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What does Conservative
Dentistry and Endodontics encompass?
With the recent advances in the materials and treatment
modalities, this speciality deals not just with restoration of
mutilated tooth but with the total oral rehabilitation including
esthetic corrections.
The Endodontic branch of the specialty deals with the prevention
and treatment of the diseases of the pulp and the periapical
tissues, so that the arch balance is not lost and the health of
the bone and the gingiva is maintained.
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Treatment provided by conservative dentists and
Endodontists
include?
• Amalgam, Composite, Ceramic and Metallic restorations.
• Root canal treatment
• Specialized restorations like crown, inlays, post and core
,veneers
• Bleaching of teeth.
• Esthetic recontouring of teeth
• Smile design
• Complete oral rehabilitation
• Periapical endodontic surgeries
Defects that afflict the teeth require restorations for
functional as well as esthetic reasons. The field of
Conservative Dentistry & Endodontics encompasses the diagnosis
and treatment of such needs of patients and also involves
performing root canal treatment and associated surgical
procedures to rid the tooth of its offender.
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What is root canal treatment (RCT)/
Endodontic treatment?
Root canal treatment, also known as endodontic treatment, is a
dental procedure in which the diseased or damaged pulp (core) of
a tooth is removed and the inside areas (the pulp chamber and
root canals) are cleaned, filled and sealed.
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When is the root canal treatment needed?
Inside the tooth, the pulp's soft tissue contains the blood
supply, by which the tooth gets its nutrients, and the nerve, by
which the tooth senses hot and cold. RCT is necessary when the
pulp, the soft tissue inside the root canal, becomes inflamed or
infected. The inflammation or the infection can have a variety
of causes; deep decay, repeated dental procedures on the tooth,
a crack or a chip in the tooth, a sudden blow to the tooth. The
microorganisms may spread inside the tooth from the crown to the
tip of the root in the jawbone, creating a build-up of pus which
may eventually cause an abscess. This can be very painful and
the teeth may become very sensitive to heat or cold.
Normally the crown of the tooth will protect the pulp against
infection, but once a tooth becomes damaged and infection
spreads, it must be treated in order to avoid further damage, or
the tooth must be removed altogether.
In some instances the tooth may also require intentional root
canal treatment as part of an adjunctive therapy during
prosthetic rehabilitation in the mouth.
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Is there any alternative to root canal treatment?
The alternative to root canal treatment is extraction of the
infected tooth. However, in order to keep your oral tissues in a
healthy state and prevent the problems caused by missing teeth,
it is always recommended to retain natural teeth wherever
possible.
Removal of the tooth is preferable to no treatment at all, as an
infected tooth can cause further painful complications if left
in the mouth. The pulp will not heal of its own accord once it
has become infected.
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What are the signs or symptoms of needing a root canal
treatment?
Severe, constant or throbbing pain in the tooth, prolonged
sensitivity to heat or cold, tenderness to touch and chewing,
discoloration of the tooth and swelling, draining pus and
tenderness in the lymph nodes as well as nearby bone and
gingival tissues are the most commonly associated signs with an
infected tooth. However, in some cases, the pulp may die so
gradually that there is little noticeable pain.
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Who performs
Endodontic treatment?
All dentists would have received some training in endodontics
while in a dental college/school. Often general dentists refer
patients needing root canal treatment to an endodontist, a
dentist who specializes in endodontic (literally "inside of the
tooth") procedures.
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Who is an "Endodontist"?
An endodontist is a dentist who specializes in the diagnosis and
treatment of disorders affecting the inside structures of the
tooth. As a specialist, endodontists limit their practice to
endodontic procedures.
Endodontists have advanced surgical and nonsurgical skills that
make them uniquely qualified to treat routine as well as complex
cases. The care that an endodontist provides is supported by
intensive education on how to perform the very best endodontics.
After completing their basic graduation in a dental college,
endodontists attend a three-year advanced course that focuses
mainly on endodontic science and procedures. Endodontists also
attend continuing education courses after they are in practice,
so they are knowledgeable about state-of-the-art research,
clinical procedures, and technology.
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What is the procedure involved during a root canal treatment?
