In the domestic literature, endodontic intervention is understood as any medical action involving therapeutic purpose, which is carried out through the tooth cavity or within it (V. S. Ivanov et al., 1984). Nikolishin A.K. (1998) defines endodontics as the science of anatomy, pathology and methods of treatment of the dental cavity and root canals. The definition is somewhat vague, since there is no clear definition of what is defined by the concept of “treatment of a dental cavity.” But then the author clearly points out that endodontics should be understood as odontosurgical interventions inside a tooth with the aim of preserving it, followed by restoration of the shape and function of the tooth using therapeutic or orthopedic methods. At the same time, it must be emphasized that in recent years, views on endodontics have expanded significantly. Previously, endodontic interventions included work only within the dental cavity and root canals. Modern endodontics has a significantly larger area and includes the following actions:

· protection of healthy pulp from diseases and (or) from chemical and mechanical damage(primarily iatrogenic);

· pulp covering (both direct and indirect);

· partial pulpectomy (vital amputation);

· mummification methods;

· total pulpectomy (extirpation);

· conservative treatment of infected root canals;

· drug therapy for periapical inflammation;

· surgical methods, including resection of the root apex, hemisection, root amputation, replantation, implantation of endodontic implants, etc.

This approach to endodontics, as an independent branch of odontology, which has its own goals and objectives, special techniques and techniques, has been established over a long historical period with the accumulation of experience and progress in science and technology. The emergence of new knowledge has led to a significant change in ideas about the possibilities of influencing pathological process in the pulp and periodontium. Through mistakes and disappointments, from the acceptance and rejection of treatment methods and techniques, from the initial goals of combating pain to today’s goals of eliminating the pathological process and preserving the tooth as an anatomical and functional unit, endodontics has come a long way. It seems important to us to illustrate the evolution of ideas about endodontics in a brief historical review.

Dental diseases have been familiar to humans since time immemorial, including those diseases that we now know as “pulpitis” and “periodontitis”. In ancient times, attempts were already made to alleviate people's suffering from dental diseases without removing the tooth, that is, by carrying out relatively conservative therapy. At that time, there was an idea that dental diseases were caused by worms, and this opinion lasted until the mid-18th century. In ancient China, preparations containing arsenic “to kill worms” were first proposed. At the beginning of our era, trephines were proposed to provide drainage from the dental cavity and periapical tissues in case of periapical abscess. Despite modern progress in endodontics, it should be noted that even today there is still no better remedy for relieving pain due to purulent inflammation of the periapical tissues. The first attempts to treat canals were made in the 17th century, but until the end of the 19th century this treatment consisted only of relieving pain by ensuring the outflow of exudate. In the late 19th century, bridges and pinned teeth became very popular, and endodontic interventions became very popular. It was believed that a “living” tooth is not suitable for supporting a bridge without prior devitalization. During this time, anesthetics (cocaine) were introduced and the production of endodontic instruments began, which were mainly used to remove pulp tissue or to remove decay.

However, the concept of canal filling had not yet been developed, and canals were mainly used to provide retention for post teeth. Since 1886, dental radiography has been widely used in endodontics. This endodontic “therapy” has gained pseudoscientific respectability. It was considered bad manners to remove any tooth or root if they could be used for orthopedic structures. Very often, with this approach, multiple fistulas were formed, which were treated conservatively with various methods. The relationship between dead teeth and the formation of fistulas with purulent discharge was known, but serious attention was not paid to it. It was only in 1911 that Hunter significantly criticized this approach. He believed that foci of inflammation in the periapical tissues cause a number of common diseases body. Numerous works appeared that, to some extent, confirmed this assumption. It got to the point that the diagrams depicted a tooth, and from it arrows were drawn to almost all tissues and organs, emphasizing the role of focal infection in the pathogenesis of the development of certain diseases of the heart, kidneys, gastrointestinal tract, skin, eyes, etc.

During this period, dentists could not, in essence, reject the accusations made, which led to unjustified recommendations - the removal of all teeth with radiological changes in the periapical area.

Looking ahead, it should be noted that modern research has not confirmed these accusations. But the idea that teeth with complicated caries are responsible for “chroniosepsis” is still present in dental textbooks.

Hunter's most substantiated accusations were based on the fact that during tooth extraction, surgical, periodontal and endodontic interventions, transient bacteremia appeared in the blood of patients for some time. The latter was accused of having a harmful effect on the body. It was believed that such bacteremia also occurred from time to time in chronic periodontitis. However, the work of Okeli and Elliot (1935) showed that the presence and degree of bacteremia depends on the presence and severity of periodontal disease and the degree of damage during tooth extraction, and not on the condition of the dental pulp. Fich and MacLean (1936) showed a discrepancy between bacteriological studies and histological changes. They convincingly proved that if a pathological pocket is exposed antiseptic treatment(cauterization) before tooth extraction, microorganisms are not detected in the bloodstream. Indeed, today the concept that a “dead tooth”, i.e. a tooth without pulp, is not necessarily infected, has become generally accepted. Previously, periodontal treatment methods included antimicrobial post-apical therapy as a mandatory attribute of treatment. Moreover, the recognition that tooth function depends on the periodontal condition rather than on the presence of living pulp has become dominant.

Another important conclusion was made by Rickert and Dixon (1931) in their classic study that led to the "hollow tube" theory. They showed that an inflammatory response occurs and occurs around the holes of the hollow tube when platinum or steel needles are implanted under the skin of rabbits. Implantation of a solid cylinder of the same size and shape made of platinum or stainless steel, which themselves do not cause either chemical or mechanical irritation, did not cause inflammatory changes in the tissues. This theory was confirmed and further developed by Torneck (1967), who repeated the experiment of implanting a sterile polyethylene tube under the skin of Wistar rats. It was confirmed that inflammation of varying severity occurs around the openings of the tube and is accompanied by invagination of connective tissue growths into the lumen of the sterile tube, while there was virtually no inflammation around the sealed end of the tube. As a follow-up to these experiments, Torneck implanted tubes of the same size filled with sterile autoclaved muscle tissue and the same tissue inoculated with Gram-negative cocci. Histopathological examination after 60 days showed that the inflammatory reaction around the openings of these tubes was significantly more pronounced than when implanting empty hollow sterile tubes. The most pronounced reaction was observed around the ends of the tubes with material contaminated with cocci - with the formation of abscesses. These data brought changes in the emphasis of the "hollow tube" theory and the attention of researchers was focused on the contents of the tube.

It was convincingly proven that it is not so much the hollow tube itself (a complete analogue root canal), how much its contents, and primarily the presence of microorganisms, influence the nature and severity of the course inflammatory process. Subsequent studies were carried out to discover specific microorganisms, their various associations and their influence on the nature of inflammation. But the main conclusion of the already modified “hollow tube” theory was not changed, and the data, rightfully, were extrapolated to teeth with necrotic pulp, since this situation is observed in most root canals requiring endodontic treatment.

The understanding that sealing the hollow end of the tube has an important role in the nature of the inflammatory response has led to the need to develop appropriate root canal debridement and apical foramen filling. Data on the morphology of teeth (the latter will be presented in Chapter 4), and the presence of additional canals and branches led to a corresponding change in views on instrumental treatment of root canals and medicinal treatment.

In most cases, it is not possible to fill all the branches and additional channels with today's instrumentation technology, but understanding what we need to strive for in order to reduce the risk of inflammation around the holes of the “additional pipes” has created the prerequisites for reducing the risk to a minimum. The task was set to develop non-irritating root canal filling materials that would not dissolve in the apical area and ensure perfect closure of the apical foramen. Instruments have been proposed that prepare a canal of a specific size and shape; root pins that would give a perfect sealing of the apex. Unfortunately, this ideal has not been achieved to this day.

Until relatively recently, the attention of doctors was directed to the search for drugs to influence root canal microorganisms. One listing would take up a significant volume of the book: various antiseptics, sulfa drugs, antibiotics - a wide range of drugs created again and again, in different combinations, different concentrations, different durations of use, with and without enzymes, with and without stimulants, etc. At the same time, instead of one drug, another was introduced, and publications on this topic continued and (of course) continue today. Before today A search is underway for a patented drug, the use of which would solve all the problems. The overwhelming attention to this problem has led researchers away from other endodontic problems, and primarily about the effect of these drugs on periodontal tissue. All drugs that have a bactericidal (as well as bacteriostatic) effect are also toxic to living tissues. From today's heights, the authors do not even think of taking their use critically. “Isn’t it because we seem like giants to ourselves because we stand on the shoulders of the great,” said one of the luminaries of science. But in thinking about the future of dentistry, let's hope that the current generation of dentists will understand this and avoid the use of harmful drugs for unjustified purposes.

From the above it is clear that the goals and fundamental views on endodontics remain the same. The doctor’s task is to diagnose dental diseases, decide on the choice of treatment tactics, and during endodontic intervention itself, to “clean” and shape the tooth canal, seal the pulp chamber and root canals. But today the possibilities for achieving these goals have increased immeasurably. If progress in diagnostics is not so noticeable (if any at all), then it must be emphasized that the most important achievements recent years associated with improved tools. Practical doctors of the old generation, and I include all doctors of pre-perestroika times, to this day try to give domestic names to entirely foreign instruments. Although even the name “drill-boring” is still not taken from our language. But we are still looking for analogues to the rasp and drill, reamer and depth gauge. It must be emphasized right away that these attempts will lead nowhere, and we must come to terms with the use of the names “reamer”, “file”, “profile” and so on (reamer, file, profile). More details about them will be reported in a special chapter, although comprehensive information about modern instruments is currently presented in the publications of Professor Nikolishin A.K., Professor Borovsky E.V. and others.

