How is root canal treatment performed?

Features of dental canal treatment

Differences in the structure and functions of the “representatives” of the dentition largely determine the nature of the treatment approach. Treatment of canals for different groups of teeth has its own nuances.

Front tooth canal treatment

The front teeth most often have one canal. They are often curved and difficult to pass through for instruments. In order to preserve aesthetics, the opening of the cavity of these teeth is carried out from the vestibule of the oral cavity. Due to their frontal location, it is important to prevent tooth enamel from darkening, so filling materials containing dyes are not used.

Treatment of wisdom tooth canals

Wisdom teeth can have more than 5 canals; they often have a branched structure, which is not always revealed by x-ray examination. These factors, along with the marginal location of the “eights”, significantly complicate the high-quality treatment of root canals. At the final stage of treatment, various filling pastes are traditionally used.

Root canal treatment of temporary teeth

Endodontic treatment of tooth root canals is usually used only at the stage of root stabilization. When choosing the optimal treatment tactics, it is necessary to take into account the specific structure of temporary teeth. The small thickness of the canal walls, the insignificant degree of dentin mineralization and the relatively large size of the apical foramen are the main reasons for special caution during instrumentation. Zinc oxide eugenol and iodoform pastes, as well as materials based on calcium hydroxide, are usually used as filling agents. They are not toxic to the permanent tooth germ and are able to dissolve along with the temporary root.

Lost temporary filling

What to do when a temporary filling falls out? It is placed to fix the medicine in the tooth cavity and prevent the entry of saliva, food debris and microbes. Arsenic, which is poisonous, is used as a medicine. Therefore, if such a situation arises, a number of measures need to be taken:

• carefully examine the tooth cavity and determine whether the medicine remains there;
• if it remains, carefully remove it with a cotton swab;
• make a warm soda solution (at the rate of 1 teaspoon of soda per glass of water);
• rinse the tooth cavity thoroughly.

When the canals are sealed, the loss of a temporary filling does not cause significant discomfort, but leaving the tooth as is is prohibited. It can be destroyed under the influence of various factors. For a filling to fail, there must be significant reasons and only a specialist can eliminate them.

If a filling with arsenic falls out immediately after visiting a specialist, you need to make a second appointment as soon as possible and have it restored. If there are several days left until the next scheduled appointment, you don’t have to reschedule it and visit the doctor when it’s scheduled. Only a dentist can tell you how long you can walk without a filling, so it’s a good idea to call and get a consultation.

Stages of tooth canal treatment

Endodontic treatment usually lasts several hours and includes a number of stages.

1. Removal of the pulp (pulpectomy).
   The inflamed soft tissue of the tooth is eliminated.
2. Root canal sanitation.
   The procedure is a “cleaning” of bacteria and dead tissue elements. Pulpectomy and canal sanitation pursue one of the most important goals - eliminating existing inflammation.
3. Channel formation.
   The root canal, freed from pathological contents, undergoes appropriate treatment. In addition to ensuring good passage of the canal, it is imperative to ensure that its apex reaches the apical part of the tooth.
4. Canal filling.
   The last stage of the intervention is filling the root canal with filling material, followed by grinding.

Treatment of teeth with problematic root canals

Filling dental canals

A relatively simple technology for treating tooth canals is filling with a special paste with or without a pin. According to the “gold standard” of endodontics, the canals are also filled with a latex-like material - gutta-percha. Several methods of its use have been developed, including the Termafil system, lateral condensation, injection or liquid thermogutta-percha (vertical condensation). In some cases, in particular when treating a tooth canal cyst, filling is carried out with a substance based on calcium hydroxide (copper-calcium hydroxide “depopheresis” method). However, special nanocomposite materials are increasingly used in dentistry.

Treatment under a microscope

The age-old “tough nut to crack” for the dentist is curved or branched root canals of the teeth. A dental microscope, often in combination with a laser, allows you to completely pass through them and adequately process them along their entire length to reduce tissue trauma. Sometimes it becomes necessary to treat a sealed tooth canal with the evacuation of remaining material of various nature, for example, fragments of fillings, tissue fragments and even instruments. Then a microscope also comes to the rescue. Read more about the technology in a separate article.

If your tooth hurts after root canal treatment

If after root canal treatment your tooth hurts when you press it, this is normal. This phenomenon is associated with insufficient anesthesia in the area of ​​endodontic intervention. Another reason why a tooth hurts after canal treatment is excessive treatment with the instrument moving beyond the apical foramen.

How long does a tooth hurt after root canal treatment? Sometimes pain persists for several days due to intensive intervention in the tissue structure in such a limited area. A similar situation occurs when an excess amount of filling material is placed into the canal, which causes discomfort when pressure is applied to the walls. As a result, the tooth “aches” after canal treatment. In any case, the presence of post-filling pain signals the need for a second visit to the dentist.

