Root canal treatment of the dental practice Carina Sell in Gießen
Root canal treatment
The root canal treatment is an endodontic treatment (treatment of the tooth interior) with the aim of removing the irreversible (irreversibly) diseased pulp (dental pulp) and closing the resulting cavity bacteria-tight after disinfecting measures with a root canal filling.
Root canal treatment is indicated for devitalized (or dead) or irreversibly inflamed pulp (dental pulp).
Painful pulpitids (pulpitis, inflammation of the pulp) and apical periodontitis (tooth root inflammation affecting the root tip) lead to the planning of a root canal treatment. They are manifested by the following clinical symptoms, which may occur individually or in combination:
- Cold pain and / or thermal pain
- Tooth feels prolonged
- occlusal pain
- regardless of food intake pain
- Pressure sensation in the area of the apex (root tip)
The diagnosis leading to the initiation of a root canal treatment is based on the clinical symptoms, if necessary supplemented by a positive radiographic finding:
Percussion Test (Check Bite / Tear Sensitivity)
- Cold test – reliability 95% to 100%
- Heat test – no longer recommended, because heat causes only 80 ° C longer lasting pain and therefore a heat damage of the pulp (dental pulp) can not be excluded
- Electrical sensitivity test: statement reliability 90% to 95%; This test method is based on the conductivity ratios of the dental hard tissues. Due to the shunt of metal and the insulator effect of ceramics, it can not be used on crowned teeth.
- Mechanical Sensitivity Test: Exposed dentin (dentin) is sensitive to contact with the probe or drill.
- X-ray examination of the root area with the question of apical periodontitis (tooth root inflammation affecting the root tip), which manifests itself in the form of osteolysis (bone dissolution).
If one of the above-mentioned indications arises from diagnostics, root canal treatment is the treatment of choice. This aims to remove the bacterially damaged pulp as completely as possible by mechanical and chemical methods, to widen the cavity of the root canals to thereby remove bacterially contaminated canal walls and to create the possibility of the root canals after reaching the symptom-less bacteria to the narrowest point of the root canal, the apical constriction (synonyms: physiological apex, physiological root tip), to provide a root filling.
The treatment process takes place in several steps:
Preparation of the access cavity (opening of the tooth by drilling) – Pay particular attention to the axial direction of the drill and the complete removal of the pulpal apex in order to have unimpeded access to the root canal entrances.
Probing and exposing the root canal entrances – Supports a magnifying glasses with 6- to 8x magnification or a surgical microscope. Files of size 10 or 15 are used to test whether the structure found is really a channel entrance. In case of doubt, a perforation (drilling through) of the pulp chamber bottom should be excluded with an electrometric length measuring device. If you do not find a channel entrance, you can work with ultrasound and then dry and stain it to make the entrance visible.
Determination of the working length – The aim of the preparation is to reach and expand the root canal to the apical constriction (physiological root tip, narrowest point of the root canal near the root tip). The exact determination of the working length is one of the most important steps of the entire root canal treatment. In this case, electrical length measuring devices are at least equal to, if not superior to, the measurement with the aid of an X-ray image. Ideally, both methods should complement each other.
Preparation of the root canal – Coronal-apical instrumentation: First you expand the coronal (near the tooth crown) channel portion, in the following you work with reamers and files (special instruments for canal preparation) to apical (root tip) before. For this purpose a wide variety of systems are available. In the case of the apical extension, instruments with standardized conicity (cone-shaped) and increasing diameter are used consecutively.
Irrigation (flushing of the root canal) – In the treatment phase, frequent intermediate rinses must be taken to wash out tissue rests and dentin shavings that are filed off the canal walls so as not to obstruct the canal lumen (root canal lumen). In addition, the rinses chemically dissolve and disinfect tissues from the ramifications (ramifications of the pulp in the root tip area) that are inaccessible to mechanical processing. As a rule, the following rinse solutions are used:
Sodium hypochlorite (NaOCl) 5%: acts as a bactericide (killing bacteria) and dissolving tissue, whereby the dissolving effect is further improved by ultrasound.
Chelators (synonym: chelating agent): z. For example, ethylenediaminetetraacetic acid (EDTA) or citric acid removes the smear layer from the canal walls and better slides the root canal instruments.
Chlorhexidine 0.2% – 2%: must be used especially in the revision of a root canal, as it is effective against E. faecalis, whose colonization is to be assumed in old old root fillings requiring renewal.
Medical Intermediate Insert – To continue the antimicrobial therapy after completion of the root canal preparation, calcium hydroxide is placed in the root canal as a first-line drug for a limited period of time. Its strongly alkaline environment makes 90% of the channels bacteria-free. However, calcium hydroxide does not work against Enterococcus faecalis (also Streptococcus faecalis). When contaminated with E. faecalis, which is particularly to be assumed in a root canal revision, on the other hand, chlorhexidine and camphor paramonochlorophenol are effective.
Root Canal Filling – It represents the completion of a root canal treatment. The key aspects in the selection of the material are the marginal integrity to make resettlement with bacteria more difficult as well as biocompatibility to exclude reactions of the periapical (surrounding the root tip) tissue. Commonly used materials include gutta-percha in combination with sealers (root canal filling cement).
Also versatile are the methods of root canal filling, currently, for example:
- Single pin method
- lateral condensation
- vertical condensation
- thermoplastic gutta-percha injection
Instrument fracture (fracture of a reprocessing instrument): Removal of the instrument is usually very difficult and, depending on the depth of the fracture, often unsuccessful. In the lower third of the root canal, a surgical root tip resection can be performed to remove the fragment.
via falsa ("wrong way"): Drill through the root canal wall especially in the area of strong root curvatures
Perforation (piercing) of the pulp chamber bottom in the search for a root canal
Overlook or not finding a root canal
Preparation not possible up to physiological apex (root apex)
Overstopping of root filling material beyond the apex, especially in apical osteolysis (bone dissolution "tooth root Windwärts")
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