Endodontics

The most common cause of bacterial challenge arises from caries. Microoorganisms and substances they release gain access to the pulp and adversely affect its condition.

In case the infected root remains not treated, microbes and their products may reach the periapical tissue via apical foramen and elicit an inflammatory response. It includes resorption of the surrounding bone, and might lead to other complications. Bone resorption is often visible in a X-ray picture.

An inflamed or injured pulp should be removed and replaced with a root filling. It prevents microbical growth and multiplication in the pulp chamber. The treatment should be performed under control of X-ray. Normally, at least 3 radiographs of one tooth should be taken during process of treatment. In some cases microscope should be used to see the operation field properly.

However, root canal treatment not always leads to a succesful clinical outcome. For example, a tooth may continue to be tender or periapical inflamantion may persist. Such treatment failures are often related with deffective root fillings (they allow microorganisms to survive in the root canal or new bacteria to enter). Sometimes canal retreatment is needed for such cases using either a non-surgical or a surgical approach.

In non-surgical retreatment the root filling is removed and the canal is reinstrumented. Antimicrobial substances are applied to kill the surviving microbes and the space is reobturared.

In surgical retreatment muco-periosteal flap is raised and entrance to the apical part of the tooth is made through the bone. Then the root tip is cutted and retrograde preparation and filling of the canal is performed.