Rotry Endodontic

Rotary Endodontic

All round treatment for a sparkling smile

Endodontic procedure is commonly referred to as the Root Canal Treatment. Rotary Endodontic is a new method used in the Endodontic procedure. This procedure uses an electric hand piece instead of manual files which eliminates the drilling noise usually associated with Root Canal. Our dental professionals using the rotary procedure starts the root canal with administering a local anesthetic. Once the affected area is numb, the dentist will use the electric hand piece to drill into the pulp chamber of the infected tooth and scrape away the infection in your root canal. Once the entire infection has been removed, the dentist will protect your tooth by fitting it with a crown.

The advantages of Rotary Endodontics

The use of the anesthetic and the hand piece makes this procedure almost pain free.

Eliminates the drilling sound.

Rotary Endodontic is a time-saving procedure.

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Single Visit RCT

Highly dependent on the condition of the tooth a root canal treatment can even be completed in one visit. By and large, when patients are used to a predictable treatment modality such as the multiple visit RCT, they are generally not receptive to changes in common practice. Dental Solutions, Bangalore aims to bust another myth about root canal treatments. Traditionally complete sterility of the root canal before the obturation process required the procedure to take place in multiple sittings. With refined and advanced cleaning techniques a single visit is enough to achieve the desired results that RCT aims to provide. Efficient and effective outcomes can be obtained with titanium instrumentations, reliable and accurate apex locators, microscopic and laser endodontics, digital radiography, biocompatible sealants and other advanced obturation systems.

Biomechanical preparation for single visit RCT:

In the multiple visit RCT, it is a common practice to involve three elements of the preparation – the mechanical removal of infected dentin and pulp tissue, irrigation of the root canal and administration of intracanal medicaments. In the single visit RCT, the third element is not required. Ideally, intracanal medicaments are placed in the root canal to disinfect it in between treatments. This is not necessary with the single visit RCT since the treatment is completed in a single visit. As a preparatory process, it is important that the pulp tissue and infected dentin of non-vital teeth also removed. Irrigating solutions are allowed to penetrate into the tubules and kill the bacteria thus disinfecting the root canal system. After that, by opening the pulp chamber it is flooded with carbamide peroxide gel and EDTA for lubrication to explore the canal. The debris is automatically loosened by the EDTA to be removed.

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Obturation:

Several techniques are utilized to obturate till the apex. In the case of over instrumentation, a lateral condensation method is recommended. For sealing, resin-based sealers are advised to create a hermetic seal.

Several techniques are utilized to obturate till the apex. In the case of over instrumentation, a lateral condensation method is recommended. For sealing, resin-based sealers are advised to create a hermetic seal.

Misconceptions of the single visit RCT

There are several misconceptions surrounding the single visit RCT listed as below:

Pain is one of the most popular illusions of the single visit RCT: It has been proven that single visit RCT is less painful than multi-visit RCTs.

Incomplete disinfection of the canal: When the RCT is done with appropriate-sized biomechanical preparation, using the right irrigants such as Warm NaOCL, 4% chlorhexidine, and hydrogen peroxide, sealing the main root canal immediately with 3D dental obturation kills any bacteria present due to the tight closure of the dentinal tubules thus enabling prompt healing.

Single visit RCTs take a lot of time: In fact, advancements in the NiTi Rotary files have reduced the average single sitting time from 60 minutes to 45 minutes.

Periapical lesions do not heal: A periapical lesion is located outside the structure of the tooth and surrounded by connective tissues that provide a good supply of blood. The body’s healing mechanism and the prescriptive medications both help in the healing of the lesions. Besides RCT is confined within the structure of the tooth only and does not affect the healing responses of periapical lesions.

Dental Solutions conduct this highly sensitive treatment with the utmost accuracy which is a pre-requisite to performing the single visit RCT.

Repeat RCT

A root canal therapy can last for several years. But there could come a point in the lifetime of the RCT that the tooth does not heal and can become diseased and painful. The occurrence of degradation can be in months or even years. The tooth may even develop new problems. Root canal failures are indicative of re-treatment. The presence of pain and swelling in most cases can be treated successfully with both methods non-surgical endodontic re-RCT and surgical endodontic re-RCT. A retreatment entails removal of the tooth, the fillings and elimination of infection after a thorough examination of the canals. The tooth is once again, cleaned and shaped and new, temporary fillings are placed. Once healed, the crown is fitted on the top to protect the tooth. Better concepts, advanced techniques, and high levels of education have improved the quality of restorations.

Fiber-optic lighting systems, headlamps for better visualization, ultrasonic devices to painlessly and noiselessly remove the old root canal and repairing it and better medicaments for disinfection and filling have made re-RCTs much easier.