As we have already indicated, the most important innovations in endodontics have been associated with the improvement of instrumentation. The tools have now become more flexible, less brittle, thinner (06 size), and have more efficient cutting surfaces. The tips of these instruments are modified so that the instrument penetrates the canal without damaging the walls and prevents the instrument from extending beyond the apical foramen. Machine endodontic instruments have evolved into the field of sonic and ultrasonic vibrations. Techniques for removing sawdust from the root canal have been significantly improved. Classic example This is the introduction of profiles that minimize the risk of tool failure. At the same time, the introduction of these canal preparation methods led to a significant problem - loss of tactile sensation. Therefore, great care is required when using them to prevent “overpreparation” or perforation. Electroapex locators have appeared, and although they do not completely replace radiography, with their help it is much easier and safer to determine the working length of the root canal. Obturation of root canals has become much more effective with the use of machines for heating gutta-percha and condensing it.

New information has also appeared about well-known materials. Thus, calcium hydroxide began to be widely used in endodontics. Although we still do not know the biological mechanism of action of this material, it is now used in many situations, for example, to close perforations, for internal resorption and to prevent external resorption, to stimulate the closure of the apical foramen in the canals of immature teeth. Calcium hydroxide is recommended as a temporary material for filling root canals, as well as as an integral part of the material for permanent filling of root canals. Its scope has expanded so much that we are forced to devote significant space to it in the future.

Thus, modern endodontics can be defined as the treatment of teeth with reversible and irreversible changes in the pulp, as well as with its complete death and to prevent damage to the pulp in order to preserve the function of the tooth in the dentition. Like any other definition, this one is not without its shortcomings, but it reflects not only the actual interventions in the dental cavity, but also the measures that prevent these interventions.

First of all, you need to understand that the best root filling for a tooth is a healthy pulp. It is necessary to clearly understand what can lead to pulp damage and how to prevent this damage, how to assess the condition of the pulp and carry out adequate treatment. It is wrong to believe that any damage to the pulp leads to its death, and that conservative treatment of pulpitis (according to indications) is a thankless procedure. On the other hand, fortunately, we have already passed the period of an unjustifiably broad approach to the conservative treatment of pulpitis. Indications for pulp preservation have been significantly narrowed. But even today the decisive criterion in choosing treatment methods is the pain criterion. Attempts on basic populations clinical symptoms Creation of an algorithm for the treatment of pulpitis has been attempted several times. The most successful, in our opinion, were the works of Seltzer and Bender, who took into account such indicators as reaction to temperature stimuli (cold and heat), reactions to electrical stimuli, histological diagnosis, frequency of pain, its severity, presence of pain in the past, presence of pain during percussion , the presence of pulp damage to develop an algorithm for selecting treatment methods. In this case, the most interesting is the analysis of the state of the pulp, which is described in the literature as reversible. The authors designated them as curable. But at the same time, the range of changes in the studied indicators varies significantly, and the question of which of them is a contraindication to conservation remains open. In the chapter " Clinical diagnosis“We will dwell in more detail on the rationale for the choice of treatment, and in this part we only wanted to emphasize that even with a clinically established diagnosis, the choice of method (and, of course, prognosis) of treatment does not yet guarantee a successful result (unfortunately, the criteria for successful pulp preservation remain uncertain).

In conclusion, I would like to emphasize that endodontics today is surrounded by numerous devices, the developers of which claim that without them it is impossible to carry out high-quality treatment. It must be said that high-quality treatment does not always require expensive equipment to achieve a good result. Today there is no published scientific evidence about the benefits of using certain methods.

It can be argued that all methods are good if they are applied consistently, justifiably and methodologically correctly. The main thing that is required today is knowledge, patience and time.

Professional endodontic training centers offer high-quality education for both restorative dentists and endodontists. Dr. John West's model for teaching mastery in endodontics is simple: “Hear it, see it, do it, measure it, and celebrate it!” New ideas help keep John's education bright and vibrant (ideausa.net).

New trends
in endodontics and treatment

“Lord, give me the serenity to accept the things I cannot change, the courage to change the things I can change, and the wisdom to tell the difference.”

American theologian
Reinhold Niebuhr

As the founder and director of the Center for Endodontics, Dr. West is recognized as one of the world's leading educators in the field of clinical and interdisciplinary endodontics*. His work combines comprehensive classroom teaching with hands-on, hands-on skills. Dr. West received his DDS from the University of Washington, where he is an affiliated professor; received his master's degree from Boston University's Henry M. Goldman School of Dental Medicine, studying under the legendary Professor Herbert Schilder, where he received the Distinguished Alumni Award. Works on the editorial teams of the Journal of Aesthetic and Restorative Dentistry, Journal of Microscope Enhanced Dentistry, Dentistry today and is deputy editor of Endodontic Practice. Dr. West is the co-inventor of ProTaper, Wave One, ProGlider, GoldGlider and Calamus technologies. He is considered a clinical visionary, inventor, teacher, author and advocate for any dentist who wants to experience the successful possibilities of endodontics in their practice. His wisdom based on 35 years clinical experience and training in relation to the rapidly and dramatically changing trends in endodontics, helps interested clinicians anticipate and adapt to the changing world of endodontics and, therefore, achieve endodontic success in the future.

Today, the endodontists of the future and the future of endodontics are at the knee of an exponential curve of change. The only constant is the changing trends in endodontics. The future belongs to those who learn from the past and adapt to changes in the future.

Over the past 20 years, endodontics has been significantly influenced by four main factors:

1. The advent of new technologies and the rapid dissemination of endodontic information have changed endodontics forever. Endodontics is now safer, more predictable, easier and therefore more enjoyable for the dentist and patient. This process is more beneficial for the endodontic clinician and represents a wise investment for the patient.

2. With an interdisciplinary approach to dentistry, endodontics has become an integral part of the comprehensive treatment planning process, with the endodontist making an invaluable contribution to predictable patient outcomes.

3. Increased life expectancy means that patients are living longer and their desire to look good, feel good and be healthy is greater than ever before.

4. The value of predictable treatment and salvage of endodontically diseased teeth now rivals the success rates of implants.

There are three areas of the classic endodontic triad - disinfection, shaping, obturation. Throughout all four of the above changes, the classic endodontic triad of disinfection, shaping and obturation remains a proven protocol for achieving long-term endodontic success. Over the past 20 years, many new endodontic technologies have allowed dentists who understand and embrace these four changes to improve all three areas of the endodontic triad.

Endodontics is the only dental discipline in which doctors work “in the dark.” We cannot see and do at the same time. We must rely on different feedbacks to ensure predictability in our radicular endodontic intervention and obturation.

ENDODONTICS IS NOW SAFER, MORE PREDICTABLE, EASIER AND THEREFORE MORE ENJOYABLE FOR THE DENTIST AND THE PATIENT

Over the past two decades, the following six endodontic technologies have enabled dentists to see what was previously impossible to see:

1) Microscopes allow us to prepare a successful access cavity and find all the canals, as well as facilitate diagnostics such as observing vertical hairline fractures. The microscope brings the dentist closer to reality through a combination of illumination and magnification, which in turn improves treatment planning. (Dr. Gary Carr is often credited with pioneering this transformative trend).

2) Practical use of virtual endodontics: before treating patients, it is necessary to conduct interactive three-dimensional visualizations of real dental root canal systems, 3D Tooth Atlas (ehuman.com) on the doctor’s desktop.

3) Digital image processing allows us to read images more clearly and in detail.

4) The use of apex locators, which allow obtaining the most accurate data on the length of the root canal and determining its physiological end.

5) Nickel-titanium endodontic rotary (forming) instruments have made mechanical shaping in root canals more predictable, safer, more efficient and easier than ever before. With improved designs and metallurgy, almost all endodontic companies today create satisfactory NiTi files, although some are of higher quality and more high cost, than others.

6) 3D CBCT allows dentists to “see” inside the patient’s tooth. Now the situation for the dentist is “when we can see it, we can do it.”

These six eye-opening technologies have brought endodontics out of the darkness, giving dentists new levels of competence, consistency and confidence. Monitoring results confirms improved results, which is important because endodontic clinicians of the future will no longer reimburse treatment with repeat procedures, but instead, whenever possible, document endodontic quality, value, and results to patients. This value-added approach will be driven by performance management systems (e.g. c-sats.com). New reimbursement models represent a giant shift in defining the value of endodontic treatment, and treatment outcomes will be measured through social media, data analytics, cloud computing, gap analysis and artificial intelligence.

The main trends of today's endodontics. How the movement forward happened and where we are going

First, advanced clinical technologies combined with advanced clinical education have made the study of the time-tested endodontic triad possible and available to any dentist who is willing to learn and master them.

The main new technological trends in the endodontic triad are as follows:

Cleaning of a complex root canal system using EndoActivator (Dentsply Sirona), lasers and multi-purpose ultrasound.

Formation of special heat-treated files (such as ProTaper Gold and WaveOne Gold (Dentsply Sirona)) to produce minimally invasive, tapered root canal instruments that were previously rare and often unavailable. Removing only enough dentin to facilitate cleaning and prepare a soft "funnel" shape for easy obturation hydraulics.

Trends in obturation are focused on precision, achieving a finely divided nanostructure of gutta-percha, and obturation based on next generation carriers. The interface layer of the main cone and root canal sealant will be initially eroded and then completely eliminated. Linking obturation materials and techniques appears promising, but without long-term evidence of success.

What future trends can you imagine (still in dreams)

Given the increasing pace of dental and endodontic technology, within 10 to 15 years we may have a phone app or other device, prescription pill, vaccine or drug to treat endodontic disease or even tooth decay, the most common dental disease in humans. Trends indicate a superior desire to treat conservatively versus surgical treatment dental caries and, therefore, endodontics. Meanwhile, future regenerative tissue endodontic materials will employ “temporary growth factors” and feature “matrix designs of materials with controlled resorption time.”

Armed with these trends and potential, we take out our smartphone and ask: “How and when will dental regeneration happen?” And the web responds: “It already exists.” We already have the science to grow teeth. Stay in touch! Meanwhile, back to the present...we have the tools to see and do endodontics with exceptional predictability, high profitability and the sense of satisfaction that is the desire of all dentists.

The interaction of large-scale companies (for example, such as Dentsply and Sirona) will ultimately benefit the entire dentistry. The combination of research and development from the two companies can support comprehensive same-day clinical solutions to help patients manage their health.

