Root canal treatment under a microscope

Root canal treatment under the microscope - characteristics

Root canal treatment under the microscope is the method of choice for the treatment of irreversible pulpitis and periapical tissue diseases. It consists in removing the cause of the disease, pathologically changed pulp from the chamber and root canal of the tooth and filling the canal with the appropriate material.

For the first time, the surgical microscope in endodontic treatment was used in 1981 by Dr. Apotheker. At that time, it was a device with poor ergonomics, low stability, 8x magnification and a simple binocular. At present, microscopes obtain an enlargement of the operating field from 3 to 30 times, and some manufacturers offer microscopes with a magnification of up to 40 times. The surgical microscope can be attached to the ceiling, walls, or be on a mobile base, which guarantees its stability.

Root canal treatment under the microscope - benefits

The root canal treatment of a single-channel tooth under the microscope eliminates pain, allows regeneration of periapical tissues or placement of prosthetic works. Large magnifications obtainable under the microscope are necessary for more precise procedures, such as searching for the mouths of the canals, with the isolated cavities (closed by the mineralized tissue), the removal of broken instruments or the closing of perforations.

The percentage of cured cases is very large in the teeth without periapical changes and / or when the cause of pulpitis is recognized and corrected. Root canal treatment under the microscope with a video path enables live observation of the performed procedure as well as its documentation.

Indications for the procedure

Root canal treatment under the microscope is performed in the treatment of irreversible pulp diseases. The causes of pulp diseases or the bundle of vessels and nerves in the tooth can be divided into infectious and non-infectious.

The most common and the largest group of factors are infectious or bacterial causes. The pathways of bacterial infiltration can be very different: from the carious cavity, through the exposed dentin, directly to the pulp through its traumatic denudation, through the pathological pocket or through the bloodstream. Carious cavity is caused by the presence of bacteria that bite the tooth deep into the pulp. Bacteria from the cavity penetrate even the clinically healthy dentin into the dentine tubules.

Inflammation of the pulp is caused by bacterial toxins, which act indirectly cytotoxically, or directly by bacteria that have an effect as antigens. On the side of non-carious lesions, dentine tubules are exposed due to processes of attrition, abrasion, erosion or abfraction.

Bacteria living in exposed tubules act similarly as in the case of carious lesions. They can lead to pulpitis, degenerative changes, as well as necrosis. Inflammatory processes that progress in the pathological gingival pockets can spread to the pulp through the root canal, root delta, side branches and pulp and dental chambers that are directly connected to the pulp. In the other side of the pulp disease, the same way can spread to the tissues of the apical periodontium.

The second group of causes of pulp diseases are non-infectious factors, which can be divided into mechanical, thermal, chemical, radioactive or light stimuli. Mechanical stimuli such as: small, often repetitive injuries or one-time sharp, strong injury.

This group includes pencil biting, thread biting, too high fillings, too fast moving of teeth in orthodontic treatment, as well as teeth grinding.

Thermal stimuli are frequently repeated stimuli exceeding the tolerance threshold of the pulp between temperatures between + 25'C and + 42'C. Such factors affect the vasomotor nerves that lead to rapid congestion or ischaemia of the pulp.

Inflammation induced by chemical stimuli is mostly iatrogenic by using medications to sterilize dentin in alcoholic solutions. As a result of frequent irradiation of the head and neck, the odontoblasts may be damaged, inflammation, necrosis and pulp calcification, then we talk about radioactive causes.

In addition, intrinsic stimulus such as: nutritional deficiencies of mainly vitamins A, C and D, endocrine and metabolic disorders as well as blood and infectious diseases may cause changes in the pulp. However, general diseases have a much smaller impact on the formation of pathological changes in the pulp, but they can affect the weakening of its defense reactions.

The indication for using the microscope in the treatment of a single-channel tooth is, among others detection of cracks within the crown and the bottom of the chamber. In addition, it is useful when finding outlets of channels and also searching for additional root canals. The microscope is used to develop the obliterated channels when the traditional method fails. This is the best way to perform a re-endodontic treatment because it allows you to avoid mistakes or to avoid the difficulties encountered with the original root canal treatment.

The microscope also helps in detecting and securing perforations or resorbtion. However, the most common use of the microscope is the removal of broken instruments from the central or apical portion of the root canal.

Contraindications for the procedure

Treatment of a canal single-channel tooth under a microscope can not be performed if the patient does not maintain proper oral hygiene and does not have sufficient motivation, which is necessary to survive a prolonged and arduous procedure.

