Endodontics is a root canal therapy, the main goal of which is tooth preservation. As it is said one can always put prosthesis, but one should try to keep his own teeth as much as possible.
During endodontic therapy the usage of modern technologies- surgical microscope, ultrasound, tooth of nickel-titanium, apex-locator and so on, give the dentist more opportunities to keep the tooth and reach positive results in such clinical cases when it was impossible several years ago.
Necessity for such treatment raises in case of development of caries complications (pulpit, periodontitis), tooth fissures, sometimes in the preparatory stage of placing prosthesis. Endodontics is indicated also in case of double treatment when at first time the tooth canales were wrongly treated.
The aim of practical endodontics is to prevent the development or eliminate already existing inflammatory centers of periodontium that are one of the main reasons of loosing teeth. To reach to that goal it is possible only by antibacterial treatment and hermetic closing of root canals which is accompanied with hermetic restoration of dental crown. To realize practical endodontics it is necessary to put the right diagnosis and to work out the precise planning of the treatment.
The diagnosis, as it is known, includes
• collection of anamnesis of illness and lifestyle to find out the allergic state, functional state of inner organ-systems;
• the objective examination of maxillofacial zone of the patient to detect asymmetry, swell, fistula;
• palpation of lymphatic nodes, temporomandibular joint.
The examination of mouth cavity is directed to turn out the state of oral hygiene, mucosa, periodontium, fistulas, the existence of inflammations. Summing up the data of clinic-laboratorial examinations the diagnosis and treatment planning is done.
The treatment of tooth canal may be done in several stages. As a rule a local anesthesia is done. The choice and dose of anesthetic drug depends on the age, weight, duration of dental intervention and allergic card of the patient. The tooth is isolated by special latex texture (rubber-dam) and then the doctor starts to clean the tooth canals with special equipments, tools and medicine under the control of X-ray and apex-locator.
The usage of rubber-dam during the endodontic treatment
The usage of rubber-dam during the endodontic treatment is desirable as far as it provides aseptic work conditions, prevents the infection of tooth cavity with microorganisms by saliva or air being respired; prevents the patient from swallowing accidentally small endodontic instruments. With rubber-dam the time is saved, it becomes easier to make a hollow on the tooth; the quality of treatment remarkably improves.
The endodontic treatment starts with making a hollow on the tooth. There may raise difficulty in tool elaboration of root canal if the cavity is not opened sufficiently or the direct approach to the root canal is impossible. While opening the hollow one must always remember the anatomic structure of the tooth. The correct detection of the length of root canal of the tooth is one of the most important stages of the treatment. The enhanced apex-locators enable to detect correctly the length of the canal; the X-ray imaging also comes to help and gives not only insight about the length of the canal, but also about its curvature or the existence of other canals. In some cases the root canals are filled in the first stage, but often medical preparations are required. In this case the final filling and treatment are done during the next stages. During the period between the stages either a temporal crown is placed or temporary inlay to protect reliably the root canals of the tooth from penetration of microorganisms.
The professional tooth stopping is very important. The classical way of stopping is filling the canals with special latex-like material which is called gutta-percha. There are several ways of stopping with this material: thermo-fill, lateral condensation and thermo-gutta-percha.
Thermo-fill and lateral condensation are used to work with available canals. The thermo-gutta-percha (movable hot mass) fills both the main and the micro canals where the tools do not reach. That material shrinks as it cools and covers all micro-cracks and holes so that the microorganisms cannot breed there.
In a word we can say that thermo-gutta-percha is the most modern and developed method. This method gives the opportunity to fill even the root canals having complex anatomic structure which are nearly impossible to fill another way.
In our practice the method of vertical condensation provides higher clinical reliability giving opportunity to fill the root canals of tooth equally that is being checked by X-ray imaging. In this case such complications as re-stopping or under-stopping are practically excluded. This method is used for most clinical case of teeth treatment, as far as it gives the opportunity to provide long-term treatment. Our clinical experience has shown that the vertical condensation method of tooth treatment with thermoplastic gutta-percha is the most productive and long-term method.
The treatment of root canals of tooth may be controlled and the final result may be estimated by X-ray imaging which is done 12-18 months later and give the opportunity to detect the existence or absence of inflammatory developments in the upper part of the tooth. But as a rule the clinical signs of the inflammation (pain, swell, etc.) are eliminated 1-2 weeks later after the beginning of the therapy and the restoration of the crown may be done several days after the treatment of the root canals.
In the practice of ‘Aregak’ clinic two methods of endodontic therapy are used as far as they fit all the standards of high-quality filling of root canals. With all this the patients always have maximal choice in the treatment methods as that allows both the doctor and the patient to choose the most suitable method for each concrete case to reach the main goal-to keep health.