Companies like Sonendo acquiring laser company Pipstek are setting the leading edge of endodontic trends. Sonendo's GentleWave system is the product of significant research and development. Innovative companies and talent will collaborate to further advance the technology, which will benefit all patients, endodontics and dentistry itself.

The next trend relates to endodontic practice sales technology.

I define marketing simply as the "exchange of value" - the skills and education of dentists for an investment fee from the patient. Increase skills and add value.

Major challenges facing endodontics today

Whenever change occurs, there are challenges and there are opportunities. For me, change is either dangerous, you adapt to it, or it is overwhelming. Change is the only constant. Currently, there are three main problems facing endodontic changes: trivialization, endo-implants and group corporate or solo practice.

In trivialization, one endodontic company offers you an early retirement if you purchase their endodontic file, while another tirelessly offers their file twice as good as the competition for half the price. Next time an endodontic rep tells you this, ask that person to prove it! Endodontics is more than a file, it is a diagnosis, appropriate emergency care, interdisciplinary treatment planning, the ability to find, follow and examine (full length) canals, and restore them, taking into account structure, function, biology and aesthetics.

The task is to answer the question about choosing a treatment method: endo or implant.

ADAPT TO CHANGING TRENDS, EMBRACE CHANGING TRENDS AND TAKE ACTION. REMEMBER THAT A GOAL WITHOUT A PLAN IS ONLY A DESIRE!

The answer is simple. Dentists have found that if the root canal system can be predictably treated and if the tooth has sufficient ferrule, dentists around the world tell me that saving the tooth is desirable for the patient and dentist rather than extraction and implantation. We still love our teeth!

Another challenge in endodontics is more complex than how we do endodontics. This is a problem of the structure of practice, its infrastructure.

Managed group practice continues to grow at a rate of 20% per year, and solo practice (personal) at 7% per year. How endodontics and endodontists fit into group and corporate practices is unknown.

The old days of the endodontic business are over.

What do I see as an exciting opportunity for dentists for the endodontic portion of their practice in the next 5-10 years?

Restorative dentists perform 70% to 90% of endodontic treatment in the United States. Learning new endodontic skills, technologies and techniques is the most quick way for dentists to further improve predictability and productivity. No cost for laboratory works Endodontics can be very productive as well as satisfying.

Dentists who want to appear professional and build trust with their patients always make it their goal to meet the needs and interests of their patients.

Successful interdisciplinary dentists have learned, for example, to encourage their endodontist to perform non-surgical and surgical endodontic retreatments when diagnoses are difficult and/or when patients are in pain, before it is too late; when it is too late to create iatrogenic blocks in endodontic cavities, protrusions, transportations, perforations, with broken files. Our patients trust us, and we must make money by solving these problems - one procedure at a time.

Are dentists directly affected by endodontic technologies, techniques and instruments?

Essentially, dentists are gadget people. For endodontics, the microscope was a breakthrough technology. This stimulated the development of dental technology before the technology became popular.

The new dentist and the dentist of the future are especially open to change. In fact, millennial dentists have only known about changes, and these changes are changing exponentially. People and machines evolve together. It's not people versus machines, it's people versus machines.

Vision of the evolutionary role of endodontics in interdisciplinary diagnosis and treatment planning

The role of endodontics will expand and will be viewed with confidence in endodontic predictability, which has been proven. Endodontists are getting better! Instead of endodontics being considered the weakest or missing link in interdisciplinary treatment planning, it will become recognized as one of its strongest links. This endodontic optimism is the result of greater knowledge, mastered skills and breakthrough technologies that make the preservation of endodontically treated teeth more predictable, safer and more cost-effective.

We can now predictably save endodontically damaged teeth that previously seemed hopeless. Complex and calcified anatomy or an insufficiently recognized root canal system were hopeless reasons for refusing endotherapy.

If the dentist is willing to study advanced technologies or has an endodontist as part of his interdisciplinary team, any endodontically diseased tooth can be saved if the endodontic biology can be treated and the tooth structurally restored.

Comparison of treatment methods: endodontic and implant-based

Both treatments have the same predictability. The question for the dentist is: which treatment option is more aesthetic, which method is easier to restore the defect, which method is structurally more predictable and which is the most economical for the patient?

On training advanced specialists

Official training centers, new media and digital technologies will transform and overcome the gaps in endodontic education, as it is familiar and appears to us. Dental school training, while providing information about less complex endodontic patients, simply cannot provide the level of education and training required for today's growing up and more technically complex endodontic patients. Cohorts of newly and properly trained dentists as well as endodontists will be trained in advanced technology and treatment planning in dedicated endodontic centers.

There are currently five significant endodontic training centers that are available to dentists and endodontists wishing to improve their endodontic skills:

1. Dr. John West, Interdisciplinary Academy of Dental Education, San Francisco.

2. Dr. Tom McCalmie, Horizon Dental Institute, Scottsdale, Arizona.

3. Dr. George Bruder and Sergio Cuttler, International Dental Institute, Palm Beach Gardens, Florida.

4. Dr. Cliff Ruddle, One on One, Santa Barbara, California;

5. Dr. Steve Buchanan, Dental Education Laboratories, Santa Barbara, California.

While training centers will undoubtedly continue to be relevant, travel and the ability to meet individual and global needs have logistical limitations.

Recognized by his peers, Dr. West has reached the pinnacle of success in endodontics as a clinician, leader, teacher and inventor.

What will happen next?

I have always considered myself a clinician, my authority is measured by my level of productivity - delivering care to a patient in one visit. Achieving successful endodontic results has become a source of endless pleasure. And I'm still learning!

This also satisfies doctors who want to achieve the same thing personally. Similar to measuring endodontic performance on one patient at a time, both mechanical and mental ability training were equally completed by one student and one audience at a time. However, this diffusion process is too slow to keep up with changes. Endodontic global training and one-stop training will soon be instantly possible thanks to global changes in the multimedia platform.

There is a huge opportunity that will change the way we study endodontics, how we do endodontics, implement endodontics and how we enjoy the process. I am referring to my upcoming participation in a weekly webcast episode called EndoShow that will be launched soon. We believe this will change everything.

The EndoShow is the long-standing ambition of the quintessential endodontic teacher, Dr. Cliff Ruddle, who is respected and revered throughout the world. The show teaches dentists, endodontists, educators and industry leaders around the world how to master endodontics, providing insights to promote continuous improvement, and teaches technical skills that impact results.

The EndoShow is dedicated to the endodontic clinician of the future and the future of endodontics. And its ultimate beneficiaries are the people who are not reading this article - our patients!

The EndoShow is at the peak of the present time. It is relevant and impartial. It makes the endodontic world a better place because it gets better. Its goal is to improve and raise the global endodontic standard.

The platform is characterized by the absence of bureaucracy, the absence of printing delays, and the absence of outdated information. New dentists, experienced dentists and specialists will discover how they benefit in training from collaborating not only with the world's leading endodontists, but also from collaborating on this platform with industry, researchers, engineers and endodontic visionaries around the world.

The show will serve as a reference, resource and forum for the debates and pressing issues of our time, shaping the narrative of an ever-evolving future and a roadmap for not only endodontic success for their patients, but also success for themselves.

The EndoShow will be a library that is a current and newly updated endodontic resource based on the timeless principles of endodontics, as well as current and future trends and techniques. Specifically, the endo show will consist of interviews, debates, forums, study clubs, hands-on demonstrations, dental care, all interdisciplinary research and business in endodontics. The show will hear and share what matters to you.

Conclusion

Adapt to changing trends, embrace changing trends and take action. Remember that a goal without a plan is just a wish!

Prepared material
Galina MASIS
according to Internet sources

) - dentist therapist, orthodontist. Engaged in the diagnosis and treatment of dental anomalies and malocclusion. Also installs braces and plates.

Endodontics and endodontic treatment methods are one of the branches of dentistry that deals with dental canal therapy, analyzing and studying:

• anatomical features and functional structure of the endodontist;
• pathological processes and changes arising in it;
• technique and methodology therapeutic effects and various manipulations in the dental cavity and its canals;
• the ability to eliminate inflammatory processes in the apical periodontium and inside the tooth cavity.

By using various endodontic methods for treating and filling infected teeth, it is possible to protect them from further severe destruction and prevent serious complications that can lead to bone and soft tissue disease and tooth loss. In other words, we can say that endodontics is odontosurgical manipulations carried out with the aim of preserving a tooth.

Before starting treatment, a thorough collection of the patient’s medical history and diagnosis of any dental problems that have arisen are carried out. In this case they do:

• visual examination - to determine the shape, color and position of the tooth. Check the condition of hard dentin tissue (presence of fillings, caries, inlays), its stability, the ratio of its alveolar and non-alveolar parts;
• collecting the patient’s medical history - complaints, history of dental disease, the presence of aggravating diseases and allergies;
• clinical examination of the patient - assessment of the conditions of the oral cavity and its mucous membrane, dentition and periodontal disease, examination of the masticatory muscles and temporomandibular joints;
• paraclinical examination - x-ray examination with taking an image, electroodontometry using sensors, laboratory and instrumental methods.

Sequence of endodontic dental treatment

Modern endodontics consists of the following steps:

Step 1. Opening (preparation) of the tooth

The procedure for cavity opening of a tooth begins with the removal of the affected dental arch and its coronal part; it is unacceptable to begin preparation from its cutting part. The boundary of the burr hole area should be such that free access of dental instruments to the pulp zone of the coronal part and to the root canals is ensured.

If the dental cavity is opened correctly, there should be no overhanging edges of the arches of the open cavity, thin walls (thickness should not be > 0.5-0.7 mm) and a bottom. The procedure is performed using turbine machines equipped with: endodontic excavators, endoburs, surgical burs, burs and Ni-Ti files for opening the orifices.

Step 2. Search and probing of canal mouths

First, they try to determine the location of the roots of the tooth with their canal orifices using x-ray examination. Further probing is carried out using double-ended, straight probes with different angles of inclination.

If access to the orifices is difficult due to overhanging dentin or denticles present, it is advisable to remove the interfering dentin layer using a Müller bur or a rose-shaped bur.

