Endocrown restorations are the treatment method to be applied in the restoration of teeth that have undergone endodontic treatment and have high crown damage. In the traditional method, the treatment of these teeth is performed with full crown restorations applied on the in-canal postcor. In parallel with the development of adhesive systems, new treatment alternatives are applied in these cases. Endochrone restorations are a new treatment option used as an alternative to post-crown restorations in the treatment of endodontically treated teeth with excessive material loss. Endochrone restorations are produced as a single piece. These restorations provide macromechanical retention as they are supported by the pulp chamber and cavity walls, and micromechanical retention is also achieved by cementing with an adhesive system. Endochrone restoration applications are relatively simpler and the number of sessions is short. The advantages of endochrone restorations include less removal of intact tooth tissue during their preparation; they can be applied on teeth with calcified, occluded and curved roots; they do not have the risk of perforation and fracture in the root; and they can be applied in patients with low occlusal distance.
Advantages of endochronous retorations
∙ Less removal of intact tissues during preparation ∙ More economical ∙ Fewer number of sessions
∙ Simpler treatment
∙ Can be applied on teeth with short canals
∙ Can be applied on teeth with curved roots
∙ Can be applied in cases with calcified canals
∙ Can be applied in cases with insufficient interocclusal distance
∙ Less plaque retention since supragingival restorations are prepared
What is Root Canal Treatment?
Root canal treatment, also known as endodontic treatment, refers to removing the damaged or infected pulp (pulp) of a tooth, disinfecting the tooth and then closing it again with a filling. The pulp extending to the root tip of the teeth contains nerves, blood vessels and connective tissue. In cases where the tooth is cracked as a result of any impact or a deep decay occurs, bacteria enter the pulp and begin to multiply here. If left untreated, the bacteria can cause a serious infection or dental abscess, leading to pulp death and bone or tooth loss. In such a case, canal treatment is applied to the decayed tooth to save the tooth.
In which cases is root canal treatment required?
Deep caries and cracks in the tooth bone are the main conditions that require root canal treatment. In cases where the tooth is too damaged to heal, the pulp part is removed and the tooth is protected. Therefore, the biggest advantage of root canal treatment is to save the dead tooth and not to lose the bone structure of the tooth. Some symptoms of conditions requiring root canal treatment can be listed as follows:
Swelling in the face and neck
Persistent tooth sensitivity, especially to hot or cold
Pain when chewing or biting
Pimple-like sores on the gums
Swelling of the gums
How is Root Canal Treatment Performed?
Root canal treatment has four main purposes: eliminating decay and infection, shaping the tooth canals, filling the canals and making the tooth functional again. Depending on the condition of the tooth, the treatment may take one or two sessions. Although the procedure followed during the root canal treatment process varies depending on the tooth damage, it generally includes the following steps:
The dentist takes an x-ray to see the root structure of the tooth and to determine if there are any signs of infection. The damage to the tooth is then assessed and a decision is made as to whether root canal treatment is needed.
If the tooth pulp is very damaged, root canal treatment is initiated.
If there is severe pain due to abscess formation in the tooth, local anaesthesia is applied before treatment.
The first step of root canal treatment is to carefully remove the pulp inside the tooth. After the pulp is removed, the dentist determines how long the procedure in the root canal will take.
The root canals are reshaped and cleaned using apparatus of appropriate size.
One session of root canal treatment takes about 45 minutes on average. After the necessary procedures are performed, the tooth is x-rayed at least twice. If the dentist thinks that the treatment is successful, after the disinfection process, the canals are filled with a permanent material to prevent contamination.
Dentists can wait for the tooth to heal for 4-5 days before performing a permanent filling. In this case, the tooth cavity is closed with a temporary filling.
In the next session, the temporary filling of the tooth is removed with a painless procedure and permanent filling is performed. Permanent filling is performed with dental putty and a rubber-based substance called gutta percha. Calcium hydroxide-based pastes prevent any leakage into the root canal from the outside.
Things to Consider After Root Canal Treatment
During root canal treatment, the tooth nerves are removed along with the inflamed tissue. Therefore, the tooth is not affected by external stimuli. However, especially in cases where pain or infection was observed before the procedure, tooth sensitivity may be felt after the treatment due to tissue inflammation. This is usually alleviated with painkillers prescribed by the doctor.
Care should be taken not to eat anything for at least three hours after treatment.
The success rate of root canal treatment is quite high. A treated tooth can be used for a lifetime with regular care.
Consumption of sugary foods known to cause tooth decay should be minimized.
