Root Canal Treatment
Endodontics is a branch of dentistry that deals with problems that have progressed to the dental pulp. The pulp is located in the center of the tooth and in the canals of each tooth root. The connective tissue that nourishes the tooth consists of blood vessels and nerves. After the tooth is formed, the pulp can be safely removed from the pulp chamber and root canals. Endodontic treatment is the process of removing the pulp, also known as root canal treatment.
Why Is Root Canal Treatment Necessary?
Root canal treatment is required if there is an infection or permanent damage to the pulp. Untreated caries can cause pulp infection. Tooth enamel and dentin lose material up to the root canal due to caries, and bacteria caused by caries cause infection in the pulp. Antibiotics are not effective in getting results for these infections in the inner part of the tooth. This infection causes inflammation, which in turn prevents blood from reaching the tooth. Therefore, it is difficult for antibiotics to reach the infection through the bloodstream. The harder the blood reaches the pulp, the harder it is for the pulp to heal itself.
Deep restorative work such as fracture, cracking, trauma or one or more fillings that have occurred in the tooth may damage the pulp after a certain period of time. In addition, any procedure made for the tooth can damage the pulp. People who will be crowned may need root canal treatment before the application.
Although there is no infection in many cases, the pulp can become inflamed and then heal and return to normal. Before root canal treatment, an X-ray of the tooth is taken to determine whether there is such an inflammation. Inflammation in the pulp can cause pain and infection. Infection in the pulp can cause abscess formation and damage to the bone surrounding the tooth.
The purpose of root canal treatment is to save the tooth by removing the infected or damaged pulp and to treat any inflammation and to fill the empty canals with a special filling material.
If root canal treatment is not performed, the tooth may need to be extracted.
It is always preferable to preserve the natural tooth. One or more missing teeth may cause displacement of adjacent teeth and deterioration of posture. In addition, protecting natural teeth does not require the application of expensive and deep treatments such as implants and bridges. If root canal treatment is not applied to a damaged and infected tooth, the tooth becomes the infection center of the body.
Root canal treatment does not mean that the treated tooth will not be extracted after a few years. In general, root canal treatments are performed due to deep and widespread caries. Therefore, the tooth becomes weak. If the tooth is crowned or filled with a tooth-colored composite filling after root canal treatment, the tooth can be used for life.
What are the Symptoms?
If there is an infection in the pulp, it is possible not to feel pain. If no treatment is given, the infection can cause pain and swelling. In some cases, an abscess may also occur. As a result, the tooth may need to be extracted.
Treatment Time
Depending on the condition of the tooth, root canal treatment can be done in one or two sessions. For an infected tooth, several sessions may be required to ensure that the infection is completely eliminated. Depending on the position of the tooth, treatment can be difficult. In addition, the presence of multiple and curved canals in the tooth makes it difficult to apply the treatment. An uncomplicated root canal treatment is usually completed in one session.
After root canal treatment, the tooth is crowned or restored with a filling.
If your tooth hurts noticeably when you bite, touch, or push your tooth with your tongue, if your tooth is sensitive to cold and especially heat for more than a few seconds, if you have swelling around the problem tooth, if you have painful or painless discoloration or a broken tooth Root canal treatment may be necessary.
Treatment Stages
• If necessary, anesthesia is applied. After the application of anesthesia, a cavity is opened in the tooth to reach the pulp chamber. The length of the root canals is then measured.
• X-rays are taken to determine the channel lengths. A file is placed in the canal to be measured. Then, the film is taken again and it is determined how close the file is to the end of the canal.
• Infection is cleaned with files, which are specially produced instruments. The canal is enlarged with antiseptic washing solutions and files. The canal is then dried.
• In order for root canal treatment to give results, all main and side canals in the tooth must be cleaned. Generally, there is one canal in the upper front teeth, one or two canals in the lower front teeth, one or two canals in the premolars, and three or four canals in the molars. But the location and shape of the channels differ from person to person.
• With the use of Nd:YAG laser in cleaning the main and side channels, disinfection is ensured in the areas where the solutions cannot reach.
• The channels are filled with gutta-perchas, which are permanent materials. Gutta-perchas prevent infection and contamination in the canals.
• Temporary filling material is placed on the gutta-perchas to cover the open part until the tooth is ready for permanent filling or crown application.
• What kind of restoration will be done depends on the condition of the tooth. The tooth is restored with a composite filling, inlay, crown or post & core crown. Crown application may be needed on molar teeth, especially due to deformation caused by chewing. The crown strengthens the tooth and protects it from breaking. The crown should be applied as quickly as possible. Ideally, it should be done within one month after root canal treatment. Restoring the tooth permanently is important to prevent further damage to the tooth. Since temporary filling is not durable, permanent filling is essential.
The pulp removed in root canal treatment is the part that reacts to heat. Since the tissue and nerves surrounding the root canal treated tooth are still in place, the tooth may be sensitive to pressure and touch.
After Root Canal Treatment
There may be pain in the tooth that has had root canal treatment for two or three days after the treatment. Care should be taken not to chew with the treated part. Pain relievers can be used to reduce pain.
Possible Complications
When the canal is opened for root canal treatment, the oxygen in the air can cause bacteria to settle here, and the bacteria multiplying here cause inflammation and pain.
Bacteria can be pushed out of the tooth root tip. At the end of the tooth root, there is a small hole that allows blood vessels to enter the tooth. Sometimes, it can reach the tissue surrounding the tooth through this small hole during root canal treatment. In this case, the surrounding tissue becomes infected and may also become inflamed. It is possible to dry and treat the inflammation with painkillers and antibiotics. The process until this inflammation clears can be a painful process.
During root canal treatment, holes may be created in other parts of the tooth due to the absence of canals or their curved nature. The instruments used in root canal treatment are produced in a way that can adapt to curved canals. But sometimes the instruments cannot adapt to the canal arch, creating a hole in the edge of the tooth. If saliva reaches this hole, the tooth may need further treatment or extraction. If it is at a distant point below the gum line, saliva may not reach this point and there is a possibility of recovery without intervention.
If a root canal is not penetrated or the canals are not completely cleaned, the canal length is not measured correctly, and infected or inflamed pulp fragments are too close to the root tip, the tooth may remain infected. As a result, root canal treatment may be required again. Root canals may have side branches and it is not possible to reach these branches with traditional treatment methods. For this reason, this problem is tried to be solved by using Nd:YAG laser.
During treatment, the canal instrument may break within the canal. If the cleaning of the canal is completed and the broken piece remains at the root tip, the treatment is continued in this way. However, if the cleaning of the root canal has not been completed, the remaining part is not at the tip of the root and the root tip cannot be reached for this reason, the part must be taken. The piece can be taken from the upper part of the tooth, but in some cases it can only be removed under surgical conditions. In this procedure, which is called apicectomy, a small incision is made in the gingiva to reach the root of the tooth and the root part where the piece is located is removed.
Is There Pain?
Usually, pain is not felt during root canal treatment. The tooth with root canal treatment and the surrounding part are completely numb. Thanks to the numbing gels and modern injection systems, injection applications are also painless.
