Therapeutic treatment and endodontics

Therapeutic treatment and endodontics

Prior to therapeutic treatment we consult the patient and conduct a preliminary examination of the oral cavity as well as additional inspection and professional hygiene of oral cavity if needed.

Our work is based on individual approach to the client and consideration of the patient’s wishes. Therapeutic treatment is indicated in case of carious lesions, defects of enamel (wedge-shaped), enamel hypoplasia, traumatic injury of the crown part of tooth, hard tissues obliterations, tooth discoloration, replacement of old seals. Availability of a laser machine DIAGNO dent (KaVo) extends the possibility of diagnosing of even hidden cavities in hard-to-reach areas and crowding of teeth.

In complex cases it is possible to prepare plaster models and conduct previous modelling allowing the patient to see the planned result, and the doctor – to perform an indirect restoration with pre-fabricated template.

In our clinic for dental filling adhesive system and restoration with photo composite materials are used. This technique allows to receive a remarkable aesthetic result for a long time, virtually eliminating the occurrence of repeated caries.

Tooth filling is performed using modern composite materials of leading dental manufacturers GRADIA DIRECT, GC (Japan), Estlelite E guick Tokuyma Dental (Japan), CHARISMA Kulzer (Germany) which have sufficient strength to withstand the chewing pressure and which colour and transparency are actually indistinguishable from natural teeth enamel.

During the process of dental fillings it is really important to use cofferdam in order to isolate tooth from the oral cavity, creating conditions for good adhesion and tight contact between the tooth tissues and seals for better retention.

Patients do not always come in time for therapeutic treatment, and often – when there is already a complication of tooth decay and endotontal intervention is needed

Earlier in the treatment of root canal the dentist almost blindly, relying only on his knowledge and experience, attempted to perform the work, on which the further “fate” of the tooth depended. That is why there was large percentage of poorly conducted endotontal treatment.

Today the doctor-endodontist in “ROMA” Clinic uses in his work Dental microscope KAPS (Germany) for the quality of endodontal treatment. Combination of powerful shadowless light and large blowback permits to work accurately and carefully and to remove only infected tissues.

Microscope use makes it possible to reveal the presence of hidden root canals and cracks of their walls, bends, side branches, facilitate the treatment of root canals with atypical structure, extract fragments of tools, to find and close the perforation of channel, treat properly previously treated canals.

Canals of teeth have a complex anatomic structure and diameter, which is calculated in millimeters and the most difficult procedure, performed under a microscope, is removing of the seal from previously filled root canal. This is caused by the fact that the canals were previously filled with cement (phosphate, resorcinol) and their hardness is higher than hardness of tooth tissues. So when you try to remove the seal from the canal, there is a high risk of breakage the tool or perforating the wall of the tooth, the consequence of which is tooth removal.

The decision on whether the tooth can be endodontically treated and if there is an expediency of such treatment becomes possible after learning the detailed anamnesis, collection and a set of additional methods of research around the tooth and dental tissues (Rvg-diagnosis, palpation, perkusil, appearance, EOD).

In anamnesis we are interested whether the tooth was endodontically treated before, for how many times, absence of exacerbations and complaints about pain. In assessing the structural condition around tooth and dental tissues, above all, we pay attention to the size of the defect of crown part of the tooth, restoration size, colour change, absence of visible textures, parodentium status, mobility status.

RVG -diagnostics allows to assess the condition of periapical tissues, bone tissue around the tooth, periodontal gap size, presence of granulomas and bone destruction, the anatomy of the root system and quality of previous endodontic treatment (not well filled root canal, output of seal material on top of root fracture, breakage of endodontic instruments, anchor pins, frakturs, perforation).

Our future orthodontic treatment plan also considers a pressure in future in prosthetic tooth construction. All this makes it possible to decide whether you need repeated endodontic tooth treatment.

We are often asked the question in our practice whether we should treat one more time the tooth, bordering with the zone of implantation and which was endodontically treated before, and which has a good obturation and there are no periapical changes in Rvg – diagnosis?

According to researches it is an axiom that the basis of all periapical changes is the presence of microorganisms and their metabolic products in the root canal. It is also interesting that in case of good root canal obturation in terms of RVG diagnosis and good crown restoration no reliable isolation exists! This means that there can be microflow and risk of reinfection of the root canal and the bone around the tooth.

There is also a reason to consider that many previously treated endo-teeth were treated without following the main principles of the protocol of endodontic treatment (tooth isolation / cofferdam / sufficient irrigation of root canal with disinfectants, instrumental treatment).

To avoid possible complications in the area of implant it is required revision of each tooth root canal, directly bordering with the zone of implantation. Today, protocol of implant treatment demands it. Not taking this into account the percentage of implant complications increases and generally compromises good treatment.

Many people are bothered with the question of forecast of endodontic treatment of tooth. It is important to convey the patient to understand that there is no 100% guarantee for a full recovery even after perfect endodontic treatment.

In case of primary endo-treatment you can expect 95% success rate, while in case of re-endo-treatment this index is much worse – 65% -80%. These data relate to teeth treated in a specialized way. Thus, in case when endodontic treated tooth was treated not according to endo-treatment protocol and without operating microscope this percentage greatly differs.

Dear patients, please note that qualitative therapeutic and endodontic treatment is the key to good health and nice smile!

The professionals of “ROMA” Clinic know how to take care of it.