Endodontic treatment

#Briefly in points

• The last option to preserve your own tooth in the oral cavity is microscopic endodontic treatment (treatment under an operating microscope).
• Our endodontic specialists are able to preserve partial vitality of the tooth (pulpotomy)
• We use biosealers, irrigation protocol according to Dr. Ricucci
• Our specialists are educated abroad every year and refine their procedures according to the latest evidence-based knowledge (scientifically proven).
• In the center of Prague (near Charles Square) with good accessibility from anywhere, come for quality, daily 07 a.m. - 21 p.m.
• Thorough diagnostics, clinical experience, perfectly sterile treatment process, sufficient time for the procedure, excellent results of endodontics and re-endodontics
• read interview with our endodontist about how we save teeth, in the section blog.

#Do I need endodontic treatment?

Most often, the patient comes with toothache – with inflammation of the dental nerve (deep caries, after previous treatment, injuries) or in connection with the so-called apical periodontitis (a pouch around the root of the tooth) and its acute flare-up

Apical periodontitis related to the presence infection inside the root system – bacteria and their toxins travel through the root canals into the surrounding tissue and trigger a response from the immune system in the form of inflammation

• Acute apical periodontitis (typically shortly after treatment, in deep caries where irritation of the surrounding tissue outside the tooth root has already occurred)
• Chronic apical periodontitis (often an incidental finding on an X-ray – dark “pouch” around the root, clinically mute teeth, sometimes a strange sensation when biting)
• Acute exacerbation of chronic apical periodontitis (flare-up of chronic inflammation into an acute form, high pain, swelling)

Deep caries extending into the pulp cavity – when drilling out infected tissue, the dental pulp is opened and if direct coverage is not possible (a procedure that aims to preserve the tooth's vitality), the tooth needs to be treated endodontically.

#The tooth with the pocket doesn't hurt me, the pocket has been there for many years, so why treat these teeth?

1. Risk of chronic inflammation turning into an acute form = pain that often forces the patient to visit the dental emergency room (lack of time for proper treatment, risk of irreversible tooth damage = tooth loss) – often happens during trips abroad, vacations (stress as an inducer of an acute condition)
2. Presence of inflammation in the body = constant weakening of the immune system, fatigue of the body, cross-reaction of antibodies with distant organs in the body (inflammation of tendons, joints, nerves, blood vessels, etc.)
3. Artificial joint replacements, valves, heart surgery, organ transplantation (bacteria from the "pockets" can travel through the patient's bloodstream and infect artificial replacements, valves and transplanted organs = life-threatening conditions!) - often the patient comes just before the operation with a request for a dental examination from the referring doctor, teeth with pockets cannot be treated quickly and reliably enough before the operation (eliminate the infection) = the only option is their extraction (pulling out)

#Indications for endodontic treatment:

1. Deep caries extending into the pulp cavity of the tooth (infection of the neurovascular bundle inside the tooth, irreversible damage to the dental pulp) with the impossibility of performing pulpotomy as an alternative treatment while preserving vitality.
2. Injuries and loss of tooth vitality (dental pulp necrosis)
3. Tooth autotransplantation (moving a tooth from one place to another)
4. Prosthetic reasons (correction of tooth inclination)
5. Resorptive processes
6. Periodontitis (infection of the dental pulp via the periodontal trunk) – pulpo-periodontal complex

#Contraindications to endodontic treatment:

1. Inability to treat tooth decay (caries affecting the tooth root, extensive tooth destruction)
2. Untreatable tooth root fractures
3. Anatomical proportions of the tooth (extreme curvature of the tooth roots, inappropriate ratio of root length to remaining crown)
4. Impossibility of performing prosthetic treatment after endodontic treatment (so-called post-endodontic treatment)
5. Limited mouth opening, time reasons (need to open at least 3 fingers, treatment duration approx. 2 hours)
6. Extensive periodontal disease (teeth with significant looseness, loss of surrounding bone tissue)
7. Untreatable tooth perforations (most often due to previous incorrect tooth preparation)

Endodontic treatment procedure:

1. Local anesthesia, rubber dam (latex membrane with the aim of isolating the working field - protecting the patient from disinfectants, preventing the presence of bacteria in the already disinfected root canal)
2. Caries removal, pre-endodontic tooth reconstruction (reconstruction of the peripheral walls of the tooth)
3. Trepanation of the tooth (penetration into the pulp cavity of the tooth), finding root canals (each tooth has a different number of roots and root canals - very variable)
4. Determining the working length (root canal length – it is necessary to treat the tooth along the entire length of the root canal, otherwise there is a risk of leaving an infection in the tooth and treatment failure)
5. Mechanical treatment of root canals and chemical disinfection of the canals (it is necessary to treat places that cannot be reached mechanically - the canals have a number of side outlets that cannot be treated mechanically). The most important is chemical disinfection, to which we devote 30 minutes of pure time from the entire treatment of the dental pulp.
6. Hermetic filling of root canals with gutta-percha filling (the root system must be perfectly sealed to prevent reinfection)
7. Completion of the tooth core with composite materials reinforced with glass fibers.
8. Post-endodontic treatment of the tooth (often in subsequent visits)

#Endodontic treatment and its time requirements:

