x-ray examination does not show perforation. They can be seen under a microscope only when endodontic retreatment has begun. Treating of these dental problems will require more visits to the endodontist.
Sometimes the clinical and x-ray examination does not monitor the vertical root fractures and when endodontic treatment has just begun, the fracture can be observed under a microscope. There is no dental treatment for this pathology and a tooth has to be removed.
4. What are possible complications?
- After the broadening of canals, drug stuffing into canals or after completing the procedure of treatment, a tooth may be sensitive and painful for a few days after the visit. Take prescribed medicine for pain and inflammation.
- If the tooth pulp has been infected before the treatment, you can swell after the procedure. Then contact your doctor for a matter of urgency without waiting for following appointed visit of treatment. Upon arrival to the doctor you may need to have a small incision in gums and release the accumulated purulent exudate and / or take a course of antibiotics prescribed by a doctor.
- Endodontic instrument splits in the root canal.
- The perforation of the pulp chamber bottom or the root canal.
- The step in the root canal.
- Canal irrigation drugs access the root apex.
- The canal filling material accesses the root top.
- Vertical root splitting.
- Due to the anaesthesia in mandibular molars block, the nerve damage, which may impair the side cheek skin and taste up to 6 months, is possible.
5. An endodontic treatment of the tooth finished. Is that all?
That’s not the whole treatment of a tooth. Temporary crown filling after endodontic treatment is sealed up to 2 weeks. During this time, it must be replaced by a permanent restoration (filling materials, glass fibre or a metal pin according to the indication specified by the dental prosthetist). High-quality permanent tooth restoration increases the success of endodontic retreatment.
Necessary dental clinical and radiological surveillance after 6, 12 months and once a year in 4 years period. A tooth symptomatics is evaluated, gingival pockets are measured, and the destruction of the bone root node value is seen on X-rays. Therefore, even without feeling any symptoms listed in the following periods, you have to come to the endodontist to perform inspection and X-ray that the first tooth renewed signs of the disease are detected and treated as early as possible.
If after conservative endodontic retreatment, the healing of bone destruction is not observed in the field of root tops (in 2-4 years), then it is recommended to apply a surgical method of treatment.
Endodontic treatment or re-treatment warranty is not granted. In each particular case, the endodontist, after assessing the situation, provides information and explains the possibility of successful endodontic treatment or retreatment of your tooth. The final choice of method of treatment depends on the patient’s expectations.