The most common endodontic procedure is the pulpectomy, which is the removal of the entire pulp (chamber and canal). After removal of the pulp, root canal therapy is performed.
This treatment consists of the internal debridement, cleaning, shaping, and permanent filling of the root canal system. During the therapy, the dentist may place medications and temporary filling material. The therapy may vary slightly because of the type of tooth and number of canals in the tooth.
An acute periapical abscess may indicate a need for incision and drainage to eliminate the infection along with endodontic treatment. Incision and drainage can be effective when the swelling and infection are localized in the alveolus with a clearly defined point on the surface of the mucosa. Endodontic treatment Should be initiated at the same appointment to remove the necrotic infected pulp. Although the periapical abscess usually is accompanied by severe pain, it is not advisable to inject a local anesthetic solution directly into the infected area when draining the abscess because of the danger of spreading the infection. Instead, block anesthesia and infiltration away from the infected area. Local anesthesia may not be as effective because of changes in the pH of the tissues in the presence of the infection. The patient must be informed to expect momentary discomfort when the area is lanced, but the pain is immediately and significantly reduced after the incision is made and the exudate (pus) is expressed. If indicated, a drain is placed to provide short term drainage and to prevent the opening from closing prematurely until the infected area drains. The dentist may prescribe antibiotics. Once the infection is controlled and the swelling and tenderness subside, the dentist will treat the tooth endodontically.
An apicoectomy (root end resection) is the surgical removal of the apical portion of the tooth through a surgical opening made in the overlying bone and gingival tissues. An apicoectomy usually is performed in conjunction with periapical curettage after the body fails to heal after endodontic treatment. Periapical curettage is the surgical removal of apically inflamed tissue associated with the tooth through an opening made in the overlying bone and gingival tissues. Treatment is limited to curettage of the area to remove all diseased material. Conditions that may indicate the need for an apicoectomy include:
Persistent, local infection following endodontic treatment.
Canal filling materials or medications extruded into the periapical tissue.
A broken instrument lodged in the canal preventing complete filling.
Obstruction caused by a calcified root canal.
Extreme curvature of the canal preventing access to the apex of the root.
Root canals that are unfilled or debrided.
This is a method of sealing the apical end of the root canal by placing a restoration in the root apex. This is usually done in conjunction with the apicoectomy. Superortho-ethoxybenzoic acid (EBA) cement or an intermediate restorative material such as Zinc Oxide and Eugenol (ZOE) is used as the filling material because they will not react with any moisture that may be present in the root canal. Some dentists prefer to use composite filling material.
Occasionally, a multirooted tooth requiring endodontic treatment may have a root that is impossible to obtain an adequate apical seal or is affected by periodontal disease. When the other roots of the teeth are treatable, rather than extracting the entire tooth, the untreatable root is amputated and removed. The opening to which the amputated root was attached is sealed with amalgam similar to that of an apicoectomy procedure. The retained section of the tooth is treated endodontically before amputation.
The use of chemical agents may be used to remove discoloration from the crowns of vital or nonvital teeth. Nonvital teeth may discolor because of pupal hemorrhage into the dentinal tubules after traumatic injury of the tooth, or from the use of medications that cause staining when used in endodontic therapy. In such cases, the appearance of the discolored teeth may be improved dramatically by bleaching the tooth.Continue Reading