Step 3. Examination of the length of the tooth and its root canals

One of the main stages of dental canal therapy. Its competent implementation makes it possible to carry out all further necessary manipulations smoothly and efficiently and eliminates the possibility of complications. Currently, three variations are used to determine the working length of the root canal:

• mathematical or tabular calculation method. Using the tables, you can determine the range of fluctuations (from the minimum possible to the maximum) of the length of the teeth. The method is not accurate enough due to possible deviations in the average length of teeth (error about ± 10-15%). The tools for measuring the working length are K-Reamer and K-File; Flexicut-File is used in a curved canal;
• electrometric or ultrasonic methods. Research is carried out using special apex locators. These devices are self-regulating and do not require additional setup or calibration. The principle of their operation is based on the difference in electrical potential between the soft tissues of the tooth (periodontium) and its hard tissues (dentine), which makes it possible to accurately determine the location of the apical narrowing.
  The apex locator itself consists of two electrodes and an instrument panel. One of the electrodes is fixed on the lip, the second (file) is tightly located in the dental canal and moves smoothly, without shocks. As soon as it reaches the lower point of the apical constriction, the circuit closes, a sound signal sounds and the value of the electrical impulse travel speed is displayed on the display, which allows you to automatically calculate the depth of the canal in the future.
  Modern electrometric apex locators operate in the presence of electrolyte, moisture, hydrogen peroxide, blood and do not distort its readings. When working with baby teeth or teeth with unformed roots, the device is not used;
• X-ray method is the most reliable and frequently used, allowing you to clearly visualize the degree of patency of the canal, establish its length and direction, determine the presence of curvatures, perforations, and find out the condition of the periodontium. For chewing teeth, the working length is calculated from the buccal dentition, for the anterior teeth - from the cutting edge of the teeth, and it should be shorter by 0.5-1.5 mm than the distance to the highest point of the coronal part of the tooth.

Step 4. Expansion of the mouths

To facilitate the insertion of the expansion instrument, for the purpose of further medicinal and mechanical manipulations in the root canal, an operation is performed to expand its upper third and mouth. During the procedure, a wide, straight, funnel-shaped, cone-shaped orifice is processed and formed. Reaming can be done manually or using a polishing endodontic tip.

Step 5. Removal of unhealthy pulp (depulpation)

Main therapeutic indications for the procedure:

• acute inflammation of the pulp, as a result of serious pathogenic lesions and toxic decompositions, of its neurovascular bundle;
• as a preliminary operation before installing crowns, clasp and bridge prostheses;
• mechanical trauma with a chipped tooth and exposed pulp;
• severe forms of periodontal disease, periodontitis;
• before ;
• dental restoration;
• unsuccessful dental intervention;
• congenital abnormal arrangement of some teeth in rows;
• as a preparatory procedure for installing a crown or half-crown.

Vital pulpotomy method

It is used for early pulpitis, when the lesions have affected a small area of ​​the pulp and it can be completely removed in one visit to the dentist. Depulpation surgery begins after obtaining an x-ray of the affected area and administering an anesthetic. Next, the tooth is drilled out, followed by removal of dentin and carious tooth enamel from the damaged cavity.

To penetrate to surfaces with inflamed and oppressed pulp, they cut off part of the tooth surface, search and expand the canals, then, using a pulp extractor, remove the inflamed, infected and softened nerve from the canals and the pulp chamber of the tooth. A medicine is placed into the resulting cavity, which has a beneficial effect on tooth tissue, promotes their healing and regeneration.

A temporary filling is installed, which is then removed by the dentist after 3-4 days, and in its place, after treating the tooth cavity with an anesthetic, a permanent filling is applied.

Devital pulpotomy

Used in the treatment of advanced cases of pulpitis. This technique provides for complete depulpation in 2 dental sessions. The step-by-step process looks like this:

• X-ray examination of a diseased tooth;
• local anesthesia;
• opening of an infected, affected cavity;
• cleaning the dental cavity from dentinal debris, rinsing with a strong antiseptic;
• immersion of medicinal paste into the tooth cavity for the death of the pulp and outflow (drainage) of pathogenic contents;
• open dental cavity with pulp and paste covered with a temporary filling;
• after 3-4 days, the temporary filling is removed and a thorough mechanical cleaning of the necrotic mass of the pulp is carried out, and the root canals are cleaned;
• treatment with a special antiseptic composition for complete mummification of the pulp, application of a temporary filling;
• If there is no pain in the treated tooth after 2-3 days, it is covered with a permanent filling.

In some cases, depulpation surgery leads to complications. Endodontists note such problems as: the appearance of cysts at the root apex, the development of purulent periostitis of the periosteum (flux), and can diagnose a fistula or a developing granuloma.

These diseases can occur as a result of poorly performed pulp removal and the introduction of pathogens during surgery. To avoid possible inflammation and the need for a second visit to the doctor, a permanent filling is installed only after X-ray control (a picture is taken) of the filling of the treated root canals.

Step 6. Permanent filling (obturation) of the dental canals

Placing a permanent filling and sealing the root canals is an important, final part of endodontic dental treatment. Filling allows you to:

• restore the functionality of the periodontium;
• prevent and eliminate the inflammatory process;
• prevent the occurrence of inflammation in the maxillofacial area;
• prevent the penetration of pathogenic microorganisms into the periapical tissues.

Methods for filling canals with filling material

1. Lateral condensation method. The technique is quite effective with a stable result and does not require large expenses. It uses several gutta-percha pins with a minimal amount of sealer (hardening paste), which makes it possible to achieve a complete hermetic filling of the root canal and apical foramen;
2. Filling with the Thermofil system. The main advantage is that it allows obturation of both the main canals and the branching lateral canals;
3. Single pin technique. A hardening filling paste and a pin are simultaneously introduced into the root canal for its uniform distribution and compaction. This method allows you to reliably seal narrow and rather curved canals;
4. Technology using liquid injection heated gutta-percha. Gutta-percha is supplied to the root canal in blocks on a carrier placed in a heating device, where it is brought to 200 °C and fills the canal. The hot vertical condensation method allows you to install a filling in curved canals, in canals with a curved root tip or bifurcation.

Basic dental materials for filling

• fillers (hard materials). These include silver and titanium pins, gutta-percha;
• sealers or cements to fill the space between the walls of the tooth and the pin. They may contain antiseptic, analgesic, and anti-inflammatory additives.

Tools for filling: pluggers, gutta-condensers, heating plugger. root needles, manual or machine canal fillers, manual or finger plugger, spreader, syringes.

Sources used:

• Repeated endodontic treatment. Conservative and surgical methods / John S. Rhodes. - M.: MEDpress-inform, 2009.
• Modern approaches to endodontic dental treatment. Textbook / O.L. Pikhur, D.A. Kuzmina, A.V. Zimbalistov. - M.: SpetsLit, 2013.

MOSCOW STATE

MEDICAL AND DENTAL UNIVERSITY

DEPARTMENT OF DENTISTRY GENERAL PRACTICE

AND ANESTHESIOLOGY FPDO

Head of the department

Rabinovich S.A.

Doctor of Medical Sciences, Professor.

Course work

Modern endodontic instruments.

Approved at a meeting of the Department of Dentistry general practice and Anesthesiology FPDO March 18, 2011

Completed by: intern doctor

Kuchevsky Pyotr Evgenievich

Curator: associate professor of the department

Stosh Vladimir Ivanovich

Moscow 2011

1. Introduction 2

2. Modern endodontic instruments.. 3

2.1.ISO size and color coding. 3

3. RESEARCH OR DIAGNOSTIC TOOLS... 5

3.1.Instruments for removing soft tissue from the root canal. 5

4. INSTRUMENTS FOR EXPANSION OF THE CANAL MOUTH.. 7

5. INSTRUMENTS FOR PASSING AND EXPANDING ROOT CANALS. 8

6. TIPS FOR WORK IN ROOT CANALS.. 19

6.1. Vibration systems for root canal treatment. 20

7. INSTRUMENTS USED FOR CANAL OBTURATION. 21

8. REFERENCES... 24

Introduction

Among the pressing problems of modern dentistry, dental caries and periodontal diseases occupy one of the leading places. This is due to the highest prevalence of these diseases in the world, as well as (in the absence of timely diagnosis and adequate treatment) with the threat of the development of various odontogenic complications, the appearance of foci of chronic infection, which have a huge impact on the patient’s health as a whole. Moreover, according to the World Health Organization (WHO), functional disorders dental system, arising in connection with the loss of teeth from untreated periodontal diseases, develop 5 times more often than with complications of caries.

That is why all efforts of society should be aimed at timely diagnosis, adequate treatment and prevention of dental caries and periodontal diseases using the latest technologies, tools and materials available on the global dental market.

Today, without exaggeration, we can say that only a doctor treats fully and successfully, who in his practical activities is based on the achievements of modern dentistry, and who reasonably and competently uses the achievements of dental science and practice in his work.

At the same time, the use of modern materials and technologies in dentistry requires a new level of training from a specialist: knowledge of the properties of materials and instruments, accurate diagnostics, high-quality manual skills, and the ability to use new techniques, devices, tools.

In this regard, it is important to talk about new tools, ways to use them, and thereby promote their wider implementation in healthcare practice.

When writing this course work, I would like to cover as much as possible the issues related to modern technologies in therapeutic dentistry.

Modern endodontic instruments

Endodontics- a branch of dentistry that studies methods of instrumental and medicinal influence on the root canals of teeth, with the exception of filling.
A number of countries have national standards for endodontic instruments, but most are aligned with the ISO 3630 standard, which was approved by the International Standards Organization Technical Committee 106 (ISO/TC 106). The ISO 3630 standard provides the main parameters of root canal instruments: shape, profile, length, size, maximum manufacturing tolerances and minimum mechanical strength requirements, color and symbol coding to identify the type of instrument, and an international numbering system for ordering instruments.

All instruments for traversing and enlarging the root canal are digitally and color coded. In accordance with ISO standards, a symbol and number indicating dl (tool tip diameter) is displayed on the end of the handle and the side surface.