The large accumulation of the bacterial plaque poses a threat to the surgical infection of the pulp and periapical tissues. This condition also accelerates the degradation of materials used to reconstruct hard tooth tissues. In such cases, the root canal treatment should be postponed, the patient should be instructed in oral hygiene and only after the improvement, proceed with the procedure.

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If in the radiological image the tooth root is based on bone only in the apical part, the prognosis for such a tooth should be additionally determined. If the root is damaged deeply subgingival or when it involves furcation, its reconstruction is not possible. The vertical fracture of the root is also a contraindication. An absolute contraindication to root canal treatment is the inability to properly develop and fill the canals.

In dairy teeth, this procedure is not performed. Before the surgery, each dentist must think whether he has the right equipment, tools and materials, and above all the appropriate skills to perform root canal treatment. The disadvantage of root canal treatment under the microscope is the increase in treatment costs associated with the expensive equipment used for the procedure.

Before the surgery

An individual, subject and radiological examination should be performed, using targeted dental photographs, a pantomogram or a consecutive CBCT digital tomography.

These tests enable to understand the cause of irreversible pulpitis and to perform the correct treatment. Root canal treatment under the microscope is facilitated by new generations of ultrasound tools that allow to remove the contents of the root canal and also facilitate its disinfection.

Type of anesthesia

Living pulp, despite being inflamed, irritated or touched by the tool is extremely painful. Therefore, in canal treatment of a single-channel tooth under a microscope, anesthetics of the type and concentration selected by the physician depending on the general condition of the patient are used.

For the teeth of the jaw, simple aesthetic anesthesia consisting of introducing the anesthetic into the submucosal tissue is usually enough. However, in the anesthesia of the mandibular teeth, it is necessary to conduct aortic anesthesia to the lower alveolar nerve or to the beard cavity due to the greater thickness of the dense plate of the bone and the difficult penetration of the anesthetic from the submucosal tissue.

Modern anesthetics used in dentistry are so perfect that the treatment of root canal treatment is completely painless.

How does the procedure work?

The procedure of root canal treatment of a single-channel tooth under a microscope consists in removing the contents, thorough chemical and mechanical development and tight filling of the canal with the physiological opening. This action should ensure regeneration of periapical tissues. The first step is correct (allowing the microscope to be set) to set the patient in a lying position.

Root canal treatment under the microscope is always carried out in conditions of complete isolation of the treatment area against the access of saliva using a rubber dam. Depending on the shape of the channels, their development can cause many difficulties for the doctor. To effectively carry out root canal treatment under the microscope, correct rectilinear access to the tooth cavity should be performed. Next, specify the length of the channel. An endometer is used for this purpose. The device consists of two passive electrodes, suspended on the patient's lip and active, which is attached to the tool currently used in the root canal. The endometer examination is completely painless and easy on the patient.

The next stage depends on the channel engineering technique chosen, but generally consists in introducing to the channel light further sizes of tools such as the pulp mill, Kerr file, Hedstroem, Kerr spreaders and others. This is to develop a channel along its entire length, and to give it a conical shape that will enable effective rinsing and tight filling.

Obliterated channels are a great difficulty in developing. Their development is a tedious and time-consuming process, requires special S type files and extensive rinsing. Machine tools nickel-titanium and ultrasounds facilitate the development of such channels. The biomechanical development of the tooth cavity greatly reduces the number of bacteria, however, regardless of the diligence of the mechanical development, about 40% of the canal walls are not affected by the endodontic tool. Therefore, the mechanical development of the canal is not sufficient and should be supplemented with a rich rinsing, which additionally ensures removal of microorganisms and organic tissues left in the canal system.

Sodium hypochlorite, used in various concentrations from 0.5 to 5.25%, with lytic properties acting on organic compounds and a broad bactericidal spectrum, chlorhexidine irreplaceable in the fight against bacteria from the group of Enterococcus faecalis and Candida albicans, serves for root canal irrigation during their development. , and EDTA, i.e. sodium edetate or citric acid as chelating agents - effectively softening dentine and removing the smear layer from the canal. Less and less often are used: 3% hydrogen peroxide, alcohol or saline solution.

After complete chemomechanical development of the canal and its drying, it can be completed. For this purpose, gutta-percha points and sealant are used. The canal is filled with the following methods: a single stud, lateral condensation, cold or warm gutta-percha.