• One-phase treatment – ​​The entire endodontic treatment is completed in one visit (from drilling the caries to completing the core of the tooth) – usually a 2-2,5 hour visit – planned procedures.
• Two-phase treatment – ​​In the first visit, the caries is drilled, the root system is partially prepared and the patient leaves with a disinfectant insert and a temporary filling. In the second visit, the endodontic treatment is completed – usually acute conditions or conditions where the root canal cannot be filled in one visit (obstruction requiring longer treatment time, inability to dry the root canal)

Post-endodontic treatment

Post-endodontic treatment = treatment of a tooth after endodontic treatment – ​​teeth requiring endodontic treatment are often significantly destroyed (extensive decay, injury) and their further weakening is caused by the need to create access to the root canals themselves (without safe access, the tooth cannot be treated sufficiently and reliably), teeth weakened in this way are very susceptible to fractures, which often end in tooth extraction

The goal of post-endodontic treatment is to reduce the risk of tooth fracture and restore the original function of the tooth (chewing, aesthetics, phonation)

#Do I need post-endodontic treatment? Will a white filling/amalgam really not be enough?

Only a white filling is rarely sufficient (it does not ensure an even transmission of chewing pressure to the weakened remaining peripheral walls of the tooth = risk of fracture and tooth loss)

The tooth often needs to be treated prosthetically (overlay, crown - replacements that allow the distribution of chewing pressure to the remaining tissues = reducing the risk of tooth fracture) - post-endodontic treatment is therefore ALWAYS part of endodontic treatment and cannot be omitted.

The most common cause of endodontic treatment failure is the absence of post-endodontic treatment or incorrect post-endodontic treatment!

#The most common complications of endodontic treatment:

1. Root canal obstruction (extreme tooth anatomy, obstruction in the root canal, notch in the root canal wall during preparation, obliteration = narrowing or disappearance of the root canal)
2. Bleeding, leakage of inflammatory fluid (inability to fill the ducts)
3. Root canal instrument separation (obstruction)
4. Failure to find root canals (very important use of magnifying devices - microscope)
5. Via falsa (wrong preparation), stripping (puncturing the root canal wall), transportation (transfer of the course of the original canal = weakening of the root wall), excessive expansion of the root tip (rinsing disinfection, impossibility of perfect filling)
6. Flare up – sudden outbreak of inflammation after endodontic treatment (a very painful complication, most often in the immune system's reaction to bacterial breakdown products)

#Does endodontic treatment hurt? Should I expect pain after treatment?

All procedures are performed under local anesthesia, so endodontic treatment is currently painless. An exception may be teeth with severe acute inflammation, where the effect of local anesthesia is reduced.

Pain after endodontic treatment is usually not significant, usually persists for the first two days and then disappears. More sensitive individuals can reach for commonly available analgesics.

#What is the prognosis of endodontic treatment?

The success rate of modern endodontics (machine processing, use of magnifying optics, adherence to disinfection protocols, hermetic closure of canals, adequate post-endodontic treatment) ranges from 90 to 96%.

How can the success of endodontic treatment be evaluated?

The basic criterion for successful endodontic treatment is the presence of a quiet tooth in the oral cavity without signs of periapical clearing on the X-ray (without signs of a cyst). However, it should be noted that cysts can heal for many years. Endodontic therapy is considered a failure if there is no reduction in the finding on the X-ray even after 4 years of endodontic therapy. Persistent toothache is also considered a failure.

#Why is the price of endodontic treatment so high?

Endodontic treatment is a very time-consuming and expensive method of saving a tooth (magnification optics, machine processing, vertical condensation of gutta-percha filling), which is of course also reflected in the price of the treatment. Currently, insurance companies do not cover this modern approach to treatment and endodontic treatment "for the insurance company" is just a postponement of the forceps with a significant increase in the cost of tooth replacement.

#Re-endodontic treatment

Re-endodontic treatment = re-treatment of the root system of a tooth after a previous unsuccessful endodontic treatment

#Do I need re-endodontic treatment?

The most common indication for re-endodontic treatment is persistent infection in the root system of the tooth. These are teeth that have already been endodontically treated, where the original treatment may have failed due to insufficient post-endodontic treatment (loosening of the tooth structure, inaccurate crown replacement - reinfection), insufficient endodontic treatment (insufficient mechanical-chemical treatment of the root canal walls, introduction of infection into the root system during treatment, insufficient filling of the canals, failure to find all the root canals, etc.). Insufficient chemical disinfection of the root system is a common reason.

What is the procedure for re-endodontic treatment?

The treatment procedure is identical to endodontic treatment. The difference is the need for complete removal of the infected root filling, which can significantly extend the duration of the treatment. There is also a higher risk of root canal obstruction (often a detached instrument, obliteration, notches in the walls after previous treatment) and thus a higher risk of failure.

#What is the prognosis for re-endodontic treatment?

The prognosis of re-endodontic treatment is very variable depending on the complexity of the procedure. The success rate of re-endodontic treatment ranges from 70 to 75%.

#Isn't it better to have the tooth pulled out?

No currently available replacement can replace the original tooth in the oral cavity. Endodontic / re-endodontic treatment is therefore the number one choice. Only when endodontic / re-endodontic therapy fails is tooth replacement with an autograft or implant recommended.