ISO size and color coding

ISO sizes Color code
006 raspberry
008 gray
010 purple
015, 045, 090 white
020, 050, 100 yellow
025, 055, 110 red
030, 060, 120 blue
035, 070, 130 green
040, 080, 140 black

The length of the surface directly affecting the tooth tissue for most endodontic instruments is 16 mm.

The working length (the length of the entire rod) can be different:

a) 25 mm - standard tools;

b) 31 (28) mm - long instruments used to process anterior teeth, mainly canines;

c) 21 mm - short instruments used for intervention on molars and for poor mouth opening.

Instrument shafts can be graduated with notches at a distance of 18, 19, 20, 22, 24, 25, 26, 28 mm from the apex for easy determination of their length on a radiograph.

There are tools with variable length of the working part. They are equipped with a measuring pen with millimeter graduations and a clamping device for setting the working length.

The size of the main instruments (files and reamers) is determined by the diameter of the apex and is indicated by numbers in hundredths of a millimeter - from 06 to 140.

Tool size coding is carried out:

a) the color of the handle, shank or the color of the ring constrictions on the metal handle, shank or working rod: 06 - pink, 08 - gray, 10 - lilac, from 15 to 40, from 45 to 80 and from 85 to 140 - on a standard scale ( white, yellow, red, blue, green, black);

b) the number of ring constrictions on the shank (one ring corresponds to white color coding, two to yellow, etc.).

Some companies produce instruments of intermediate sizes (usually 12, 17, 22, 27, 32 and 37), which are used when it is impossible to insert the next file number into the channel. They are called “Golden mediums” instruments and are coded in the same way as instruments with a smaller diameter by 02 (for example, file 12, which is inserted into the channel after 10, has the same coding as it - white color) . To distinguish them, instruments of the “golden mean” have a gold label on the handle.

The shape of most instruments (files, reamers) is characterized by a constant taper - an increase in diameter from the tip to the base of the working part by 0.32 mm (0.02 mm per 1 mm of length). This makes it possible in practice to carry out a fractional increase in the number of the instrument by removing 1 mm of the tip with subsequent rounding of the tip (Weine technique). However, a new generation of instruments has now appeared with an increase in diameter of more than 0.02 mm per 1 mm of length (Profiles, Quantec series 2000), which, according to the developers, ensures optimal efficiency of the instrument along the entire length of the canal, and not just in its apical part.

ISO distinguishes the following groups of endodontic instruments:

1st group - manual - files (K and N), reamers (K), bullet extractors, pluggers and spreaders (vertical and lateral gutta-percha compactors);

2nd - machine - H-files and K-reamers with shanks for the tip, channel fillers;

3rd - machine - Gates-Glidden burs (G-type), Peeso (P-type), reamers of types A, D, O, KO, T, M;

4th - pins - gutta-percha, silver, paper.

This classification is quite inconvenient for clinical use. Therefore, it is most advisable to adhere to the classification of endodontic instruments according to their clinical use (Curson, 1966):

1st group - research or diagnostic tools;

2nd - instruments for removing soft tooth tissues;

3rd - instruments for passing and expanding the root canal;

4th - instruments for filling the root canal.

It is advisable to consider Group 3 in the interpretation of I.M. Makeeva et al. (1996) and E.V. Borovsky (1997):

3.1 - tools for expanding the mouth of the canals;

3.2 - instruments for passing the root canal;

3.3 - instruments for expanding the root canal.

It should be noted that initially instruments intended for passing root canals by rotation were called reamers (from the English reamer - reamer, a tool that expands wells), and instruments intended for their expansion by scraping up and down movements were called files (from English file - file). However, nowadays, with the advent of a wide variety of tools, including multifunctional ones, this division is not always observed.

RESEARCH OR DIAGNOSTIC TOOLS

Root needles (smooth broashes) are divided into smooth, round and faceted - Miller needles. There is another type of root needle that is not directly related to diagnostic tools. This is a root needle for fixing turundas, having a round cross-section with zigzag notches. This tool is rarely used due to the availability of more convenient paper points. When using the X-ray method for determining the length of the root canal, files or reamer are often used, which can also indirectly be classified as this group of instruments.

Instruments for removing soft tissue from the root canal.

Pulpextractor(barbed (nerv) broash) has the shape of a rod with approximately 40 spirally arranged teeth 1/2 the diameter of the wire in height.

Root needles.

The teeth have an oblique positioning and have little mobility: when inserted into the canal, they are pressed against the rod and when withdrawn, they effectively capture the soft tissue. The encoding of sizes differs from that adopted for files and reamers, since the increase in diameter from size to size is less than 0.05 mm (0.02-0.04 mm). The length of the part with teeth is about 10 mm (10.5 mm); the increase in diameter per 1 mm of length is about 0.01 mm.

Instruments for removing soft tissue from the root canal.

Rootrasp(rat-tail-file, rasp). Sometimes refers to this group of instruments, although it is used mainly for expanding the root canal. Its structure resembles a pulp extractor, but it has about 50 teeth 1/3 of the wire diameter long, located at right angles to the axis of the tool. The encoding of sizes, as with pulp extractors, differs from the encoding of files and reamers (the increase in diameter from size to size is about 0.03 mm, the length of the part with teeth is 10.5 mm, the increase in diameter per 1 mm of length is about 0.016 mm). The symbol is an eight-pointed star with right angles.

INSTRUMENTS FOR CANAL ORIGINAL ENLARGEMENT

Gates-Glidden type bur (gates-glidden drill, reamer “G”; from the English gate - gate; glide - sliding) has a short teardrop-shaped working part on a long thin rod; manual or equipped with a shank for a contra-angle handpiece. It is a rotary tool (recommended rotation speed is 450-800 rpm). Provides better access to the canal, expands its mouth and coronal part. Many instruments of this type have a safety (blunt) tip. The length of the working part with the rod is usually 15-19 mm; sizes - 50 (No. 1), 70 (No. 2), 90 (No. 3), 110 (No. 4), 130 (No. 5), 150 (No. 6).

Reamer type Peeso (Largo) (peeso reamer) is equipped with an elongated working part that turns into a rigid rod. Used in rotary mode (recommended rotation speed - 800-1200 rpm) and equipped with a shank for a contra-angle handpiece. It is used after the formation of the tooth cavity to develop the straight part of the canal, straightening, opening the mouths, and preparing the canal for pins. Some have a safety tip. The length of the working part with the rod is usually 15-19 mm; sizes - 70 (No. 1), 90 (No. 2), PO (No. 3), 130 (No. 4), 150 (No. 5), 170 (No. 6).

Instruments for widening canal mouths

Canal mouth expander (orifice opener (widener)). It is a hand or machine tool with a uniformly tapering faceted working part. Used in straight sections of the canal, to expand the mouths (in rotational mode). Effective in molars where it is difficult to work with a root bur. Typically available in 3 sizes and 3 lengths (14, 15 and 16 mm). Variety - Orifice Opener MB - with diamond coating of the working part (Maillefer).

Beutelrock reamer type 1 (Bl) (Beutelrock reamer 1) is a machine tool with an elongated flame-shaped working part and a four-pointed cross-section (with four cutting edges). Used to create and expand access to canals and work in their straight sections (in rotational mode with a recommended rotation speed of 800-1200 rpm). The length of the working part is 11 mm, sizes from various manufacturers are 70 or 90 (No. 1), 90 or 100 (No. 2), 110 or 120 (No. 3), 130 or 140 (No. 4), 150 or 160 (No. 5) , 170 or 180 (No. 6).

Beutelrock reamer type 2 (B2) (BeuteirocK drill reamer 2) is a machine tool with a cylindrical end, made by twisting a flat blade with two cutting edges. Highly aggressive, works in rotational mode (recommended rotation speed - 450-800 rpm). Expands straight sections of channels. The length of the working part is 18 mm. Usually it has the following sizes - 30 (0), 35 (No. 1), 45 (No. 2), 60 (No. 3), 75 (No. 4), 90 (No. 5), 105 (No. 6).

INSTRUMENTS FOR PASSING AND EXPANDING ROOT CANALS

Type K tools.

TO- the initial letter of the name of the first manufacturer of this type of instruments - the Kerr company. The K-type includes tools made by twisting a workpiece of a certain cross-section (when twisting, the metal fibers are not interrupted, which helps maintain bending strength). The cross-section is usually triangular (tools with this cross-section have higher cutting properties, but also become dull more quickly) or square. More often, the cross-section of tools up to size 40 is square, sizes 45-140 are triangular (to prevent excessive rigidity and elasticity and increase cutting ability). The tip angle for standard instruments is 75°.

K-reamer. A K-type tool in which the angle between the cutting edge and the longitudinal axis is 20°. The number of cutting planes (turns) is from 17 for small sizes to 5 for large ones. Stages of work: insertion (penetration), rotation (rotation), withdrawal (retraction, during which the cutting ability of the tool is realized). Rotation is allowed no more than 1/4-1/2 turn clockwise; in narrow or curved channels and for reamers large sizes- 1/4. The symbol is a triangle.

K-file(K-file). A K-type tool, in which the angle between the cutting edge and the longitudinal axis is 40. The number of cutting planes (turns) is greater than that of the K-reamer - from 33 for small sizes to 8 for large ones, so their cutting ability exceeds that of K -examples. In the canal, the instrument must move in a vertical direction (up and down), but it can be used as a reamer. Preferred for working in curved channels. The symbol is a square.

Modifications of K-tools.

K-flex (file)(K-flex, flexicut-file; from the English flex - bend around, bend). A tool that combines reamer and file properties. Used independently as both. Halfway between a triangle and a square with concave sides, the cross-section provides high cutting performance, flexibility and the ability to remove sawdust.

Flex-R file(flex-R-file; R is the first letter of the surname of the author of the development - Roane). It has a safe (blunt) apex and apical edges, which ensures passage along the curvature of the channel without perforations. The stress is not concentrated at the apex, but is distributed over a large area of ​​the wall. The cross section is triangular.

