Endodontic therapy

Under a root canal treatment is understood in dentistry treatment with the aim to get a tooth whose pulp is ( " tooth nerve" ) vital, but irreversibly inflamed or non-vital ( dead ). Here, the vital or non-vital pulp tissue is removed from the root canal, root canal expands while removing surrounding the root canal infected root dentin. The root canal treatment is part of endodontics.

  • 4.1 access cavity
  • 4.2 Cleaning
  • 4.3 shape
  • 4.4 filling
  • 4.5 Example

Causes

The causes of the inflammation of the dental pulp ( pulpitis ) are varied. Most first there is a carious defect, which serves as portal of entry for bacteria and runs often painless. A tooth fracture or trauma treatment, for example, by overheating during grinding of the tooth for a dental crown can lead to pulpitis, which can be acute extremely painful. Rarely can also cause inflammation of the pulp of retrograde occur when the periodontium is so damaged that the infection of the gum pocket rises into the root canal.

In the course of odontogenic infection, the pulp dies and the germs are spreading in the system of root channels. The body may be located outside of the tooth with an inflammation of the gums ( periodontitis apicalis ) respond in terms of a defense reaction. An apical periodontitis can be present in an acute or a chronic form. The acute form is often associated with pain, it can be difficult radiographically verified under certain circumstances, while a chronic apical periodontitis can be visible at a resolution of the bone structure in the region of the root tip in the X-ray image.

Indications

A root canal is performed usually in two indications:

  • If the tooth vital and damaged the pulp irreversible, a vital extirpation is performed. After a local anesthetic (dentistry) the pulp is removed with a Exstirpationsnadel and mechanically cleaned the system of root canals by a so-called treatment. The channel wall is polished with files in ascending thicknesses. After further purification processes using sodium hypochlorite, the tooth is resealed.
  • Is already the devitalized tooth is the goal of treatment, the removal of the gangrenous pulp and seeds from the tooth inside. The system of root canals cleaned - After the opening of the tooth is also here - as in the vital extirpation.

In some cases, a vital, healthy tooth by means of a root canal treatment must be devitalized. This may be necessary in the following cases when the tooth can not be prosthetic treatment:

  • The tooth has a poor, mostly tilted position and will serve as a cornerstone for a prosthetic supply, eg a double crown prosthesis, but it must be so far been sanded due to the Kippungsgrades that the pulp is opened,
  • The vital tooth is fractured at gum level, the pulp is not opened and it has to be rebuilt by a pin structure. To this end, a fastening pin to be inserted into the root canal.

Goal of treatment

Objectives and principles of root canal preparation

  • Complete removal of the pulp tissue, germs and necrotic material from all channels
  • Preserving the integrity of the periapical tissue or creating the condition to heal existing lesions periapical
  • Treatment exactly to the endodontic apex
  • Allseits uniform processing of the channel walls without change in shape of the channel and without excessive weakening of the root
  • Shaping to facilitate and optimize the final filling

Objectives and principles of the root filling

Bacteria poet and permanent closure of the root canal system with non-resorbable, marginal, radiopaque and biocompatible materials such as gutta-percha. The filling material is intended to be optionally also easy to remove.

Practical implementation

Access cavity

After a possibly of a rubber dam, access is initially set to the channel system. This must be one hand large enough to carry out treatment under good visibility can, on the other hand, but not too large to avoid the unnecessary loss of healthy tooth substance.

Cleaning

After a length determination of root canal or canals (by a single X-ray image in connection with special measuring needles or electrical means by endometric ) channels with hand files or mechanically driven rotary instruments are flared ( " processed "). By irrigating solutions such as: sodium hypochlorite, 3% H2O2 solution, EDTA or CHX, impurities are removed from the channels eliminating the smear layer and combat microorganisms. A laser can be made in addition to the usual rinsing solutions used to disinfect prior to filling of the channels. The rinse solutions may be activated by ultrasound, to increase the effect. In this way, channel branching and infected dentin can be disinfected, which are an instrumental treatment is not accessible. Use that specialize in Endodontics Dentists in root canal treatment, a surgical microscope, which facilitates with its additional light source with coaxial light and magnification to locate and view the channel inputs.

