Endodontics

Dental pulp is the soft tissue of the tooth, which is situated in the crown part of the tooth and root canals. It is frequently referred to as the nerve, although it contains not only nerve fibres, but also connective tissue, blood vessels and various types of cells. The inflammation of dental pulp is called pulpitis. When the infection has spread through the root canals, the inflammation of the apex of the root of the tooth or apical periodontitis may arise. It can also be asymptomatic and may be diagnosed by means of an X-Ray examination of the oral cavity. The inflammation of the dental pulp and apical periodontitis are the most common reasons for root canal treatment.

Consultation of the patient on the planned course of therapy, costs and prognosis is mandatory before therapy. Specialists of endodontology perform treatment under microscopy control, which provides magnification, additional lighting and the opportunity for higher precision work. Dentists use special equipment, materials and digital X-ray devices.

The endodontists of our clinic are members of the Latvian Society of Endodontology and European Society of Endodontology. The guidelines of the European Society of Endodontology are used to select therapy methods.

The number of endodontic therapy sessions depends on the diagnosis of the tooth and the anatomy of root canals. Most commonly, the treatment is performed in 2 sessions, but single session therapy is also acceptable, if there is enough time. In some cases an additional treatment session may be required.

Anaesthesia, isolation of the tooth, opening thereof and preparation of dental root canals under microscopy control is usually performed during the first therapy visit. During the retreatment of the tooth the removal of the existing filling under microscopy control is performed. During therapy, the tooth is isolated from the oral cavity with special rubber - a cofferdam, which protects the patient from the potential entry of infected tools into the airways or oesophagus. At the end of the session, the tooth is sealed with temporary medication and high-quality temporary restoration.

During the second therapy visit anaesthesia is used (if necessary); isolation of the tooth, repeated treatment of the root canal and filling of the root canal system is performed under microscopy control by using the vertical filling method, which ensures a denser filling compared to traditional methods. The tooth is sealed with temporary restoration.

Prognosis is the determination of a therapy outcome for a longer period of time; it is determined after the diagnosis is set. The probability of healing of the existing inflammation (apical periodontitis) or the probability of developing new inflammation is forecast. The use of magnification, biomaterials and the vertical canal filling method increases the probability of a successful therapy result.

It must be considered that endodontic diseases are diseases caused by an infection and cleaning absolutely all micro-organisms from root canals is impossible. The prognosis of therapy is affected by all factors that enable the access of micro-organisms to the root canal or their survival in the canal system - initial diagnosis of the tooth and its anatomy, large number of sessions, repeated infection during the therapy, quality of temporary filing and restoration, previously made mistakes and the quality of the filling. Factors lowering the therapy result (re-infection during treatment, low quality temporary restoration, etc.) are excluded in the practice of endodontology specialists. The prognosis of re-treatment of the dental root canal in the event of pre-existing apical periodontitis (AP) is lower than that of primary therapy.