U.S.Dental ( also known as Tufts Dental )
Dr.Gina Sohn - Tufts Graduate
U.S.Dentist in Seoul / Licensed in MA, CT, NJ
http://www.drginasohn.com
Tel 02-553-7512 / Overseas 822-553-7512
Root Canal Treatment
Good root canal treatments begin with proper diagnosis.
This involves listening to the patient’s description of the problem, followed by clinical tests to reproduce the patient’s subjective pain or symptoms.
The clinical tests that need to be incorporated into the diagnostic evaluation are 1) cold, electric pulp tester (EPT) and/or heat tests for pulp vitality; 2) percussion testing to determine the status of the periodontal ligament; 3) palpation testing to evaluate the gingival tissue and bone for infection or inflammation; 4) probing and mobility testing; and lastly, 5) radiographic examinations.
Also, it is important to review a patient’s medical and dental history as part of the diagnostic process.
One of the more influential factors regarding the long-term restorative prognosis is the periodontal (surrounding gum and bone) status of the tooth being treated. Primary pathosis from a root canal certainly can cause secondary periodontal lesions. When the root canal etiology is removed in these situations, the periodontal problem is also likely to resolve. However, when the bone loss is primarily from gum disease, it can create a less predictable prognosis for the tooth even with the appropriate root canal treatment.
Root canal disease is mediated by bacteria.
Treatment goals should be directed to reducing the critical concentration of microbial irritants to the lowest level possible. Thorough canal instrumentation, with either stainless steel hand files or Ni-Ti rotary files, removes the bulk of tissue and microbial contamination, but adjunctive chemical agents are needed to optimize debridement. Current concepts support the following approaches:
• lubricating and chelating agents during cleaning and shaping,
• copious irrigation during all phases of instrumentation with 2.5% sodium hypochlorite, constantly refreshed
• deep penetration of a side port, narrow gauge irrigating needle, constantly moving in and out of the canal space during each irrigation
• removal of residual smear layer at completion of instrumentation prior to obturation.
In addition to the quality of the root canal treatments performed ,root canal success is equally dependent upon the quality of the coronal seal established by a filling and a crown,during and after the procedure. Consideration also must be given to whether the tooth will need a post.
Timely placement of these restorations are critical. If bacteria are allowed to enter the coronal portion of the root canal, they will eventually penetrate the interface between root canal and the obturation material, resulting in recontamination of the canal space and subsequent inflammation.
Root canal performed teeth tend to get drier, more brittle over time,and more prone to frature. Tooth fractures occur while chewing foods most of the time. Crowning prevents these possible tooth fractures by embracing the tooth as one entity. It is hard to predict when the root canal tooth will break. The best timing for crowning might be the night before the tooth will break. :-)
Before treatment planning a crown for a root canal treated tooth, the tooth should show;
1. Radiographic evidence of a good apical seal.
2. No sensitivity to pressure (percussion).
3. No sensitivity to palpation of the periapical area.
4. The tooth is asymptomatic.
5. Acceptable root canal filling.