Formation

Root canal instruments are used in addition to the dentine (in terms of cleaning) primarily for shaping the root canal cavities. The instruments create by editing the root canal walls of space to improve the efficiency of irrigation solutions and to prepare a custom profile for the foreseeable closure.

Filling

After the cleaning and shaping of root canals, the cavities are filled. This is done mainly with gutta-percha and a sealing cement, known as a sealer ( engl. "sealer "). The root filling should contain as much gutta-percha and sealer as little as possible, because the gutta-percha is the biocompatible and stable material.

If an immediate root canal filling be possible, first a drug insert. It usually is a calcium hydroxide preparation, rarely used a cortisone - antibiotic preparation. In these cases, the root canal be finally closed until another treatment session.

The root filling can be done classically by means of a cement and a gutta percha ( A - pin method) or by lateral condensation, where in addition allow additional gutta-percha points a denser root filling. There is furthermore the possibility by means of thermal obturation techniques fill the tooth. Here, a gutta-percha is heated and then introduced into the channel, so that thereby it is possible to penetrate through liquefaction of the material into the root canal Aufästelung at the root tip to the small lumen. Here there may be a pressing out of Sealermaterials around the apex come ( Puff ). There is also the opportunity to bring a pen first and then fill these to heat and separate the channel ( so-called down -pack) and the rest of the channel with liquid gutta-percha ( backfill ). Is a surgical microscope for a better view of advantage for the latter technique. In addition, the surgical microscope allows to locate additional minor channels in the tooth or to cover perforations in the duct with special materials.

Example

The process of a root canal treatment on tooth 17

Opened tooth, the pulp should be removed

Pulp extirpated

Measurement recording

Processed and formed three channels

Often upper molars, however, have four channels

Filled all four channels

Follow-up radiograph after root canal treatment

Deck fill

Control after 20 months

Possible complications

Complications of root canal treatments can be caused by:

  • Inaccessible channel sections ( relocation of the channel lumen by denticles, strong curvature of the root, branches),
  • Broken instruments,
  • Particularly stubborn microorganisms such as Enterococcus faecalis and Candida albicans, which penetrate deep into dentinal tubules up to 0.4 mm and can survive as a single infection,
  • An additional periodontal damage to the tooth,
  • Via falsa ( " wrong way") - iatrogenic ( caused by the doctor ) perforation of the root or
  • Fractures of the root.

In some cases is indicated in addition an apicoectomy with retrograde root filling. Alternatively, a revision of the root canal treatment be appropriate, should be given generally preferred over apical resection.

Health Insurance Legal Aspects

In Germany on January 1, 2004, the cash guidelines were changed for root canal treatment. A root canal treatment can only be provided by a dentist then by the statutory health insurance, if the policy of the Federal Joint Committee ( G -BA) are met for each tooth. Endodontic treatment of teeth that do not meet these guidelines may be agreed with the statutory insured patients whose desire for pleasure, the fees for dentists ( GOZ ).

The root canal treatment in molars is usually displayed when

  • So that a closed series of teeth can be obtained
  • A unilateral free-end is avoided,
  • The maintenance of good working dentures is only possible result.

In addition, the guidelines of the G -BA limits the contracting dental root canal treatment further.

9.1 A treatment under the contractual dental care is only displayed when the reprocessed and the possibility of filling of the root canal are given up or to close to the root tip.

9.4 In pulpentoten teeth with diagnosed on radiographs of pathological change at the root tip is to check critical in predicting whether the attempt the preservation of the tooth is made ​​by preserving or conserving surgical treatment. For the treatment of teeth with the root canal fillings and apical change surgical intervention are primarily displayed.

9.5 In the case of combined periodontal and endodontic lesions of the preservation of the teeth in relation to the periodontal and endodontic prognosis should be critically assessed.

10 In general, the removal of a tooth is displayed if it is not capable of conservation according to the criteria described in these guidelines. A tooth that is not worthy of preservation according to these guidelines will be removed. Another treat not hopeless teeth is not part of the contract dental care.

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