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Types of Re-RCT

Surgical endodontic RCT:

1. The procedure is done under local anesthesia

2. Flap adjacent to the affected tooth is raised

3. Entry is gained into the infection to expose it

4. Curettage is performed where the diseased and infected tissue is removed by scooping

5. The granuloma is separated from the bone

6. An apicoectomy procedure removes the infected root portion and the tip of the root

7. The healthy part of the tooth is sealed at the tooth root with the help of a filling

8. The infection is eliminated completely

Re-RCT microscopic endodontics:

Receded pulp tissues are so tiny that they are not visible to the naked eye. In such cases, a powerful surgical operating microscope is used to magnify the area for better visualization and accurate treatments.

Re-RCT with laser:

Stubborn debris is melted away with the help of a parallel beam of high-intensity light that cleanses the inner canals. Infection and bacteria are removed from the root thoroughly.

Non-surgical endodontic RCT

The non-surgical endodontic RCT is one of the safest procedures that can be conducted on the endodontically failed tooth. Non-surgical endodontic RCT is done as follows:

1. The earlier undetected canals are located

2. Prior filled material is removed from the root canal space

3. Broken instruments if any are removed from the pulp

4. The quality of root canal since previous is visibly improved

5. All mechanical and pathological perforations that are present are treated

6. The root canal space is then cleaned, re-shaped to achieve complete disinfection and sealed

7. For functionality and aesthetics, a protective restoration may be placed

Dental Solutions performs highly successful retreatments of the root canal. More often two sittings may be required for the re-RCT, first for the removal of the debris and treating the tooth and the second for the placement of the crown. The patient is provided with a post-surgical treatment schedule and plan that has to be followed stringently.

Post and Core Procedure

Post and core procedures are done to anchor a crown or stabilize weakened tooth. When tooth structure is inadequate to reinforce a conventional restoration then a small rod or post is inserted into the root space with a few millimeters of protrusion. This protrusion which is the core supports the large crown or filling, whichever is appropriate. The missing coronal tooth structure is replaced sufficiently to restore full functionality and aesthetics of the tooth.

Post and Core Procedure

For a tooth that has already undergone root canal therapy:

The carious tooth structure and temporary material are removed to expose the distal apical margin to visualize the structure of the tooth

Caries detection dye will ensure that all decay and debris is removed

A laser gingivectomy may have to be performed to the apical extent of the decay to visualize the tooth structure

Probing will reveal if there is any violation of biological width

Spaces are created for the posts in the buccal and lingual canals and a matrix is placed – post drills finalize the post space

The posts are placed and cemented using a composite resin which is also used to build-up the core A final preparation is done for the placement of the crown

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Principles of post placement

Root canal system contamination should be avoided

Healthy tooth structure should be well-preserved

After completion of the root canal tooth should be restored as soon as possible

Posts should be used only for a core build-up

Minimum 4 mm of gutta-percha should be left at the apical end (this is determined with the help of radiographs)

The length of the post (below bone crest) = height of tooth (above bone crest)

Types of post and core

Prefabricated post and core:

Prefabricated post and core do not involve any laboratory work and are easy to place. These can be inserted immediately as soon as the endodontic therapy is completed which reduces the time for placement. Prefabricated post and core come in different ranges and sizes and the best fit is selected for clinical application. The posts are cemented or screwed inside the root canals along with dental cement and composite materials. At the time of cementing the post into the root space, the core is packed with dental composite material.

Prefabricated posts:

Materials:

Metal alloys: titanium, base alloys, gold and silver: they are screwed inside the root space

Fibre-reinforced composite resin posts: provide better resistance and aesthetics

Dental Inlays and Onlays

Restorations performed to rehabilitate the decayed, fractured or cracked teeth located in the rear are called inlays and onlays. They are also known as indirect fillings and are sometimes used as conservative alternatives to full coverage dental crowns. Inlays and onlays are long-lasting reparative solutions that successfully re-establish aesthetics and functionality of the damaged tooth. They fit well, are strong and a widely chosen alternative to traditional fillings. Tooth decay and structural damage are repaired with inlays and onlays fabricated in a dental laboratory and then bonded to the damaged tooth.

In an inlay the material is bonded into the centre of the tooth and in an onlay cusps may be included depending on the extent of damage and if full coverage of the biting surface is required.

Benefits of inlays and onlays:

Inlays and Onlays are conservative preparations that are bound to offer a better fit and preserve most of the healthy tooth

They are one of the best alternatives to full coverage crowns

It comes with assured aesthetic longevity and do not discolor like resin fillings

Tooth structure is safeguarded in addition to restoring damaged and decayed areas

Functional endurance is guaranteed

Inlays seal the space between teeth tightly avoiding bacterial formations

Procedure

Inlays and onlays comprise of two visits

First, the damaged tooth is prepared

The impression of the tooth is taken where an inlay and onlay has to be created

An inlay preparation typically involves making an initial entry into the central fossa; a tapered fissure bur is used for the purpose; Mesial and distal proximal boxes are created with a thin layer of enamel left as a protective modality to the adjacent tooth

Onlay tooth preparation involves reduction of cusps, preparation of non-centric cusp, gingival and shoulder bevels and retention grooves

In the following appointment, the inlay and onlay are cemented into place after removing the temporary restoration

Treatment completion is ensured with a smooth finish

Inlays and Onlays at Dental Solutions

At Dental Solutions, Bangalore the latest technology is used to send images of the damaged tooth to the technician to discuss optimal treatment options. Treatment plans are formulated by communicating real-time information with the patients.