K-flexofile and flexorimer(K-flexofile, K-flexoreamer) - tools of increased flexibility due to the triangular section of all sizes, starting from 15. Equipped with a safe Batt-type top. Sizes - from 15 to 40. Number of cutting planes - from 24 to 26. Symbol - letter F.

Farside(farcide) - an inflexible short reamer with a thin tip, designed to begin work in the canal or resume it after a break and for passing very thin canals, especially molars, with difficulty opening the mouth. Sizes - from 06 to 15, length - 15 and 18 mm. Deepstar is a tool similar to a farside, but in larger sizes - from 20 to 60.

K-Reamer (Kerr drill) is a tool for performing a root canal.

Pathfinder(pathfinder, from the English path - path, finder - finder) is a thin instrument with a sharp tip, designed for passing obliterated canals. Minimal tapering of the tool tip helps spread apical stress along the entire length of the tool, reducing the tendency for the tip to bend.

K-Flexoreamer - drill with increased flexibility.

Length - 19, 21 and 25 mm. Dimensions: K1 - between 06 and 08 (the diameter at the base of the working part coincides with the diameter of the file 06, at the top - 08), K2 - between 08 and 10 (at the base - 08, at the top - 10). Coding - orange pen. Pathfinder CS (CS - Carbon Steel) - differs in the material of manufacture.

Instruments for passing and expanding the root canal.

Nitiflex(nitiflex, Ni-Ti-K-file - a less precise name, since the tool cannot be made by twisting due to the flexibility of the workpiece) - a file made of nickel-titanium alloy (in a ratio close to 1: 1), giving the tool extremely high flexibility and durability . Equipped with a safe tip that prevents changes in the anatomical shape of the canal and the appearance of ledges. The disadvantage is the impossibility of preliminary bending of the instrument along the curvature of the channel. Sizes - 15-60. The symbol is a half-filled square.

Tools type N.

H-file(H-file, H is the initial letter of the name of the first manufacturer - Hedstroem). The tool is made by turning a round cross-section from a workpiece. In the domestic set of endodontic instruments it is known as a drill.

K-Flexofile is a flexible canal expander golden medium.

Has a maximum angle between the cutting edge and the longitudinal axis - 60°, as well as greatest number cutting planes - from 31 to 14. This determines a higher cutting ability than that of K-tools. However, it has less strength, which can lead to breakage, due to the fact that during manufacturing the metal fibers are interrupted at the places where the cutter is processed. Movements in the channel are vertical, cutting ability is realized at the exit from the channel. Rotation is allowed no more than 1/4 turn. When working, you usually select a size that is 1 size smaller than the previous tool. The symbol is a circle.

K-Flexoreamer Golden medium - drill of intermediate sizes.

H-file modifications.

Unifile and Dynatrak burs- with two spirals (section in the form of the letter S) and higher cutting abilities.

S-file- a variation of the Unifile, which differs from the classic tool in the depth of the grooves and the height of the blades.

A-file. Part of the Canal Finder System.

K-Reamer forside is a drill for passing very thin root canals.

Headstroem File (Headstrom Drill) is a tool for leveling the walls of the root canal.

Instruments for passing and enlarging root canals.

Features a safety blunt tip, extra sharp edges and steep grooves. Effective in curved canals (the concave part with “collapsed” blades is not aggressive towards the inner wall of the canal; only the outer wall is processed, unlike the traditional H-file).

Safe H-file(seftihedström) (safety H-file) - an H-file with a smooth surface, ground off on one side, designed to facilitate the removal of a jammed instrument and insertion into curved channels (the smooth surface should be facing towards the lesser curvature to prevent its perforation).

Other types of instruments.

U-file. A rotary tool, the cross-section of the working part of which has three U-shaped grooves, forming smooth runners (radial chamfers) along the outer edge, sliding along the walls of the channel, which eliminates the possibility of self-cutting and jamming of the tool in the channel. Not available in ISO. U-file modification - Profile 04 Taper Series 29 Rotary Instruments (Tulsa Dental Product, USA). Made from nickel-titanium alloy. At the tip of this series of tools, radial runners flow smoothly into a secure, non-cutting tip. The diameter of the top of each subsequent tool differs from the previous one by 29%. This gives the effect of uniformly increasing the diameter of the root canal. An increase in the diameter of the instrument per 1 mm of length is 0.02, 0.04 and 0.06 mm, as a result of which stress is distributed throughout the canal wall, mainly in the coronal and middle parts, and not at the apex. Tool sizes differ from the ISO standard.
In order to reduce the aggressiveness of cutting endodontic instruments, varieties with a reduced effective area have been developed.

Heliapical file type(English helix from other Greek helikos - spiral, helix, lat. apex - apex). A file with a length of the cutting part at the top of 4-5 mm.

Apical K-reamer- a tool that has a small number of turns only in the tip area (3-4 mm). Designed for preparation of apical retaining form. Not included in the ISO specification. Length - 25 mm, sizes - from 20 to 70.

Reamer Canal master. A reamer 1-2 mm long on a long flexible smooth rod with a blunt tip-conductor 0.75 mm long. There is a variety of Canal master U-type. The tool is most effective when rotated 60° clockwise. The disadvantage is the relatively high risk of breakage.

Flexogate(flexogate). A hand tool of increased flexibility, which is a smooth flexible rod with approximately one turn at the end and resembles the shape of the working part of a Gates-Glidden type bur with a safe tip. The connection between the rod and the handle has less strength: this leads to the fact that when jammed, the tool breaks in this particular area, and removing it by the long rod is not difficult. The instrument is intended for apical preparation. Sizes - 25-50.

SAF— endodontic file in the form of a metal lattice hollow cylinder, 1.5 mm in diameter, made of nickel-titanium alloy.
SAF - Uses one instrument for complete 3D preparation and cleaning of the root canal.
SAF is available in 3 standard sizes: 21mm, 25mm and 31mm.
The cylindrical hollow structure of the SAF file allows it to compress along its cross-section (A) when inserted into a root canal pretreated with a 20-gauge K-file (B).

Operating mode

When introduced into the root canal, SAF gradually expands radially and creates a light constant pressure along the entire perimeter of the root canal walls. Through gentle vertical vibration, the abrasive surface of the file ensures a gradual expansion of the root canal contour.

The hollow structure of the SAF allows continuous irrigation of the root canal through the existing cavity.
SAF has increased flexibility. It does not change the shape of the channel depending on its own, but adapts to the original shape of the channel in the transverse and longitudinal sections. The longitudinal axis of the channel maintains its original position along its entire length.

Formation of the root canal

	Instrumentation of curved channels Micro-CT analysis of SAF treatment in the palatal root of an upper molar with a curved root canal structure. (A) Before the procedure (red) (B) After the procedure (blue)
Pay attention to the preservation of the longitudinal axis of the canal in the same place and to the high rate of processing of the canal walls.
	Instrumentation of oval canals Micro-CT analysis of SAF treatment of a maxillary second premolar with an extremely flat oval cross-section with a curved root canal structure. Buccolingual and mesiodistal views of a root canal reconstructed using micro-CT. (D) Cross section at 4 and 6 mm from the root apex.
	Morphology of problematic root canals Micro-CT analysis of SAF treatment in a mandibular first molar with extremely complex root canal anatomy. (E) Two views of a curved flat canal with mesial spoon-shaped concavity reconstructed using micro-CT. (F) Cross section at a distance of 6 mm from the root apex. Red: before the procedure. Blue: after the procedure. Pay attention to the adaptability of the file and how it removes an even layer of dentin over the entire cross-section of the root canal.

Cleaning the walls of the root canal

	Control: smear layer X1000	Removing sawdust X200	Cleaning the smear layer X1000
Coronal third channel
Average third channel
Apical third channel

Evaluation of the degree of cleaning of the root canal walls using a scanning electron microscope (SEM)

Operating the SAF with a continuous flow of irrigants (sodium hydrochlorite and EDTA) results in the root canal being completely clear of sawdust and almost completely free of the smear layer.
(A) Positive control: presence of smear layer and sawdust in all parts of the root canal.
(B) Root canal after SAF treatment: complete absence of sawdust in all parts of the root canal.
Root canal after SAF treatment: no smear layer in all parts of the root canal.

Endodontic irrigation system

Canal irrigation during endodontic treatment
Irrigation is the most important component of root canal cleaning... unfortunately, numerous studies show that currently used chemical-mechanical methods do not provide effective cleaning the entire root canal system.

Controlled Irrigation

The VATEA irrigation system allows fresh irrigation fluid to penetrate into the canal. The movement of the endodontic file inside the canal promotes constant renewal of the irrigant solution throughout the procedure due to its mixing. Flow regulation is ensured by adjusting the built-in pump of the VATEA irrigation system.

Self-contained portable system

The VATEA irrigation system is portable and can be operated either by connecting to an external power source or using replaceable batteries that provide up to 4 hours of operation when fully charged.
VATEA capacity - up to 400 ml. liquids.
Irrigation switching is accomplished using a simple, miniature foot-operated switch.

Product Description

The positive displacement hose pump prevents fluid from flowing out that could cause cross-contamination of the patient.

The user interface includes two control buttons for regulating fluid flow, a large LCD screen, built-in timing sensors and error notification.

The VATEA system includes an AC adapter to charge the battery pack, as well as a set of disposable silicone tubing.

TIPS FOR WORK IN ROOT CANALS

There are three groups of operating modes for endodontic handpieces:

1st - rotational (with speed reduction up to 16:1 to 300-800 rpm). Handpieces with this mode of operation use tools such as Gates Glidden burs, Peeso reamers, Beutelrock 1 and 2, Canal master, profiles, and channel fillers. Special files with an off-centered tip are also used, which makes them easier to follow along the curvature of the root canal. Speed ​​reduction is achieved through a built-in gearbox or micromotor and gearbox. Some handpieces operating in this mode are marked with a green ring;

2nd - with reciprocating movements (clockwise and counterclockwise) at 90°. Tips of this type may be marked with a yellow ring;

3rd - with vertical movements up and down with an amplitude of 0.3-1.0 mm; Typically, the tips of this group combine movements of the second and third types.

