Endodontics
Endodontics is the treatment of the dental pulp and any infection of the area around the end of the root of the tooth, otherwise known as root canal treatment. Where surgery is involved, it is referred to as an apicectomy, where the root end is removed surgically. Successful removal of infection and filling of the root canal, results in a dead tooth that continues to function. All the following radiographs are taken with the Schick Dental Imaging System.
Non Surgical Root Canal Treatment
Due to the limited access and visibility and the varied anatomy of each tooth, this is best carried out with isolation in the form of rubber dam and with the use of a dental microscope. Root treatments are normally carried out with rotary nickel titanium files of various dimensions that shape the canal and allow for the access of irrigants that clean the canals. Now we have available the NEW and altogether better Self Adjusting File (SAF) that combines a significantly better cleaning and shaping action, with minimal damage to the healthy root.
Root Canal Treatments
Further examples of root canal treatment are as follows: Most molar teeth have three or four canals which range in complexity. Premolars have from one to three canals and canines and incisors one or two.
Example 1: Pre-op.
UR7 prior to root canal treatment.
Post-op.
Completed root canal treatment of UR7
Example 2: Pre-op.
LL7 prior to root canal treatment.
Post-op.
Completed root canal treatment of LL7
Re-Root Canal Treatments
Re-treatments are occasionally necessary if there is persistent infection. This is commonly due to the original root filling being inadequate either in length or degree of cleanliness.
Example 1: Pre-op
Original failing root filling in UR2.
Post-op
Completed re-root treatment of UR2
Example 2: Pre-op
Original very short root filling in LR6
Post-op
Completed re-root treatment in LR6.
Complex anatomy
Occasionally the anatomy of the tooth can be somewhat more complex, with significant curvatures of the root canals and multiple root canals. Extra care is required to ensure that the canal is fully insturmented without fracture of the files, in order to ensure a satisfactory outcome.
Example 1: Pre-op
UL7 priot to root canal treatment.
Post-op
Completed root filling in UL7.
Surgical Endodontics - Apicectomy
Where there has been a previous root canal treatment carried out that has not resolved the apical infection, it is sometime necessary to surgically access the root end and remove it along with the infection, this is followed by placing a root end filling. The current material of choice being a purified form of Portland Cement; mineral trioxide aggregate (Pro Root MTA or the most recent addition Biodentine).
Below is an example of the new bone growth that occurs over a period of years at the root end once the infected material has been removed.
Pre-operative, immediately post-operative and one year post-operative views to show healing of the bone at the apex of the root.
Pre-operative view of tooth with large post and no root canal.
One year after removing the apex of the root and retro-grade root filling with MTA.
Area of infection around the root end of LR4.
Nine years after apicectomy with complete bone healing.