Patients commonly have to take the difficult decision whether to have a painful tooth removed and get rid the problem permanently or to attempt to save the tooth despite significant costs and patience required in such an option. In the face of this dilemma, you should remember that tooth extraction is an irrevocable step, requiring replacement of the removed tooth in the future. Thus, such a solution should be reserved for irremediable cases only. It is always worth taking up the challenge and using the last and usually only chance to save the tooth thanks to modern endodontics.
Endodontic treatment applied in the case of dental caries complicated by inflammation, necrosis or gangrene of the dental pulp consists of the removal of infected or dead pulp from the chamber and root canals, mechanical dilatation and disinfection of the canals and tightly filling the canals with special material. To ensure the success of canal treatment, the Villa Nova Dental Clinic applies the most recent technical developments:
- modern tools for canal preparation, both manual and mechanical (K3 KENDO, PROFILE, PROTAPERY);
- tools for measurement of the canal depth, eliminating the need for X-ray, based on electronic signal analysis: the endometers ENDO MASTER Apex N.R.G. LOKATOR that allows appropriate canal treatment in pregnant women, as due to the harmful effect of radiation the treatment would be otherwise have to be postponed until after the delivery.
- systems for filling the dental chamber and root canals (OBTURA, THERMAFILE);
- titanium magnifying glass SANDY GRENDEL that allow 2.5x and 3.2x magnification of the observed picture; this improves the comfort of the dentist's work and precision of the procedures performed;
- ultrasound scaler Endo - Chuck - facilitating denstist work and it allows to reach inaccessible for hand tools places;
- endodontic microscope Carl Zeiss, a technology providing a invaluable improvement in endodontic treatment. Thanks to this device, many teeth that would otherwise be removed may be saved. The microscope, providing an enlarged image at great depth, a wide field of vision and very good illumination, allows observation of details invisible to the naked eye. The application of the microscope is of particular assistance in seeking root canal openings and in the localisation and removal of broken canal tools. A video camera included in the set allows image transmission and recording of the procedure, and then presentation of subsequent treatment steps to the patient.
The correctness of any procedure performed may be immediately verified by X-ray taken at the scene in our X-ray laboratory and not leaving the dentist's unit in endodontic cabinet (dental x-ray Picture).

BIOLOGICAL TREATMENT OF THE PULP

The aim of biological treatment is to keep alive the dental pulp (internal tissue of the tooth) in the event of the initial stages of reversible inflammation. The success of the treatment allows the most effective treatment available, i.e. to maintain the living natural tooth. The treatment consists of the removal of the underlying cause of the disease, which is usually dental caries, preservation of the tooth affected using special agents and filling of the cavity. The method gives the great possibility of saving the tooth; however, the method may be applied if the patient is young, and has a good general health condition and perfect oral hygiene.

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TREATMENT OF IRREVIRSIBLE PULP INFLAMMATION

This method of treatment is successfully used in cases of more advanced pulp inflammation. The core of the canal treatment is the removal of the affected pulp from the dental chamber and root canals, mechanical dilatation and disinfection of the canals and tightly filling of the canals with special material. There are two methods for the removal of the content of the chamber and root canals which are used to provide the patients with the maximum treatment comfort, i.e. lack of pain and efficient treatment:
- enucleation under anaesthesia;
- enucleation following devitalisation;.
After this initial stage, a further course of treatment is routine. The treatment effect is assessed immediately, thanks to an X-ray taken at the time, in our X-ray laboratory.

TREATMENT OF PULP NECROSIS AND GANGRENE

Such treatment differs from the canal treatment used for pulp inflammation in its need for complete removal of infected dead or gangrenous pulp, more extensive dilatation of the canals and the application of strong disinfecting agents to remove bacteria that may pose a threat to the whole body.

TREATMENT OF INFLAMMATION OF PERIAPICAL TISSUES

Inflammation of periapical tissues, i.e. tissues adjacent to the roots of the teeth, may pose a significant problem to the patient. Pain of teeth can take a stand chewing difficulties, and in some cases swelling, fever and general weakness. However usually it is asymptomatic. The treatment of such conditions is similar to that of pulp gangrene or necrosis; however, it frequently requires significantly more visits at longer intervals, e.g. every three months and a regular X-ray check-up. This is the reason why it is so important to take panoramic x-ray Picture when a full dental diagnostic is undertaken.

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REVISION OF ROOT CANAL TREATMENT

Revision of endodontic treatment, i.e. repeated canal treatment is performed in the following circumstances:
- pain caused by the tooth after canal treatment;
- inappropriate root canal filling visible on the X-ray, if the tooth is to undergo prosthetic treatment (prosthetic crown, root-crown inlay, bridge);
- bone lesions visible on the X-ray, which have not healed after canal treatment.
Repeated endodontic treatment is more difficult and complicated than the initial one. It requires the dentist to remove the material filling the canal(s), to find the omitted canal or localise and remove the broken part of a canal tool (which is a common cause for the revision). In such conditions the application of the endodontic microscope is inestimable benefit, enabling many teeth that otherwise would be removed to be saved.

COURSE OF TREATMENT

Detailed diagnostics is the foundation of correct diagnosis and planning of efficient endodontic treatment, similar to other branches of medicine, which include:
- medical history that allows the dentist to learn about the patient's ailments, general health condition and expectations from the treatment;
- clinical examination, particularly detailed when concerning the tooth in question, but also involving the whole dentition, occlusion and condition of the periodontium and mucous membrane;
- additional examinations, of which an X-ray provides the most information, in particular on the tooth structure and condition of the adjacent bone.
Having considered the examination results, making a diagnosis and proposing a treatment plan for the patient, the actual treatment may be commenced; the course of treatment depends on the condition diagnosed.

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FAQ

1. Why should I decide on canal treatment for my teeth?
2. Is endodontic treatment painful?
3. Why do teeth after canal treatment become dark and less durable than the others?
4. How darkening of the tooth after canal treatment can be prevented?

1. Why should I decide on canal treatment for my teeth?

Many people dream of having their own healthy teeth up to very old age, but usually it is very difficult to maintain dentition in perfect condition. However, it is always of use to fight for every single tooth, even if it causes pain. In such a case, endodontic treatment may be the last and usually only chance to save the tooth, and recent enormous progress in endodontics allows teeth to be saved that would otherwise have to be removed.

2. Is endodontic treatment painful?

The only painful element of the canal treatment may be pulp removal. However, to provide the patients with the maximum comfort during treatment, i.e. painless efficient treatment, the procedure is performed under local anaesthesia or after previous application of a necrotising (devitalising) agent. The next stages of the treatment are performed with gentleness and precision, to minimise any discomfort to the patient.

3. Why do teeth after canal treatment become dark and less durable than the others?

The reason for this phenomenon is the fact that teeth are deprived of their pulp during the treatment. This is a living portion of the tooth responsible for its contact with the rest of the body and which plays the role of supplying the tooth with nutritional substances. Thus, the tooth after canal treatment is a dead tooth, the signs of which are its darker colour, decreased mechanical endurance and lack of reaction to temperature changes.

4. How darkening of the tooth after canal treatment can be prevented?

Such a tooth may be bleached by means of various methods. One of the most common methods of tooth bleaching is an intrachamber one that consists of placing a bleaching agent in the tooth's chamber and then closing it with a sealed dental dressing. The procedure is repeated until the desired result is obtained.

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