How Do I Choose between a Root Canal and an Extraction?

Root canal therapy, also known as endodontic therapy, is an operation for treating dental pulp necrosis and root infection in dental medicine. The surgery retains teeth and is therefore complementary to tooth extraction. The operation is tedious. It usually takes 2-4 visits to complete. With the development of technology and materials, one-time root canal therapy has been accepted by more doctors and patients. Painless treatment has also been widely used clinically, and the treatment is no longer painful.

Root canal therapy

Root canal therapy

The debate over "endodontics" has been going on for more than a century. People continue to generate new ideas, meet new challenges, develop new materials, and propose new technologies; at the same time, some errors have been repeated again and again, and some treatments still rely entirely on personal experience. During this period, what has been considered a "small but unimportant organization" has been repeating history, which has prompted us to choose a different approach-a path rarely encountered by previous generations. With an in-depth understanding of the root canal anatomy system, some of these methods and paths have proved to be infeasible, useless, deviating from direction or no way out; some methods are markedly improved, while others are retrogressive; Some are just repetitions; some are based on physiology, and some are based solely on experience. As the new millennium approaches, we need to not only revisit these different methods and paths, but also learn from the historical experience and lessons of the past centuries-because it enables

The hollow part of the tooth contains soft tissue called pulp. The upper part of the cavity is broad, known as the pulp cavity, and the lower part has a tubular root canal from which the blood vessels of the dental and vegetative nerves are led. Humans generally have 1-4 root canals per tooth, with the posterior root canals being the largest.

Infection of the dental pulp can cause pain, infection of the jaw bone, and eventually the teeth become weak due to the death of the dental nerve.

Step 1: Root Canal Preparation

Before the root canal preparation, the preoperative assessment, medullary cavity preparation and working length measurement of the root canal therapy must be performed, and the second stage is the root canal preparation. There are two methods of root canal preparation, and there are different preparation methods depending on the selected instrument. To do the root canal preparation for root canal therapy, it should be emphasized that because the root canal system is very complicated, the preparation of any instrument and any method cannot reach the entire root canal system, so the combination of mechanical preparation and chemical preparation is very important .

Step 2: Root Canal Disinfection Phase

In root canal therapy, experts recommend that live pulp teeth or infected teeth that are limited to the coronal pulp can be used once, and others can be sealed with root canals.

Step 3: The root canal filling stage

In root canal therapy, when filling the root canal, we must grasp the timing of filling. Generally, there are no conscious symptoms, no obvious pain, no odor in the root canal, no leakage, and no acute periapical inflammation. It is not necessary to wait for all symptoms to disappear, and it is not necessary to wait for the fistula to fully heal. Repeated seals are likely to cause greater irritation to the periapical area. The filling method, cold tooth gel lateral pressure method is still the mainstream, hot tooth gel is the future trend.

Root canal procedure

1. Take X-ray pictures to determine the structure of the affected area and surgical plan.

2. Apply local anesthesia.

3. Drill the teeth to remove the decayed dentin.

4. Open the pulp cavity and remove the necrotic pulp.

5. Expand the root canal with a root canal drill.

6. Rinse the inside of the root canal with a disinfectant (such as sodium chlorate solution).

7. Fill the root canal with special materials to ensure long-term sterility.

8. Fill the drill holes of the teeth, or install

1. Pulpitis: The pulp is inflamed by bacterial infections. The pulp is in the sealed pulp cavity and is generally not infected by bacteria. When the tooth has a hole due to dental caries, when the hole is too deep, external bacteria will invade. The pulp cavity is infected in the pulp cavity.

2. Apical periodontitis: After the dental pulp is infected by bacteria, bacteria will invade the alveolar bone through the apical foramen, causing inflammation of the tissue around the apex of the tooth. As long as the infected pulp is removed, the apical inflammation will subside.

3. Exposing the pulp: When the teeth are broken and the nerves are exposed, root canal treatment is usually required.

May fail due to incomplete disinfection

Proficiency in the basics of dental root canal anatomy is a guarantee

After the formation of enamel and crown dentin, the root of the tooth begins to occur, and the epithelial root sheath is important for the normal development of the root. For example, the continuity of the epithelial root sheath is damaged, or the lingual protrusion of the epithelial septum at the root bifurcation is not fully integrated Or, the growth of epithelial root sheaths around blood vessels can not induce the differentiation of odontoblasts and cause dentine defects there. The pulp and periodontal ligament pass directly, forming lateral collateral root canals, apical divergences and intercanal communication branches. . Lateral canal refers to the branch root canal that is nearly perpendicular to the main root canal and reaches the root surface directly. It is found in more than one-third of the root of the root, more often in the posterior teeth and occasionally in the anterior teeth. The accessory canal is a small branch from the bottom of the medullary cavity to the root bifurcation, which is more common in molars. Apical divergence is the divergent root canal that occurs in 1/3 of the apex from the main root canal. Lateral and lateral root canals and apical divergence may become channels for the interaction between pulp disease and periodontal disease, which also adds to root canal treatment. Complexity.

When the tooth just emerged, dentin was not yet formed, the medullary cavity was large, and the apical foramen were open. The tooth root continues to develop after eruption, and it takes about 3-5 years to complete the formation of the apex. Under abnormal conditions, the tooth root and apex may also stop developing and form short roots or flank apex. In clinical treatment, the equipment, Drugs or fillers can easily penetrate the apical foramen, stimulate the tissue around the apex and cause inflammation.

Dentin continues to form throughout life. As the age increases, there is secondary dentin deposition on the inner wall of the medullary cavity, which gradually reduces the volume of the medullary cavity. All calcifications are obstructed. This will cause some difficulties in root canal preparation and must be handled carefully.