Teeth should be cleaned twice a day with a soft-bristled toothbrush and once with dental floss.
Care should be taken to have a general dental examination at least twice a year.
In some cases, root canal treatment may not be completely successful. The physician factor, the shape and number of root canals, anatomical factors and the characteristics of the devices and instruments used are effective in this. If the root canals are not completely filled during root canal treatment, the infection at the root tip may not heal. In this case, a repeat root canal treatment (Retreatment) may be required.
The most important step of retreatment is the evacuation of the root canal treated roots. In this case, if the root canals were not properly expanded and shaped during the previous root canal treatment, root shaping is performed as much as possible. A common situation in retreatment is the exposure of canals that cannot be found in the teeth. Each tooth may have anatomical variation and may have extra root canals and bifurcations. If these canals are not seen during treatment, they are not filled and can be a source of infection. it is possible to achieve a high rate of success in the treatment process. In the repeat root canal treatment, the filling material in the canal is removed and filled with a drug that will treat the inflammation at the root tip. At the end of the period determined by the physician, the root canal is filled and the root canal treatment is repeated.
Toothache is an important criterion for the indication of root canal treatment. Pain that does not go away spontaneously or despite the use of painkillers indicates that the tooth can no longer defend itself. In these cases, root canal treatment is required. In some chronic cases, although there is no discomfort in the tooth, inflammation in the root can be found in radiographic controls. In these cases, root canal treatment is also required. Inadequate root canal treatments previously performed on the tooth can remain in the mouth for a longer period of time with a proper root canal treatment.
What is Micro Endodontics?
The root canal treatment process performed under a dental microscope is called micro endodontics.
What are the Advantages of Using a Microscope?
Today, one of the revolutionary tools in root canal treatment is the Dental Microscope. With the dental microscope, we can treat the tooth by magnifying it up to 25 times. This eliminates many optical factors that are overlooked and affect the success of the treatment. Many teeth that are indicated for extraction can be saved with this method.
Thanks to this special microscope, extra canals and connections between canals that cannot be seen with the eye can be seen and treated. In addition, this special microscope also allows the repair of damage caused during the previous treatment in cases where canal treatment needs to be repeated.
It is the removal of the inflammatory structure together with the tissues around the root tip.
PURPOSE: In the mouth of teeth that cannot be successful with root canal treatment
is to hold it.
Situations in which apical resection can be performed
Curvature of the root tip or calcified obstruction in the pulp cavity
If the instrument is broken in the canal, the tip protrudes and causes a foreign body reaction in the bone
Fractures in the apical 1/3 region
In teeth with perforated or side canals during treatment
If culture (-) results cannot be obtained in root canal treatment
If there is pathology covering 1/3 of the root tip
In the presence of flood channel embankment
In teeth with previous unsuccessful apical resection.
Cases where apical resection cannot be performed:
If there is infection at the resection site
Luxurious teeth with periodontal problems
If there is traumatic occlusion
In teeth with crochet feet
If the lesion is too large, if too much resection is required.
What is Fibre Post Application, Why is it Preferred?
Fillings applied to teeth with too much damage or loss of material can often result in failure. For this reason, in such risky teeth, the nail, screw-like structures applied with the support of the existing or canal treatment performed by us are called “post”. The post allows us to get support from the root of the tooth. It is planned and applied in a size suitable for the canals in the root. The prosthesis superstructure made on it is called “core”. The whole of this structure is called “post-core”. Nowadays, with the development of adhesive (bonding) systems, treatment approaches have also changed in teeth with excessive material loss with filling materials. Using adhesive systems, canal treated and completely destroyed teeth can be restored. In the case of teeth with excessive destruction of the crown, it is necessary to get support from the root of the tooth to ensure the retention and strength of the restoration. In the past, substructures prepared in the laboratory using metal alloys required both impressions and a second appointment. Today, with the availability of fiber and adhesive systems, this procedure can be performed in a single session. Thus, both the treatment steps are shortened and a more successful aesthetic and function is achieved.
When should fiber applications be performed?
If there is not much material loss in the root canal treated tooth, normal filling, if there is excessive material loss, inlay, onlay (porcelain filling) treatments should be performed to prevent the tooth from breaking. If there is no tooth wall left and the roots are intact, a “post” supported by the root canal should be made and a crown (coating) should be made on it. Why is fiber post preferred? They are much less likely to break. It adheres to the tooth both mechanically and chemically. Since there is no metal reflection under full ceramic restorations, an aesthetic appearance is obtained.