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Endodontic treatment, commonly known as root canal treatment, is needed when the pulp becomes inflamed or infected. This can happen for several reasons: deep tooth decay; repeated dental procedures to a tooth replacing a large filling, for example ; or traumatic damage such as a crack, chip or even a fracture. If the pulp dies, the pulp chamber and canals can become infected. That infection can eventually spread into the surrounding bone and other tissues around the tip of the root.
Endodontists use radiographs x-rays , or sometimes CBCT scans cone beam-computed tomography that create three-dimensional views, to examine root canals and diagnose disease that might otherwise go undetected. Conventional root canal treatment involves drilling a small access hole into the pulp chamber through the biting surface of a back tooth, or from behind a front tooth.
Inflamed or infected tissue is removed from the pulp chamber and root canals, and the space is disinfected, shaped with tiny flexible instruments, filled, and sealed. A temporary or permanent filling material will then be placed to cover the access hole. A permanent cap crown is often used to replace lost tooth structure and to protect the tooth from biting stresses and further damage.
As you can see, a lot of work goes into treating root canal infection. But root canals may become re-infected for a variety of reasons: new or recurrent decay; previously undetected accessory extra canals branching from the primary canal at the root end of the tooth; and, occasionally, calcification narrowing and hardening of canals — a reaction to trauma or aging that can block the canals and prevent them from being fully cleaned by conventional root canal treatment.
Sometimes, conventional root canal retreatment may not be feasible, or may even jeopardize the tooth. For example, accessing the canals of a tooth that has a crown and a post in place may require taking apart the entire restoration, which could further weaken the tooth. In such cases, a better alternative is to treat infection from the root end of the tooth instead of the crown end with an apicoectomy. Unlike traditional root canal treatment, an apicoectomy is a surgical approach through the gum.
This allows removal of any inflamed or infected tissue near or around the tip of the root — along with a few millimeters of the root tip itself. A very small filling is then placed in the end of the root canal to seal the canal and prevent further infection.
Afterward, a few sutures stitches are placed to assure that the gum tissues are closed and will heal properly. Where necessary, bone grafting or other techniques are used to help the bone to grow and fill back in, particularly if infection has left a significant void. Over time, the absence of infection will allow the area to heal and return to normal function. Endodontists use state-of-the-art technology such as fiber optic lights, operating microscopes, and ultrasonic instruments that clean via high frequency vibration, when performing endodontic surgery.
These advanced technologies give endodontists a very accurate view of the tooth, making the treatment quick, comfortable and successful. Mineral trioxide aggregate MTA is a cement containing mineral oxides which absorb water to form a colloidal gel, which solidifies over a period of approximately 4 hours. It has proven very popular as a root-end filling material and has shown generally high success rates.
Reported success rates for apicoectomy vary widely. Studies generally focus on one material or method of treatment compared to another, so it can be difficult to obtain any good evidence on the overall success rate.
If performed correctly, it can be highly successful in preventing loss of teeth which would otherwise be extracted. From Wikipedia, the free encyclopedia. Apicoectomy X-Ray of a tooth after root end surgery. Compendium of Continuing Education in Dentistry. June ISSN American Association of Endodontists. Retrieved Journal of Endodontics. PMID Journal of Indian Society of Periodontology. PMC CiteSeerX Medicine portal. Dental radiography Dental pulp test.
Periradicular surgery Apicoectomy Root resection Tooth hemisection. Dental dam Apex locator Electronic apex locator Files and reamers Nickel titanium rotary file Operating microscope Silverpoints. Categories : Dentistry procedures Endodontics. Namespaces Article Talk.
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