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.
ROOT CANAL THERAPY
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.
INCISION AND DRAINAGE
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.
APICOECTOMY AND PERIAPICAL
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
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.
BLEACHING OF DISCOLORED TEETH
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.