Why does pain occur?

Caries first attacks the hardest tooth tissue, the enamel. Then the dentin underneath begins to deteriorate. When the carious cavity reaches a large size, the infection will reach the pulp, ending in the root canals. An infected pulp causes increased blood flow, pressure in it increases and, not finding a way out, leads to painful sensations. Thus, the need arises for the treatment of pulpitis or periodontitis .

The pulp can become infected for other reasons:

1. due to mechanical damage resulting from an impact;
2. with impaired blood circulation in the jaw area;
3. with neuralgia of various origins;
4. due to infection spreading from periodontal pockets in patients with periodontal disease and periodontitis.

Possible complications

Not all cases go smoothly. Let's consider the main problems that arise after the procedure.

• Perforation.
  The phenomenon is the formation of holes between the dental canals and surrounding tissues. Treatment of perforation consists of medicinal treatment and filling.
• Cheek swelling.
  The reason why the cheek is swollen after root canal treatment is believed to be the impregnation of the periodontal tissues and mucous membranes with an anesthetic drug, which themselves are quite loose and easily absorb liquid.
• Instrument fracture.
  The probes for passing through the channels are very thin. If they break during medical procedures, the fragments are removed with special devices. Modern dental instruments made of nickel-titanium alloys are less susceptible to wear and break less often.
• Adverse reactions to medications.
  The range and severity of side effects of modern anesthetics are minimal. Before treatment, the doctor must collect an allergic history - information about drug intolerance - and the likelihood of a full-blown allergic reaction is practically reduced to zero. Adverse reactions of moderate and minor degrees are mostly short-term, can be easily corrected or can be overcome by changing the drug.
• Other complications.
  Situations such as swallowing particles of fillings, tooth dust, and small instruments now practically do not occur thanks to the use of a rubber dam - a latex plate that separates the tooth or teeth being treated from the oral cavity.

When is tooth extraction necessary after root canal treatment?

It happens that you have to part with a treated tooth. Typically, such a sad outcome is due to the following factors:

• initially unsatisfactory root canal treatment with the development of poorly controlled inflammation;
• some cases of wisdom teeth treatment;
• the complexity of the anatomical structure of roots and canals in a particular patient;
• late request of the patient for specialized help, in which adequate therapeutic measures do not lead to the desired result.

What to do if an impacted tooth is found?

There are 3 solutions to the problem of an impacted tooth:

1. Orthodontic traction and placement in the dentition. This is often done with impacted teeth that are located in the smile zone - canines and incisors, provided that there is a place for them in the dentition and the tooth itself is healthy.
2. Removal is a common fate for impacted eights, especially if the patient is undergoing orthodontic treatment. Very often, wisdom teeth erupt partially – this provokes inflammation and complications. Even a completely impacted (“hidden”) tooth serves as a potential source of caries, tooth displacement, and instability of orthodontic treatment. There are many reasons - there is only one verdict: it is better to delete it. Other indications for the removal of different types of impacted teeth are cysts, signs of inflammation, lack of space in the dentition, destruction of the neck of the tooth, caries.
3. Preservation and surveillance. It is justified when the patient has no problems with the place in the dentition or bite, orthodontic treatment is not required, the tooth does not provoke complications and its absence does not spoil the aesthetics of the smile. Such teeth are observed; in case of the slightest problem, they are recommended to be removed.

What is the cost of treatment?

How much does root canal treatment cost? The cost largely depends on the method used and the quality of the materials. When using laser and microscopic technology, nanocomposites and other advanced developments, the cost of tooth treatment with canal filling increases significantly. Approximate prices for root canal treatment in Moscow with gutta-percha filling and composite filling are presented in the table below.

The cost of root canal treatment should not be the determining factor in choosing a clinic. Contact only dentistry with a good reputation and experienced specialists who use modern equipment and the latest techniques in their work. Remember - the future fate of your teeth and the aesthetics of your smile depend on the quality of canal treatment!

How to pull out and place an impacted tooth in the dentition?

In some cases, if the root of an impacted tooth has not yet formed and there is an obstacle to its eruption, then removing such an obstacle is enough for the tooth to come out of the gums and take its place in the dentition. If the tooth root is already formed, this method will not help.

To “get” and move a fully formed impacted tooth into the dentition, treatment is carried out in 3 stages. Here we present the “classical” scheme, because in individual cases there may be deviations from this scheme.

1. Preparatory orthodontic stage - you need to prepare a place in the dentition to which the orthodontist will move the extracted tooth. To do this, a braces system is installed, which aligns the teeth in the dentition and frees up the necessary space.
2. The surgical stage is the image of the crown of an impacted tooth, on which a bracket or button is installed to transmit force from an arch or elastic element.
3. The main orthodontic stage, during which the impacted tooth is pulled out and placed in its “rightful” place in the dentition.