Sometimes bacteria get inside the tooth, which results in a painful inflammation of the dental pulp. A slow infection can lead to gradual and even painless tooth nerve decay. Bacteria in the pulp chamber multiply, working their way through root canals towards the bone and causing inflammation (and eventually an abscess or a granuloma). Pulp inflammation makes endodontic treatment necessary to save the tooth. Restoring tooth structure with fillings or crowns will not be possible until root canal treatment has been done properly, i.e. the cause of infection has been removed and the root canals have been cleaned and filled. Feeling some discomfort and slight soreness after root canal treatment is normal; they are caused by the immune system’s response to remaining microorganisms. At times endodontic treatment may fail due to narrow, inaccessible root canals, improperly done previous procedures, etc. In such cases a procedure called apicoectomy (root resection) can solve the problem.
Apicoectomy is an oral surgery procedure in which the tooth’s root tip is removed. It is done when usual endodontic treatment is not enough to remove infectants from the root canal, seal it and prevent further inflammation in the root tip area. If inflammation persists after endodontic treatment, the root canal is probably very forked and its minute endings may be inaccessible. Such a canal cannot be cleaned properly and often causes repeated treatment failure. In an apicoectomy the tooth’s root tip is removed and the root end cavity is prepared and filled with biocompatible material. This way infected root parts can start to heal, while the filling prevents contamination and re-infection. The procedure is brief and barely involves any risks. First, local anaesthesia is administered to the affected tooth. Then an opening is made in the gingiva (gums) and the jaw bone through which the surgeon can access the root tip. A couple of millimetres of the tip are removed along with the diseased tooth pulp, and the tooth is filled. Then gingiva is placed over the opening in the bone and stitched over the incision spot. The stitches are removed after 5 to 7 days, the gingiva heals and bone regenerates to fill the void.
Ultrasonic root canal treatment
Endodontic treatment is a complex and challenging dental specialty because, although there are certainly ground rules for performing the procedures, internal structure of teeth can differ considerably from person to person.
Lately, endodontic treatment has benefited greatly from the development in ultrasonic technology. Machine-assisted endodontics enables us to provide state-of-the-art treatment, increase the success rate of root canal procedures and shorten the recovery time. Ultrasonic instruments make it easier for dental practitioners to find hidden root canals. Also, ultrasound agitates irrigant solutions, improving root canal irrigation and allowing your dentist to reach internal tooth parts that cannot be cleaned with mechanical methods.
In our practice we use Air-Flow Master Piezon® by EMS. Its flexible nickel-titanium rotary files remove infected tissue swiftly and efficiently, preparing root canals for the permanent filling. Additionally, electronic devices that determine the length of the root canal, so-called apex locators, make sure the instruments don’t get to the area beyond the root tip.
Example of an endodontic procedure
Endodontic procedure (root canal therapy) before prosthetic treatment
Endodontic treatment is a sequence of procedures in root canals performed to preserve the tooth and its functions (chewing food, pronunciation, articulation and improving our physical appearance).
The pain is most often caused by a bacterial infection of the root canal that developed from dental caries (cavities). However, chronic pulp infections (granulomas) are not always painful and are often only seen on dental X-ray images.
removal of the pulp („nerve“);
cleaning and widening of the root canals; if necessary, prescribing antibiotics to treat severe bacterial infections (gangrenes);
filling the canal space with rubber-like material (gutta-percha);
follow-up radiography imaging to verify that the tooth has been properly sealed;
composite filling or a crown (metal-ceramic or zirconium alloy).
The procedure is completed in one to three visits.
In this case we perform an apicoectomy – it is a procedure in which the tooth’s root tip is removed and the infected root canals and bone are cleaned.