Root canal treatment

Effectiveness in saving the tooth, maximum precision thanks to innovative methods and excellent control under the microscope.
Dear Patients,

with use of the acquired didactic experience, I would like to outline the root canal treatment issue, also called endodontic treatment by doctors.

In Cadent Clinic we have created Microscopic Endodontics Center for you. We have equipped it with the highest quality equipment, including Kodak 9000 CT scanner, Kaps treatment microscopes and root canals thermal filling systems as well as specialized materials for restoring continuity of root canal walls resulting from perforation and RVG apparatuses. Dentists working in the Clinic have up-to-date knowledge in the field of endodontics and experience allowing to solve the most complicated endodontic cases.

Why a CT scanner? Isn't an X-ray or RVG apparatus enough?

In fact, in most cases, X-ray or RVG imaging is sufficient. However, complicated cases such as: canals that are not accessible despite preparation, perforations close to the apex of the dental root, deep strip perforations, root deformations, hidden inter-channel isthmus, vertical cracks or inflammatory changes around the tooth root that are not healing for an unknown reason and require extended diagnostics. In this case computer tomography imaging is very helpful. The image obtained in this examination is three-dimensional and extremely accurate. We can see the tooth from all sides, both "inside" and "outside", thus obtaining a lot of additional diagnostic information needed to establish or modify the treatment plan.

RVG imaging

During the entire treatment, a dentist takes several RVG (radiovisiography) pictures. The image obtained in this way is saved in a computer program. The first image is taken before the treatment begins. This allows to discuss with the patient the treatment plan and the anticipated prognosis.
It may turn out that during the treatment it is necessary to take further photos for diagnostic purposes: to determine the length of root canals or to assess the correctness of the preparation. After the end of the tooth treatment, i.e. after filling the root canals, a control photo is taken to check whether the canals have been filled up completely to the predefined length. It happens that patients are worried about the number of RVG images taken. Needlessly. The radiation dose is negligible and has no negative impact on the patient's body. Additionally, the patient is always protected by a lead apron.

Pregnant women and endodontic treatment

Pregnant women are given special care during root canal treatment. This ranges from an anaesthesia that is safe for the child and does not penetrate the placental barrier, drugs that are suitable for the "condition" and that are placed in the canals between visits, to the correct filling of the canals.

Usually it is controversial to apply RVG during pregnancy. The decision is made on a case-by-case basis, after considering a number of factors, including the main one covering the development of the diagnosis and treatment plan. Sometimes it happens that the treatment is brought to a certain stage and then postponed until delivery. On the one hand this allows to eliminate the inflammation from the patient's body and, on the other hand, to obtain time for proper treatment in the near future when diagnostic is uncertain (perforations, broken canals, extensive inflammatory changes around the root apex and others). Then the tooth is properly protected, usually with a composite filling.

What are the benefits of working with a treatment microscope?

Invaluable in short.

The basis for long-term success in root canal treatment is to find all canals, including additional canals, branches, and develop (cleanse) them along their entire length and then fill them tightly and precisely.

Dental microscope allows for the treatment of teeth which until recently had been condemned to extraction. It enlarges the field of vision several times and illuminates it very strongly. Thanks to that, it is possible to find canals that are invisible to the naked eye, remove obstacles such as broken and left in the canals tools, metal , fiberglass, silver refilling. Very often the cause of canal obstructions are "steps" left inside the canals which were created during attempts to unblock the canals "blindly". Their location and smoothing allows for further work along the entire length of the root canal.

Can a broken tool be removed during root canal treatment?

In the vast majority of cases- The answer is yes.

During tooth root canal treatment, especially with a complicated anatomy (curved or very narrow canals), it may happen that the dentist’s tool gets broken and some of it remains in the canal. The biggest problem that results from this situation is that the rest of the canal, that is the part below the broken tool, remains inaccessible to subsequent tools and therefore it is not developed, cleaned, rinsed or filled.

An empty space below the broken tool leads to the development of bacteria and consequently to failure of root canal treatment. That is why its removal is so important, even if the tooth is asymptomatic and the patient found out about the existence of the left tool by accident while taking an X-ray for another reason.

In order to remove such an obstacle from the canal, an endodontic microscope is needed so that the dentist can locate it without unnecessary destruction of tooth tissue (the magnification under the microscope is 6-30 times). Then, still under the microscope's control, the instrument is accessed and removed with use of one of several methods. The method depends on, among other things, the location of the tooth, its anatomy, where the tool is stuck and the access to the tooth cavity.

What is PERFORMATION? How can you close it? What is the prognosis?

Perforation is the discontinuity of the tooth root hard tissue. Colloquially speaking, it is a "hole" in the tooth root of different sizes depending on how it was made. It occurs during an improper or careless search of the root canals, mistake or other events or it was caused by a carious defect (we are talking about carious perforation then). We also distinguish "old" and "fresh" perforations, whereas the latter prognosticates much better.

There are also open apex perforations which are created by destroying the apex of a tooth root by its excessive instrumentation.

Depending on the location of the perforation and extent thereof, different procedures as well as different materials (MTA, Geristore) are used to restore the continuity of the tooth root tissues. The earlier the perforation is closed, the better the prognosis for the tooth. The "wait and see" policy in case of perforation results in the formation of inflammation around the perforation and consequently bone atrophy and subsequent loss of the tooth.

In order to close the perforation excellent equipment and tooling facilities are needed (treatment microscope, sterile materials dedicated to closing the perforation, auxiliary materials) and, most of all, an experienced operator.

Long-term prognosis is estimated on an individual basis as the success of the procedure depends on many variables, however in most cases we define them as "good" or "very good".

So what is root canal treatment?

There are nerves and blood vessels in the root canals of a healthy tooth. They form a structure called dental pulp.

Root canal treatment is necessary when due to bacteria inflammation of the tooth pulp occurs (i.e. in case of deep carious defects). The inflammation often manifests itself in pain but not always. In some cases it is asymptomatic especially when the process is slow. Only during the preparation of a tooth for composite filling the dentist notices that the carious process has already covered the pulp. This is a clear message for the dentist that root canal treatment should be started. Another indication for endodontic treatment is tooth necrosis and tooth gangrene. It occurs when the tooth pulp dies as a result of chronic inflammation of the tooth pulp (which may be symptomatic and "gone over" by the patient or asymptomatic).

Root canal treatment usually covers two visits. At the first visit canals should be cleaned and then shaped, rinsed them and medicine inside should be applied. This is called mechanical-chemical root canal development. If a tooth is damaged cariously, its missing walls must be rebuilt before treatment is undertaken.

At the second visit the dentist fills the channels with dedicated material. Most often it is gutta-percha. In the Microscopic Endodontics Centre we use the thermoplastic gutta-percha method. This means that a warm plastic substance is poured into the canals with very often irregular shape and then the substance tightly fills the canals and flows into the lateral canals or fills the interstitial spaces.

Sometimes additional visits may be needed or it happens that only one visit is enough. Such decisions are most often made either on an intraprocedural basis as only the dentist is able to receive full information about the condition of the tooth treated or between visits when the patient reports persistent or increasing pain.

I hope that thanks to this non-short description I have brought you closer to the teeth endodontic treatment issue. If you have any questions, please do not hesitate to contact or consult us before the root canal treatment.

Marzena Biegańska, MD
Dental surgeon