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Endodontics
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Endodontic or root canal treatment consists of all those procedures aimed at maintaining the dental pulp or part of same.
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When is root canal treatment required?
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When the pulp is affected irreversibly by deep level caries or trauma. In these cases the tooth becomes sensitive to heat or cold, or mastication. The pain may be intermittent or constant. The tooth may even change colour or a swelling may appear. Root canal treatment may also be recommended for teeth which require exhaustive shaping for the subsequent attachment of crowns or bridges.
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How is root canal treatment performed?
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The treatment consists of various steps:
- First, an aperture is made in the palatal surface, in the case of the anterior teeth; or in the occlusal surface for molars or premolars.
- After removing the diseased pulp (pulpectomy), the pulpal chamber and the root canals are cleaned and subsequently filled with a specific material.
- In the case of treatments which require more than one visit, the aperture in the crown is restored temporarily in order to protect the tooth until the next session.
- On the following visit, the temporary material is removed in order to proceed with the permanent restoration of the pulpal chamber and the root canals. To do so a material called gutta-percha is inserted into each of the canals and then sealed with cement.
- The final step is to proceed with a reconstruction, if the tooth permits it, or the attachment of a crown to return the tooth to its natural shape and appearance.
- This procedure is undertaken on permanent teeth, as in the case of primary teeth the canal is filled with a reabsorbable material and a pre-formed crown is attached to protect the tooth.
Dental pulp damaged by deep caries
The pulp is extracted and the root canals are cleaned prior to filling them.
The chamber is filled and sealed.
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Rotary Technique (Protaper®)
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This new technique is based on the cleaning and preparing of the root canals using rotating instruments at low speed with specially adapted files, following a specific sequence. Generally, after the biomechanical instrumentation, these canals are filled with a thermoplastic material (Thermafil®), which with one sole movement hermetically seals the preparation.
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Endodontic re-treatment
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Endodontic re-treatment is the procedure whereby the root canal treatment is repeated in a tooth where the initial endodontic treatment has not produced the desired result.
When symptoms of infection, inflammation or persistent pain appear in an endodontically treated tooth, the need for re-treatment must be evaluated through an exhaustive clinical and radiographical evaluation.
The technique begins with the removal of the material contained within the root canals thanks to the use of different products. The structures are prepared again, followed by the subsequent filling of the canals in the correct manner.
Endodontic re-treatment is a rescue therapy which should be performed in various sessions. This is why, despite using the correct technique, the treatment may fail as many factors are involved, some impossible to control, reducing the success rate to 60%. It is therefore very important to undergo regular monitoring of the treatment, both clinical and radiological.
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