Dental root canal treatment (endodontics)

Endodontic treatment, or root canal treatment, helps to preserve the natural teeth and is used to treat root canals. Endodontic treatment makes it possible to save a decayed or badly infected tooth without breaking it. It is used when the decay not only affects the surface of the tooth itself, but also extends so far that it reaches the soft tissues of the tooth (pulp). When the pulp is damaged, the blood vessels and nerves die and the tooth becomes dead. Endodontic treatment may also be necessary due to multiple dental procedures performed on the same tooth, or trauma to the tooth when it cracks or splits due to a poorly made crown restoration. When the inner tissues of the tooth become exposed, they are vulnerable to bacteria that cause inflammation. The longer this inflammation is left untreated, the deeper it spreads into the surrounding tissues, causing periodontitis. Eventually, the jawbone around the infected tooth dissolves and a focal area forms. Without timely endodontic treatment, it is possible to lose your own tooth, which will then have to be restored with an implant or dental bridge.

The aim of endodontic treatment is to preserve the natural tooth so that it doesn’t need to be pulled. Thus, root canal treatment can be said to be a sparing procedure that seeks to preserve the natural teeth for as long as possible.

Dental root canal treatment is carried out under high magnification with customised optics, using an ultrasound machine, special instruments and other high quality materials. This ensures the quality of canal shaping and filling. Complex root canal procedures such as closing perforations and removing broken instruments are also carried out.

Endodontic treatment can be carried out in one or several visits. The procedure is as follows:

1. The patient is examined and undergoes an X-ray to assess the condition of the tooth, determine the number of canals present, their length and curvature;
2. Local anaesthesia and isolation of the tooth with a cofferdam system if necessary;
3. Opening the tooth pulp through the top of the crown and removing damaged tissue;
4. Mechanical and chemical cleaning of all canals using very small instruments, thorough removal of infected or inflamed pulp;
5. The tooth canal is widened, shaped and sterilised in preparation for the therapeutic calcium paste or final canal sealing;
6. In the absence of inflammation, the root canal is completely isolated by filling it with a biocompatible material – gutta-percha;
7. In some cases, root canal treatment can be completed in one visit. In this case, after the root canal is filled, the crown of the tooth is restored with a restoration.

After the endodontic treatment, the next step is the restoration of the crown. Sometimes a filling is enough to restore it, but most often a denture is needed. After the final restoration, the tooth functions as a natural tooth.

In most cases, all teeth can be treated endodontically. Very rarely, a tooth can no longer be saved because its root canals are impassable. Root canal treatment is a complex process and the success of the treatment depends not only on the dentist but also on the patient. It is not recommended to chew or bite with an endodontically treated tooth until the crown has been fully restored. A tooth that has not been fully restored is susceptible to fracture, so the crown must be fully restored immediately after the canals have been cleaned and sealed. It is very important that the patient follows all the steps prescribed by the doctor and that he/she attends regular preventive check-ups after endodontic treatment, during which the tooth is closely monitored.

Dentists usually have to re-treat root canals of teeth that have been treated endodontically for a very long time. In earlier times, doctors lacked the right equipment, advanced tests and materials, so endodontic treatment was carried out “blind”. Modern dental technology is very far advanced and offers much better diagnostic and treatment possibilities.

During endodontic retreatment, the canals are re-cleaned and resealed. It is a complex treatment that requires a lot of knowledge and care.

Endodontic re-treatment is needed when the first endodontic treatment was not successful. This happens for various reasons:

• poorly cleaned, poorly sealed canals, resulting in inflammatory foci at the root apex;
• all the canals in the tooth are missed;
• recurrent or incomplete healing of inflammation during initial treatment;
• tooth trauma;
• if a fistula (“abscess”) forms in the gums near the endodontically treated tooth;
• if the X-ray clearly shows incompletely or non-hermetically sealed canals at the time of initial treatment;
• if you have a leaky or loose temporary filling in your mouth and you are planning to have dentures;
• if there were complications during the previous treatment, such as perforation of the canal or the base of the tooth, a separated instument in the canal, or canal “clogging”;
• delayed crown restoration after root canal filling, etc.

At “Dantų Meistrai”, individual optics ensure good illumination and increased visibility of the working area when the canal treatment involves removing old filling, redoing the chemomechanical preparation of the canal, often removing old complications (e.g. “clogging” of the root canal), and finally sealing the root canal. The optics we use help to assess the anatomical features of the root canals. After a successful root canal treatment, a sealed restoration of the coronal part of the tooth is necessary. We recommend that the endodontically overtreated tooth be restored by prosthetic/microprosthetic restoration due to the size of the lesion and the remaining weak walls. This restores the chewing function and ensures strength.