Root canal treatment aims to restore tooth functionality. Endodontic treatment is necessary if the patient is diagnosed with pulpitis or periodontitis.
Root canal treatment of the tooth consists of three stages:
- Maximum access to the canal is provided by dental manipulations
- The pulp is removed and the canal is rehabilitated
- The canal is hermetically sealed with a material with a therapeutic effect
The pulp, or the nerve of the tooth, is the contents of the root canal and crown. It consists of a large number of nerve endings, blood vessels, collagen fibers and connective tissue. The pulp is abundantly supplied with blood through arteries and veins, which together with nerve fibers form a neurovascular bundle. The tooth cavity consists of two chambers – the actual cavity of the crown and root canal. The area of the cavity where the channels originate is called the cavity bottom. The root canals of the tooth have a complex structure, usually individual to each tooth.
A dental disease that manifests as inflammation of the pulp is called pulpitis. The disease begins as a result of pulp intoxication from the carious surface of the dental cavity. Depending on the degree of development, pulpitis is divided into several stages. We will describe each of them separately below.
- The initial pulpitis is manifested by hyperemia of the gums, which increases the blood supply to the pulp due to increased blood flow in the main arteries. This change creates a certain tension in the nerve fibers and is not manifested by severe pain. As soon as the stimulus is removed, the pain subsides within 1-2 minutes.
- The development of acute pulpitis can be said when the patient is bothered by a sharp toothache. At insignificant inflammation of pulp there is a possibility of its preservation. If the irritant is removed in a timely and professional manner, the pulp heals on its own, the pain and external manifestations of inflammation disappear. In the case of continued exposure to the stimulus, the pulp loses its ability to self-healing, the process becomes irreversible, characterized by continuous throbbing pain of an acute nature. The patient’s pain can be felt both localized and spread throughout the periosteum.
- Suppurative pulpitis is a complicated form of acute inflammation. The symptom of this disease is an acute, unbearable toothache, especially occurring at night. Upon detailed examination, the doctor finds a tooth that is completely damaged by caries, which responds painfully to probing the cavity.
- Chronic pulpitis is a disease characterized by periodic pain attacks that occur when the pulp is irritated and gradually disappear after the stimuli are removed. During the examination, the doctor states the presence of carious destruction and poor condition of the pulp, which responds to the examination of bleeding and discomfort.
- Chronic hyperplastic pulpitis is an irreversible stage of the disease that affects the teeth of children and patients with advanced caries. One of the main symptoms of this form of pulpitis is the appearance of a pulp polyp or tissue hyperplasia. The disease has a chronic recurrent course.
- The most severe form of pulpitis is pulp necrosis. In this case, there is a complete atrophy of the pulp tissue, which occurs due to prolonged adverse effects of bacteria, or as a consequence of suppurative pulpitis in the acute form. This leads to the need to remove the tooth with subsequent implantation.
Stages Of Pulpitis Treatment
In the treatment of root canals it is very important to follow a sequence of interdependent procedures. At the beginning of treatment, a gradual analgesia of the oral cavity is performed. Then a cofferdam is applied – a special rubber sheet to block the access of saliva to the gums. This stage is very important, because when salivary bacteria enter the root canal, its sterility can be violated.
The next step is to prepare and provide access to the canal by excising the carious surface. Then the root canal is disinfected by mechanical and chemical methods. This step should be performed especially carefully, as it is very important to remove all infected pulp tissue.
The next procedure is to process the channels with files. This treatment is performed on the basis of an X-ray, which determines the length of the channel.
After the canal has been thoroughly treated and disinfected, the main stage of treatment begins – sealing. For this stage the condition of full sealing of channels is extremely important.