Time and course of convalescence

The time of convalescence after the treatment of a single-channel tooth canal under the microscope depends on the extent of pathological changes. Most often, all ailments disappear immediately after the procedure. Sometimes, however, the tooth is still tender and slightly painful after surgery which may be associated with irritation of periapical tissues by the doctor during canal development. This condition can last up to one week after the procedure. At this time, mild analgesics and anti-inflammatories may be used.

Effects after surgery

Working with the use of a microscope increases the accuracy of diagnosis and treatment, and definitely extends therapeutic options. The surgical microscope contributed to the improvement of the effectiveness of conservative treatment of chronic changes of periapical tissues. It has been estimated that more than two-thirds of the changes undergo repeated root canal treatment. If the doctor's indications were not different, the tooth after root canal treatment may function normally after its reconstruction.

Depending on the degree of damage, it can be rebuilt with adhesive material or, with greater damage, with a crown-root insert and a prosthetic crown. Periapical tissues heal depending on the extent of up to several months, sometimes even without healing to the end due to significant damage before the procedure and natural limitations of the body for regeneration. The most important advantage of properly performed root canal treatment of a single-channel tooth under a microscope is the abolition of pain immediately after or a few days after the procedure.

Recommendations after the procedure

After the canal root canal treatment of a single-channel tooth under the microscope, the patient should be instructed about the need to maintain oral hygiene, which has a big impact on the durability of the filling.

After three months, a clinical and radiological control is recommended to ensure that the inflammatory process and healing are stopped.

How long do the effects last after the treatment last?

The durability of the sealed canal filling after root canal treatment of a single-channel tooth under a microscope is very good and lasts for years of use.

The durability of the tight filling of the composite defect is about four to six years, while the well-made crown on the crown-root insert can withstand about 10 years.

How to avoid complications after the procedure?

To avoid complications after root canal treatment of a single-channel tooth under a microscope, good oral hygiene should be maintained by daily brushing twice a day using a toothpaste with a fluoride content suitable for the patient's age, dental floss or interdental brushes to maintain interdental space and use special rinses containing fluorine.

In addition, the patient can check the course of treatment by asking the doctor to perform and show an X-ray photograph of the completed canal. The image of a properly performed root canal treatment presents a tooth and a white line at the canal site.

If it is visible along the entire length of the canal and has the same saturation, it means that the procedure was performed correctly. If the white line does not reach the end of the canal, we can question the correctness of the procedure and ask the doctor to fill the canal again. In the picture, we'll also see if there are any broken parts of the tool in the channel. Remember that we take a picture to assess the correctness of the procedure, so let us take a moment to look at it, so that we can be sure that everything is in the best order.

Possible complications after the procedure

After the root canal treatment of a single-channel tooth under the microscope, there is a risk of transient discomfort. Sometimes a bruise may temporarily appear after the root canal treatment.

Possible complications include infection and inflammation of periapical tissues due to bad oral hygiene. As a result, it can lead to the extraction of a tooth or even osteomyelitis, which is a serious complication and can give different symptoms depending on the form.

Recommended additional treatments after the procedure

The longer it takes to complete the complete tooth restoration - that is, to protect it with the crown, the greater the risk that it may be again infected by bacteria as a result of dehydration and weakness, and consequently, it will be necessary to re-treat the canal or even extract the tooth.

It can also break the crown of the tooth, which will make it difficult or even impossible to restore it, as an indication for its extraction. With extensive periapical changes, it is also recommended to use magnetoledotherapy to accelerate tissue regeneration processes.

Read about:

Root canal treatment of a two-channel tooth under a microscope

Channel treatment of a three-channel tooth under a microscope

 

Author: Lek. dent. Maciej Jabłoński

Bibliography:

Arabska-Przedpełska B. and Pawlicka H., Contemporary endodontics in practice, ed. 2, Łódź 2012, ISBN 978-83-927915-6-0; Jańczuk Z., Kaczmarek U., Lipski M., Conservative dentistry with endodontics, ed. 4, Warsaw 2014, ISBN 978-83-200-4863-6; Barańska-Gachowska M., Endodontics of the developmental and mature age, ed. 2, Lublin 2011, ISBN 978-83-7563-091-6; Torabinejad M. and Walton R. E., Endodontics, 1st edition, Wrocław 2011, ISBN 978-83-7609-272-0

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