The 1st group includes tips NiTiMatic (USA), MM 10E (France).

The 2nd group includes Giromatic handpieces (developed in 1964), Endo-Cursor (also allows fixation of hand instruments), Endo-Lift handpiece (Kerr) (also provides a vertical component of movement). The Giromatic handpiece is used with instruments designed for it: Giropointer (orifice opener 16 mm long), Giro-broach (a tool similar to a root rasp), Giro-file (having an H-file configuration), Giro-geameg (reamer) , Heligirofile (a tool having three cutting edges on a cross section).

The 3rd group includes handpieces operating according to the Canal Leader system: Canal Leader T-1 “Titan” (Siemens) and Canal-leader 2000 (SET, Germany). These tips provide reciprocating and counterclockwise movements up to 90° (30°) and vertical up and down movements with an amplitude of 0.4-0.8 mm. Both types of movements are dependent on the speed of the micromotor and the resistance in the root canal. The tips are used with tools specially designed for them, such as K- and H-files. This group also includes the Canal finder system, SET, France, which provides vertical movements with an amplitude of 0.3-1.0 mm and free rotation clockwise and counterclockwise. As tip pressure increases, the vertical component of motion is reduced or eliminated, and free rotation allows the tip of the tool to freely move out of jammed areas.

Used with instruments designed for it, such as Canal master and H-file with a safe tip.

You can also separately highlight the W&H - Excalibur tip, which provides random lateral vibration movements at a speed of 20,000-25,000 rpm. Used with modified K-files.

Some endodontic handpieces operate simultaneously in apex location mode with light and sound notification (Tri Auto ZX handpiece from J. Morita, Japan).

Vibration systems for root canal treatment

Includes tips for sonic (with an oscillation frequency of 1500-6500 Hz) and ultrasonic (with a frequency of 20,000-30,000 Hz) treatment of root canals. The transmission of oscillatory movements in the channel occurs in all directions, causing the effect of cavitation. During sound vibrations, combined movements of the file occur vertically (with an amplitude of about 100 microns) and in the horizontal plane (with an amplitude of vibration of the apex of up to 1 mm). Systems that generate sound vibrations for root canal treatment include Sonic air 1500 and MicroMega, as well as Endostar systems.

Similar systems are used with specially designed instruments: Helisonic (or Trio Sonic, or Triocut) - an instrument of intermediate configuration between K- and H-files, similar to a three-helix H-file; Rispisonic and Shaper (Sonic) are root rasp type tools, of which the Shaper is the most aggressive with larger and stiffer teeth.

Ultrasonic vibrations are generated by two methods: magnetostrictive and piezoelectric. The first method requires constant water cooling - irrigator supply (NaOCI). The second method is simpler and does not require refrigeration. Two types of files are usually used: a K-file and a diamond-coated file with a safe tip (used mainly in the straight part of the canal). Before work, the canal is manually expanded to size 20. The instrument for subsequent ultrasonic treatment is selected one size smaller in order to ensure its free vibration in the canal.

Other instruments and accessories are also widely used in endodontic work. These include paper absorption pins of standard sizes, endodontic tweezers with longitudinal grooves on the cheeks for holding needles and pins, safety chains with rings and safety threads for securing instruments to the doctor’s finger, stoppers for endodontic instruments - silicone or steel with a spring inside and with or without a notch along the contour. When preparing the tool, the stopper recess should be directed towards the bend of the channel. There are dispenser designs for putting on stoppers and fixing them at a certain distance from the top of the instrument, as well as numerous devices for measuring and establishing the working length of the instrument - from sterilizable rulers and tape measures with millimeter divisions to special multifunctional endoblocks. Measuring structures have been developed that are fixed on the doctor’s finger.

There are devices for pre-bending instruments, washing and aspirating the contents of the root canal, placing instruments during work, storing and sterilizing instruments.

INSTRUMENTS USED FOR CANAL OBTURATION

Channel filler (paste filler, root filler “L”). The design was proposed by the French dentist Lentulo in 1928. It is a machine or hand instrument with a working part in the form of a centered conical spiral, reminiscent of the anatomical shape of the canal. Designed for introducing paste-like filling materials into the canal. The optimal rotation speed is 100-200 rpm. The symbol is a spiral. Tape channel filler (Hawes-Neos type) has the shape of a drill, twisted in the opposite direction.

Gutta condenser (gutta-condensor) - a tool with a working part in the form of a reverse H-file. Used in a contra-angle handpiece with a rotation speed of 8000-10,000 rpm. When rotated, it forces gutta-percha into the canal, softening it due to friction and compacting it in the apical part.

Spreader (lateral sealer of gutta-percha, spreader; English spreader - spreader, distributor) - an instrument with a smooth, pointed working part, designed for lateral (lateral) condensation of gutta-percha pins in the root canal. A finger spreader has a handle for the fingers, a manual spreader (one-sided or two-sided) (handle spreader) has a handle for holding in the hand. Corresponds to the size of other endodontic instruments, but spreaders with a larger taper are also available, repeating the shape of non-standard gutta-percha points.

Plugger (vertical gutta-percha compactor, root plugger, plugger; from the English plug - to plug) - an instrument with a working part in the form of a smooth truncated rod, designed for vertical condensation of heated gutta-percha in the canal. A finger plugger is equipped with a handle for the fingers, a hand plugger is equipped with a handle for holding in the hand. Compares with the sizes of other endodontic instruments.

Heating plugger (heat-carrier plugger) is a double-sided instrument for vertical condensation of heated gutta-percha. It has two types of working parts: a spreader-type rod, heated and inserted into the channel to soften gutta-percha, and a graduated plugger for its condensation.

Lentulo canal filler is a tool for filling the root canal.

Condenser is a tool for condensing gutta-percha in the canal.

Instruments used for obturation of root canals.

Instruments intended for obturation of root canals include pluggers for retrograde filling with amalgam during resection of the root apex, as well as various devices for introducing filling material into the canal (syringes, tweezers, etc.).

BIBLIOGRAPHY :

1. Journal “Clinical Dentistry” No. 4 / 2009

2. Journal “Endodontic Practice” No. 2 / 2007.

3. Dental Times magazine No. 4 / 2010

4. Steven Cohen, Richard Burns Endodontics 8th ed., St. Petersburg: STBOOK / 2007

5. L.A. Khomenko, N.V. Bidenko Practical endodontics. Tools, materials and methods, M.: Book Plus / 2002

6. Nikolishin A.K. Modern endodontics of a practical doctor. 3rd ed. Poltava / 2003

7. Lumley F. Practical clinical endodontics. M.: MEDpress-inform / 2007.

8. Maksimovsky Yu.M. Therapeutic dentistry, M.: Medicine / 2002.

9. Nikolaev A.I. Practical therapeutic dentistry. M.: MEDpress-inform / 2008.

10. Dubova M.A., Shpak T.A. , Kornetova I.V. - Modern technologies in endodontics St. Petersburg Publishing House state university/ 2005

11. Gutman J.L., Dumsha T.S., Lovdel P.E. - Solving problems in endodontics. M.: MEDpress-inform / 2008.

12. Goryachev N.A. Conservative endodontics: Pract. management. Kazan: Medicine / 2002.

13. Mamedova L.A., Olesova V.N. Modern technologies of endodontic treatment, M.: Medical book / 2002.

14. Petrikas A.Zh. Pulpectomy M.: AlfaPress / 2006.

15. Poltavsky V.P. Intracanal medicine: Modern methods M.: Medical Information Agency LLC / 2007.

16. Skripnikova T.P., Prosandeeva G.F., Skripnikov P.N. Clinical endodontics, Poltava /1999

17. Tronstad Leif Clinical endodontics, M.: MEDpress-inform / 2009.

18. Troup Martin, Debelyan Gilberto Guide to endodontics for general dentists, Azbuka Publishing House / 2005.

MOSCOW STATE MEDICAL AND DENTAL UNIVERSITY DEPARTMENT OF GENERAL PRACTICE DENTISTRY AND ANESTHESIOLOGY FPDO Head of the department Rabinovich S.A. Doctor of Medical Sciences, Professor. Course work Modern endodontic instruments. Approved

The incomprehensible word “endodontics” has little to say to the average person, but it is important for patients in dental clinics to at least partially understand this concept. After all, this mysterious term hides the very painstaking work of doctors to save teeth that are “under attack” and can be removed without the competent help of specialists. Why? We propose to understand this in detail in today’s material.

What is hidden under the term “endodontics”

In dentistry, this is the name given to one of the therapeutic sections, in which the emphasis is on the treatment of root canals and tissues surrounding the tooth root, in particular, periodontal tissue. Carrying out manipulations in this area requires a high level of professionalism and attentiveness from a specialist, because in essence, this is working with the insides of the tooth, which are responsible for its nutrition and vital activity, for functionality. Therefore, any mistake here can threaten further infection of the tissues and loss of the dental unit. If the procedure is carried out efficiently - and according to statistics, up to 97% of all teeth can be successfully treated with endodontic treatment - then with timely prosthetics, the tooth will serve its owner for at least another ten years, even if before that the situation seemed hopeless.

In general, a dentist-endodontist (or endodontist) has a rather narrow specialization, so such treatment today is most often carried out by highly qualified specialists with a broader profile: dental therapists.

Details about what an endodontist works with

To understand exactly what area an endodontist works with and why his work is so important, let’s remember what a tooth consists of and what its structure is:

• visible, outer or supragingival part: this is the crown that each of us can easily see simply by opening our mouth. The crown is covered with translucent enamel, which is the hardest part of our body and is 96 percent composed of minerals, and only 4% from water. And under the enamel is dentin. It is more fragile, because only 70% consists of minerals. But the color of the teeth depends on its shade, since it shines through the enamel,
• internal part: this is what is hidden from our view inside the tooth itself and under the gum. This is where the root system is located. Each tooth has a different number of canals (usually it is equal to the number of roots), and the canals themselves are penetrated by nerve endings and vessels that connect to lymph and blood. Hidden from our view is the pulp, which is located under the dentin; it is soft tissue, penetrated by nerve endings, it is also called the “heart” of the tooth, because Thanks to the nerve, it functions normally, “lives”, receives the necessary nutrition, and also reacts to different types of stimuli (heat, cold).

