Apicoectomy and Endodontics
When you go to your dentist, they often talk in a lot of numbers. These number represent various aspects of your mouth’s health.
Dentists divide your mouth’s interior into four sections called quadrants. The upper right quadrant has teeth numbered 11 through 17. The lower left quadrant has teeth numbered 21 through 28.
Root canals are necessary when a tooth’s soft pulp tissue is infected, exposed or decayed due to severe tooth damage. Prompt treatment relieves pain and discomfort, prevents infection from spreading, and promotes healing. Symptoms of an infected or abscessed tooth include severe tooth pain, swelling or bad taste in the mouth.
To treat a root canal, the dentist first numbs the area with a local anesthetic. He or she then removes the damaged tissue, cleans and disinfects the canals (tiny pathways inside the tooth), and fills the space with a hard material.
He or she may place a crown on top to strengthen the tooth and protect it from chewing forces that can cause it to break. After the procedure, you can expect some mild discomfort or sensitivity, but over-the-counter pain relievers can help manage this. Follow the aftercare instructions provided by your dentist to encourage healing and minimize discomfort.
While a root canal is often all that’s needed to save inflamed or infected teeth, sometimes it is not. In those cases, a microsurgery called apicoectomy may be required. In this procedure, the endodontist removes the infected tissue at the tip of the root and cleans the root surface before sealing it. The tooth is then restored with a filling or crown, and it functions like any other healthy tooth going forward.
Beneath the enamel and dentin layers of each tooth is a type of soft tissue known as dental pulp. This tissue contains blood vessels, nerves and connective tissue, and it is essential to a tooth’s growth and development. However, a fully mature tooth can exist without it, because the tooth is nourished by tissues around it. Symptoms of pulp inflammation or infection include pain, prolonged sensitivity to cold or hot, or drainage. When left untreated, the condition can lead to an abscess. The goal of endodontic treatment is to save the tooth and prevent complications.
Irrigation is considered the primary factor in eradicating microbes from the canal space and preventing reinfection due to coronal leakage. Successful endodontic treatment requires access cavity preparation, location of all root canals and their apices, instrumentation, irrigation and disinfection and placement of an appropriate root filling.
The most effective irrigant in the removal of smear layer and cleaning of canals is undiluted sodium hypochlorite. However, NaOCl has its drawbacks: it is odiferous and toxic, it cannot reach the apical portion of the canal, and it induces dentinal erosion when combined with chelating agents such as EDTA.
In order to overcome these limitations, several irrigating solutions have been developed. Among them are a combination product with detergent (SmearClear) and a low-surface tension solution with a high penetration ability into the root canal (Qmix). In addition, it is possible to activate irrigants by ultrasonics or high-speed suction (EndoVac system). MTAD, a new irrigating agent, is both antibacterial and effective in removing the smear layer and cleaning canals without the dentinal erosion associated with EDTA.
It is important that the practitioner has an appropriate endodontic instrumentation system to achieve effective removal of infected and affected dentin, adequate shaping, and fitting of a master filling point. There are many available systems and it is best for the clinician to experiment with a few of these. Practitioners should be cautious in deciphering fact from marketing and avoid a system that appears to oversimplify the process.
Rotary NiTi files have revolutionized instrumentation techniques, making it much less fatiguing for the practitioner and producing a quality of shaping that is not possible with hand instruments. There are now a variety of unique design features being offered for these files, and it is important that the clinician carefully deciphers these claims.
Separation of an endodontic instrument during treatment is common, and it may result in a perforation. Regardless of the reason for a separated instrument, it is a complication and the patient is entitled to a full, honest explanation of this incident as well as arrangements for remedial treatment/review.