Root canal treatment is performed under local anesthesia. A thin
sheet of rubber, called a rubber dam, is placed in the mouth to
isolate the tooth. The dentist removes any tooth decay and makes
an opening through the natural crown of the tooth into the pulp
chamber. Creating this access also relieves the pressure inside
the tooth and can dramatically ease pain.
The dentist determines the length of the root canals, usually
with a series of x rays. Small wire-like files are then used to
clean the entire canal space of diseased pulp tissue and
bacteria. The debris is flushed out with large amounts of an
irrigant (normal saline or sodium hypochlorite usually). The
canals are also slightly enlarged and shaped to receive an inert
(non-reactive) filling material called gutta percha. However,
the tooth is not filled and permanently sealed until it is
completely free of active infection. The endodontist may place a
temporary seal, or leave the tooth open to drain, and prescribe
an antibiotic to counter any spread of infection from the tooth.
This is why root canal treatment may require several visits to
the dentist.
Once the canals are completely clean, they are filled with gutta
percha and a sealer cement to prevent bacteria from entering the
tooth in the future.
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Will the tooth need any additional treatment?
A metal post may be placed in the pulp chamber for added
structural support and better retention of the crown
restoration. The tooth is protected by a temporary filling or
crown until a permanent restoration may be made. This
restoration is usually a metallic or porcelain crown, although
it may be a gold inlay, or an amalgam or composite filling
(paste fillings that harden).
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How long will the procedure take?
Root canal treatment can be done in a single visit requiring one
appointment only or multiple visits requiring more than one
appointment depending on the indication for the treatment.
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What is the aftercare required for root canal treated tooth?
The tooth may be sore for several days after filling. Pain
relievers may be taken, on the advice of the dentist, to ease
the soreness. The tissues around the tooth may also be
irritated. Rinsing the mouth with warm salt water several times
a day will help. Chewing on that side of the mouth should be
avoided for the first few days following treatment. A follow-up
appointment should be scheduled with the dentist for six months
after treatment to make sure the tooth and surrounding
structures are healthy.
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How long will the tooth last after root canal treatment?
Often as long as the other teeth in the mouth, provided the
person is in good health and his or her body has the ability to
repair damaged bone. The tooth must also have healthy fibers
supporting the tooth in the bone (healthy gums around that
tooth).
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Is there any risk associated with root canal treatment?
There is a possibility that the root canal treatment will not be
successful the first time. If infection and inflammation recur
and a radiograph of the tooth indicates retreatment is feasible,
the old filling material is removed and the canals are
thoroughly cleaned out. The dentist will try to identify and
correct problems with the first root canal treatment before
filling and sealing the tooth a second time.
In cases where a radiograph indicates that retreatment cannot
correct the problem, endodontic surgery may be performed. In a
procedure called an apicoectomy, or root resectioning, the root
end of the tooth is accessed in the bone, and a small amount is
removed. The area is cleaned of diseased tissue and a filling is
placed to reseal the canal.
In some cases, despite root canal treatment and endodontic
surgery, the tooth may have to be extracted when there is a non
healing lesion or failure of endodontic treatment.
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What is
Endodontic retreatment?
In few situations, however, complete healing may not occur.
There may be new problems months or even years after the initial
treatment. When this happens, it is sometimes possible for the
endodontist to perform the treatment again with more successful
results. This process is called retreatment.
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Is retreatment the best treatment option when advised?
The decision to retreat should be made by the patient, the
dentist and/or endodontist. While retreated teeth can last a
lifetime, there is no guarantee that treatment will be more
successful the second time. The treatment option for any
particular patient must be chosen on an individual basis.
The only alternatives to retreatment are having the tooth
extracted or having it retreated surgically, if the root cannot
be accessed through the crown. If the tooth is extracted, it
must be replaced with a bridge, implant or removable partial
denture. This will restore chewing function and prevent adjacent
teeth from shifting. Generally, nonsurgical retreatment and
restoration of the natural tooth is the least expensive option.
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What is
Endodontic surgery?
The most common endodontic surgical procedure is an apicoectomy
or root-end resection. It is used to relieve inflammation or
infection in the bony area around the end of the tooth that
continues after endodontic treatment. The endodontist lowers the
gum tissue and removes the infected tissue and may remove the
very end of the root. A small filling may be placed to seal the
root canal.
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