So, the endodontist works with the internal contents of the tooth (“endon” translated from Greek means “inside”), namely with its root canals and pulp, which are not so easily accessible.

Which patients need endodontic treatment?

So, let's look at when you will definitely need treatment:

• all forms as well deep caries,
• and periostitis, i.e. flux,
• inflammation in the hilar area, for example, perihilar cyst,
• preparation for prosthetics,
• replacing old fillings,
• injuries leading to serious damage and destruction, cracks and the formation of large cavities through which pulp infection can occur.

What are the goals of the specialist?

The doctor who will conduct the treatment sets himself a number of tasks that must be completed. First of all, it is important for a specialist to determine whether it is advisable to fight for the tooth or whether the situation is so advanced that it makes no sense to work with root canals; it is easier and more effective to carry out removal. Naturally, professional doctors take such measures only in extreme cases, but if you delay going to the dentist, they are sometimes inevitable.

• preparation of instruments and materials: all instruments used in work must be sterile and of high quality, not cause allergic reactions in the patient,
• working with the pulp: its painless extraction, complete or partial,
• work with root canals: excision of infected areas, treatment and disinfection of canals, elimination of pathogenic microflora from them, expansion of walls, high-quality filling and sealing,
• work with previously treated units: re-treatment of units that have previously undergone endodontic intervention,
• high-quality verification of work results and x-ray control at all stages of treatment.

As a result, the specialist eliminates infection from the root canals and prevents their re-infection, and also preserves the tooth itself and significantly extends its life.

Will it hurt during treatment?

Modern endodontics allows procedures to be performed with the greatest comfort for patients and painlessly. Therefore, before carrying out the main manipulations, the patient must be given (in some cases, with contraindications to all types of anesthetics or with panic dental phobia, anesthesia or sedation may be used).

On a note! The first attempts to carry out endodontic treatment were made back in Ancient Egypt. There, local healers tried to save their patients from severe pain by cauterizing the pulp with a hot needle. Later, experts invented mummifying pastes that made it possible to simply preserve the nerve without removing it. All these methods only harmed patients and did not allow them to achieve the desired result. Today, doctors can remove the damaged pulp completely (extirpation) or partially (amputation) in just one step and without pain.

What does a doctor need to provide quality treatment?

Today, not a single specialist in his medical practice can do without a set of special equipment, tools and materials that allow him to carry out therapy in the most high level. Let's take a closer look at what helps endodontists save our teeth.

1. Tools

This includes pulp extractors, which help specialists easily extract pulp. Doctors also use files - root canal expanders and canal fillers - thanks to this set of tools, they can perform fillings and fill all gaps. Devices for working with gutta-percha and for filling canals are also used. When preparing for prosthetics with core inlays, doctors use drills that help expand straight root canals.

Each instrument is selected based on the clinical situation, has a specific diameter and cone, and can be manual or automated. All instruments today are made so that the doctor consistently performs canal treatment, and the risk of errors, instrument breakage, and damage to the inside of the tooth is minimized.

2. Instruments and apparatus

Name	What is it for?
Apex locator	Using this instrument, the doctor can easily determine the length and bottom of the root canal. This allows you to avoid errors during the work process: in particular, excessive application of filling material, damage to the root apex, incomplete treatment and disinfection of internal areas
Instruments for electrophoresis	Their work is based on the action of electric current. Using the device, the doctor injects medicinal compounds inside and carries out disinfection and root canal treatment, reaching the most inaccessible areas and leaving no chance for bacteria to continue their destructive activities.
Ultrasound	The use of ultrasound makes it possible to make the effect of drugs and medications on the internal cavities of the tooth that have undergone treatment more effective. This good method anti-inflammatory and antimicrobial treatment of root canals
Laser	In endodontics today, this area is relatively new, but it is gaining popularity among doctors and patients. The application is most effective for combating pathogenic microorganisms that have started an inflammatory process in the root canals
Microscope	Working under a microscope is indispensable when it is necessary to fill very narrow root canals (up to 1 millimeter), complex endodontic treatment and surgical manipulations for filling in the root area (for example, if the tooth has already been treated previously and the patient has an inlay, as well as in the presence of broken instruments in root canals). Also, in some clinics, a microscope is used for better treatment of pulpitis or periodontitis and in ordinary, standard clinical situations. But the patient should always remember that such tools can significantly affect the overall cost of treatment towards its increase.
Visiographs and tomographs	Without these devices, diagnostics and subsequent work by a specialist simply cannot be performed efficiently. With their help, the doctor receives two-dimensional () or three-dimensional images ( computed tomography), which allow you to assess the degree and scale of the inflammatory process, the condition of tissues and roots, the quality of the work done, and monitor each stage of treatment.

3. Materials

Here the specialist gradually uses antiseptics (chlorhexidine or sodium hypochlorite), filling pastes and gutta-percha pins. All materials used must be hypoallergenic, not change the shade of enamel and dentin, easy to insert and, if necessary, removed, detectable under x-rays, and should not shrink.

How long will treatment take and how is therapy carried out?

Let's consider what stages of treatment a modern patient must go through in order to cure dental diseases such as pulpitis or periodontitis, as well as save a tooth.

“Endodontic treatment requires great responsibility and difficult, painstaking work on the part of the doctor. Each stage must be accompanied by X-ray control of the work done. The patient must expect that such therapeutic measures will take time. Depending on the clinical picture, you will have to visit the doctor at least 2-3 times. This is the best case scenario. For some, treatment may take several weeks or even several months.”- thinks.

Stage 1: radiography. After receiving the images, the doctor assesses the situation and makes a decision on treatment or removal. Next, the specialist draws up a plan for carrying out therapeutic measures.

Stage 2: anesthesia. To completely numb the affected area, doctors use conduction or infiltration anesthesia. The gums can be pre-treated with local freezing - a special spray.

Stage 3: drilling out a carious cavity.

Stage 4: depulpation. During endodontic treatment, doctors almost always decide to remove the nerve, i.e. carry out depulpation. Depending on the chosen treatment method, the patient may be given an anesthetic and then the nerve removed in one step (extirpation, when the nerve is completely removed, or amputation, when only its coronal part is removed and the root part is preserved). If the patient has a number of contraindications to the procedure or anesthesia, then a devitalizing arsenic paste can be previously applied to him and a temporary filling installed, with which he will need to walk for several days to kill the nerve, and only then the doctor will remove it.

Stage 5: root canal treatment. The specialist provides access to them, cleans, disinfects, removes remaining pulp, expands them and dries them. Further, depending on the clinical situation and the presence of an inflammatory process, for example, with periodontitis, the doctor may apply medicine inside and install a temporary filling. You will need to come for an appointment in three to seven days and, if necessary, repeat this stage as many times as the situation requires.

Stage 6: Gutta-percha filling. The material is preheated, after which it is introduced into the channel and all its branches using an instrument. After all the channel cavities are filled, the material is compacted.

Stage 7: restoration of the crown. For this purpose, filling material or an artificial prosthetic structure can be used. Some patients prefer to ignore this stage, believing that the inflammation has been eliminated and that is enough. But this opinion is wrong, because the pulp has been removed from the tooth, which means it becomes fragile and more susceptible to any negative influence. Even in the process of chewing not very hard food, it can break off or break.

What complications can you encounter after treatment?

Modern technologies used in endodontics today, in most cases, eliminate the risk of complications. But there are situations when the patient falls into the hands of an inexperienced or unprofessional doctor, who makes a number of mistakes during therapy: for example, does not conduct X-ray control of the situation, leaves a fragment of an instrument in the canals or acts too traumatically on them, perforates the root walls, does not apply a sealing sealant material or takes it beyond the root tip. Then, even after a long time after the treatment, the patient may experience pain or face the need to re-treat the tooth due to the occurrence of an inflammatory process in it.

On a note! After treatment, you may experience pain, increased sensitivity and discomfort in the first days (5-7 days), which can be easily relieved with painkillers. Your gums may also become slightly swollen. This situation is normal, because the doctor performed an intervention on living tissue. But if the pain does not go away, and its intensity only increases, then it is time to immediately consult a doctor.

Features of endodontic treatment in children

Pediatric endodontics presents some challenges:

• on baby teeth: there is a high risk of infecting the rudiments of permanent teeth and thereby negatively affecting the formation of a permanent bite and the health of the child. Therefore, in case of inflammation in the root canals baby tooth, for example, when, doctors often decide to remove the unit,
• to permanent ones: in children, the permanent units, which have just replaced the milk ones, are still quite weak, thin, can collapse at any time from minor injury and have an incompletely formed root system - the root apex is finally formed over the next three years after eruption. Therefore, if during this period of time a child becomes ill with pulpitis or periodontitis, then the specialist must first stop the inflammation and wait until the formation process is completed. To speed up this process, calcium paste is placed in the canals and a temporary filling is installed. Afterwards, the doctor performs a permanent filling and installs an inlay or crown.

How much does treatment cost?

If you really want to extend the life of your natural tooth, then you should be aware that endodontic treatment can actually do this even in quite complex and advanced cases, but you will have to expect significant expenses accordingly. They can range from 5,000 to 30,000 rubles. Why so expensive?

Firstly, you need to take into account the number of root canals, because the tooth can be single-rooted, double-rooted, three-rooted or even four-rooted (wisdom teeth). Accordingly, the more there are, the more time it will take for treatment, the more materials and antiseptics will have to be consumed.

Secondly, it all depends on the scale of the inflammatory process and the number of visits to a specialist. Add here the number of x-rays, and there will be at least three in the most ideal case.

Thirdly, the filled tooth needs to be restored with a crown as quickly as possible. You will have to visit additionally, and artificial crown in turn can be made from different materials– ceramics, zirconium dioxide, metal ceramics. All this is worth the expense and expense.

Video on the topic