Endodontology is the science of the identification, prevention and treatment of dental pulp disease or the inside of the tooth. Endodontic treatment is necessary when inflammation or infection is present inside the crown and/or the root part of the tooth. Among the most common causes are caries or tooth decay and damage.
The Importance of Thorough Treatment
The pulp chamber, along with the root canals, is a complex vascular and nervous system. Caries, injuries or other causes can cause irreversible damage to this system and the tooth starts to diminish. This can be accompanied by pain, but most often the patient has no issues. In this case, the dead tooth is detected randomly during a clinical or X-ray examination.
When the tissue in the tooth dies, the residue of a necrotic organic substance in the interior becomes a medium for bacteria. The growth of bacteria triggers an inflammatory response, causing a bone cavity to form above the roots. This is called a granuloma.
The main purpose of the endodontic treatment is to remove the inflamed or necrotic tissue from the entire root system. Tissue and bacterial residues reduce the likelihood that treatment will be successful and problems may therefore persist or occur later in spite of the performed endodontic treatment. If the treatment is performed accurately and thoroughly, in most cases the bone cavity is closed within a year.
The primary endodontic treatment is performed when the tooth has not yet been treated and we are cleaning the roots for the first time. The effectiveness is high (more than 90%), and treatment is not usually complicated.
In re-endodontic treatment, the tooth has been treated in the past, but inflammation persists. This type of therapy is more complex and the probability of treatment being successful is slightly smaller (more than 80%).
Rarely, despite a well-conducted procedure, inflammation in the bone still persists. In this case an apicotomy is made - this is a small surgical procedure in which the infected root tip along with the surrounding inflamed tissue is removed.
For the best possible results, in the treatment, we use modern devices such as microscope, rotary root canal instruments, laser and ultrasound. This, in addition to continuous education and patient and accurate work, greatly increases the effectiveness of the treatment compared to the standard type of work.
Planning the Final Care
The purpose of endodontic treatment is the removal of inflammation resulting from an infection of the root system. Through various prosthetic procedures, which include everything from simple composite fillings to larger full-ceramic restorations, we restore the lost function and aesthetics of the tooth.
A key step in endodontic treatment is to assess the reasonability of the treatment. It is necessary to foresee the final form of the functional and aesthetic rehabilitation prior to the start of the treatment. If we estimate that the tooth could not be completely prosthetically treated after the endodontic treatment, the treatment is not reasonable.
A common complication after completing a successful endodontic treatment is a fracture of the tooth or dental crown. Teeth that need the cleaning of the canal system are more fragile due to the cause (caries, injuries, ...) and the teeth are further weakened by proper endodontic therapy due to effective spreading and cleaning. Appropriate prosthodontic care after endodontic therapy is an important step in the overall treatment, as this will greatly reduce the possibility of complications in the future that would lead to loss of the tooth.
Working with an operational microscope allows us to greatly increase the field of vision and improve the illumination. In this way, it is easier to discover additional canals in the root system and remove possible broken instruments and remains of unsuccessful fillings and thus we increase the effectiveness of the treatment.
Ultrasound and Laser
In combination with an operating microscope, the endodontic ultrasound removes residues of infected tissue and fillings, calcifications and additionally irrigates the canal for thorough disinfection.
The hard tissue laser provides additional irrigation of the root system with disinfectants.