Clinical cases. Repeated canal treatment.

Cleaning the tooth canals is a procedure for removing microparticles of the inflamed pulp from the roots, i.e. affected tissues. This is a particularly labor-intensive process, since the final effect of caries treatment depends on the quality of the work.

Clinical case: a patient has caries that has developed into pulpitis. When opening the tooth, the dentist diagnosed an infection and a severe inflammatory process; it was recommended to remove dead pulp tissue from the roots. If the work is not performed perfectly, an infection gets into the roots, a filling is placed on top, and the pathological process already develops under a thick layer of filling material. The toothache does not subside, the patient goes to the doctor again or endures the pain, quenching it with medications, and eventually loses the tooth. That is why, in case of caries, pulpitis and other problems, it is important to contact trusted doctors who perform high-quality root cleaning. It is advisable for the dentist to work with a microscope - multiple magnification allows you to monitor the process of cleaning the canals from remnants of pulp tissue.

One tooth may have two or more tubules, which are localized in the layers of the periodontium. The main task of the canals is to be a connecting link between the crown pulp and the nerves.

More than 10 years ago, deep caries and advanced pulpitis were the reasons for removing a unit, but now, thanks to effective cleaning and treatment of the canals, it is possible not only to preserve the crown, but also to restore its integrity to an ideal result.

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.

How are impacted teeth diagnosed?

Impacted teeth are often “found” by accident during an X-ray diagnosis for another dental reason. If a patient asks about orthodontic treatment and is missing some teeth, or has symptoms that may be caused precisely by the presence of hidden impacted teeth, then a special diagnosis is carried out.

The problem of impacted teeth is solved by two specialized dentists - an orthodontist and a surgeon, so the patient will have to undergo diagnostics by an orthodontist and diagnostics by a surgeon. Most of the diagnostic procedures will be general, and the key is x-ray diagnostics, and it is preferable to do CT - computed tomography (3D diagnostics). Unlike an orthopantomogram (OPTG), it shows the spatial location of the impacted tooth in the jaw and relative to other teeth, which is very important for the surgical stage of traction - exposing its crown, because allows the surgeon to choose the optimal “approach”.

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.

How is surgery performed to expose the crown of an impacted tooth?

1. As a preliminary stage, preparation for the operation is carried out. The patient undergoes professional hygiene and sanitation to reduce the amount of infection in the oral cavity and speed up postoperative healing.
2. The operation to expose an impacted tooth is performed under local infiltration anesthesia and is considered a fairly serious surgical intervention.

The operation to expose the crown of an impacted tooth and install an orthodontic element on it can be carried out according to 2 schemes:

I Delayed bracket installation.

1. The mucous membrane in the projection of the crown of the impacted tooth is excised, the entire crown of the tooth is exposed, and a special tampon is installed in the wound.
2. After 2-3 days, a button or bracket is installed on the crown of the exposed tooth, which is tied to the orthodontic arch and traction begins.

II Bracket installation during surgery

1. The dentist-surgeon peels off a small mucoperiosteal flap and exposes part of the crown of the impacted tooth, onto which the locking element is immediately fixed.
2. The bracket is tied to an orthodontic arch or additional devices.
3. After installing the orthodontic element, the flap of tissue is placed in place and the wound is sutured.

The disadvantage of this method is that in this case, repeated surgical intervention is possible if the bracket on the tooth comes off.

After surgery, the patient is prescribed antibiotics and antiseptic rinses, if necessary, to speed up healing. Light, non-traumatic food is recommended.

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.

Is it possible to close a hole in a tooth yourself?

The question often arises as to what can be used to seal a temporarily opened cavity if a filling falls out. People use a wide variety of materials for these purposes - from cotton wool to chewing gum, in general - everything that can be used to fill a hole at home. Under no circumstances should this be done. Before you tape a tooth, you should think about the consequences. The cavity will not be closed hermetically, which means food debris and bacteria will get into it.

Before you think about how to plug a tooth at home, it is worth considering that any material will create extremely favorable conditions for the proliferation of microbes and the occurrence of infection or inflammation. Therefore, the question of how to cover the tooth should not arise. To avoid the accumulation of food debris in the cavity, it should be rinsed regularly at least 6-7 times a day.

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.

Diagnostic methods

Diagnosis of tooth perforation is based on patient complaints and visual examination of the oral cavity. In most cases, perforation in the crowns of teeth can be recognized using an x-ray. If there is a suspicion of perforation localized in the area of ​​the bottom of the dental cavity, an X-ray with contrast is performed. In any case, an image is taken that allows you to determine not only the presence of perforation, but also to identify complications caused by the pathology.

When holes form in the dental canal, additional equipment and tools are required to identify them. It is easier to diagnose perforation when there are already symptoms: sharp pain, mild bleeding, changes in the movement of the instrument during dental treatment.

With old perforation formed in the canal, symptoms appear, which in their manifestations resemble periodontitis. It is diagnosed along with inflammation, which affects the tissues located near the roots of the teeth. In the presence of such perforation of dental units, characteristic pain in the tooth is observed, which appears when pressing on the damaged segment, swelling of the gums, concentrated in the area of ​​​​inflammation.

Tooth perforation, localized in the root of the teeth, is diagnosed using a paper pin by immersing it in the canal. The location of the perforation is determined by the trace of blood that remains on the paper.

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.

Pain after a filling falls out and other unpleasant consequences

Simple recommendations for patients on what to do when a filling falls out and a tooth hurts:

• You need to rinse with a solution of baking soda and salt.
• You can take a painkiller, it could be Ketanov or Analgin.
• During the inflammatory process, the temperature may rise. It must be knocked down after exceeding 38.5° C. For this, antipyretics are used.
• If there is bleeding from a tooth, you should immediately consult a doctor. There can be many reasons for this phenomenon, and it will be possible to accurately determine the possible problem only after an appropriate examination.

You can find many tips on how to numb a tooth at home, but the most effective option is to rinse and take appropriate medications.

When a filling with arsenic falls out, you need to carefully remove the remaining medication with a cotton swab and rinse the tooth cavity with a soda solution.

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 are the types of tooth impaction?

There are two types of retention - partial, in which part of the tooth is visible from the gums, and complete - in which the tooth is completely located under the gum tissue and/or jaw bone.

Such teeth can also be positioned differently, both being in “their” place in the dentition and occupying an incorrect position outside the dentition.

• Vertical
• Horizontally.
• At an angle to the jaw

If a tooth does not erupt in the right place beyond the border of the dentition, they speak of tooth dystopia.

There are even reverse retentions, when the tooth lies “upside down,” that is, upside down with its roots.

There may be only one impacted tooth in the dentition, or two impacted teeth may be located symmetrically. This problem concerns both milk and permanent teeth.

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.

Loss of fillings in children

When a child’s filling falls out, you should not ignore the problem, even if the teeth are baby. Caries and other diseases can provoke severe pain and the development of an inflammatory process.

What to do if a temporary filling falls out of a baby tooth:

1. Call your doctor, consult and make an appointment as soon as possible.
2. Ensure that your child maintains good oral hygiene.
3. Rinse your teeth regularly to remove food debris.

Important! Fillings on baby teeth fall out for various reasons, and only a specialist can determine what causes this phenomenon. So, in any case, you cannot do without a visit to the dentist.