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Conservative Endodontics

Conservative dentistry in endodontics deals with the preservation of teeth. It is ideally a combination of operative dentistry and endodontics. The specialty encompasses restoration and preservation techniques of teeth and the diagnosis and treatment of dental caries to re-establish full functionality and aesthetics of the tooth.

By definition operative, dentistry prevents diagnoses and treats defects in the dentin and enamel of individual teeth. At one point the aggregate field of dentistry was considered as operative dentistry. It is from this base of operative dentistry that other spheres of dentistry evolved. The Early dental practice involved tooth extraction but with more educational institutions evolving to teach dentistry by the beginning of the 18th-century dental programs and its tutelage progressed. With the father of modern dentistry Dr. G.V.Black standardizing cavity preparations and the manufacturing process of silver fillings, the scientific foundation for operative dentistry was laid down with a scope for massive expansion. Today, the specialty plays a major role in the enhancement of dental health and is an active component in dental practice. Operative dentistry with endodontics helps to meet the overall goal of dental sciences such as the elimination of disease, restoration of the tooth, along with its form and function.

The purpose and responsibility of Conservative Endodontics:

Operative dentistry comes with an understanding of infection control and examines not just the affected tooth but also the systemic health of the patient. It correlates the diagnosis of the dental problem with body tissues. A well-drafted treatment plan has the capability of restoring the health and function of the affected area. Usage of the right material, its demands and limitations are understood well by the specialty. It comprehends the biological basis and functionalities of tooth components and supporting tissues with a thorough apprehension of the oral environment and dental anatomy.

Diagnosis:

detecting the nature of the disease is critical to developing a treatment plan

Interception and prevention:

to avoid any recurrence of the disease and any further loss of the structure of the tooth thereby stabilizing the active disease process

Restoration and preservation:

restoring all shape and aesthetics along with the performance of the tooth and sustain vital periodontal support of the surviving structure of the too

Conservative and endodontics at Dental Solutions, Bangalore is practiced as a combination of microbiology and human biology. The surgeons possess highly accomplished technical skills and demonstrate artistic capabilities in tooth restoration. The clinic specializes in the restoration of all types of dental caries, wear and tear of tooth, trauma and developmental defects. Restoration treatments at Dental Solutions are supported by the latest technologies in microscopic endodontics and digital radiography. Microscopic endodontics is a tooth-saving technique where a surgical microscope is used at extreme magnifications to view all the root canals to treat them accurately and effectively. Digital radiography can enhance the brightness and contrast of the images taken, magnify the apical zone along with easy transmission and storage of the images. Dental Solutions makes valuable investments for their patients.

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Pits and Fissure

Tooth decay is a common oral problem and most of the adults between the ages of 20 and 64 years suffer from tooth decay. The chewing surfaces of the teeth develop deep grooves called pits and fissures. They are found on the molars and premolars. The cavities in the molars are deeper than in the premolars. While chewing food may not be an issue food can still get stuck and form a bacterial film called plaque that accumulates if not cleaned regularly. A regular toothbrush may not be able to remove the food particles stuck in these areas. So the plaque stays in place and causes a cavity. A narrowed morphology provides the perfect space for the development of caries. Molars are the first set of permanent teeth and are the most susceptible set of teeth to occlusal caries.

Treatment for Pits and Fissures

Several anatomical and clinical conditions are studied before the treatment such as the age and eruption of the tooth, visualization of a deep and retentive fissure anatomy, demineralization of the fissures, and if the LF values are 0-20 / 0-24. Erbium laser 2780 and 2490 nm is used for fluorescence diagnosis and individualization of the pits and fissures.

Erbium lasers are also used for:

Minimally invasive technique for pretreatment – decontamination and conditioning of the deep fissures; also done with initial demineralization before acid etching and sealant

Noninvasive technique for pretreatment and conditioning of the pits and fissures before LAS

Minimally invasive ablative technique for removal of caries and white spots after which the fissure is conditioned, before etching, bonding, and composite in the PRR method (preventive resin restoration)

Advantages of erbium laser:

Contributes to decontamination of the fissures

Used in the ablation of enamel in pits and fissures

All hidden debris is removed with the laser technique

Laser increases the surface roughness and creates favorable characteristics for the resin sealant to adapt to the enamel Er:YAG laser reduces the microleakage of the fissure: laser at 120 mJ and 20 Hz applied with 37% orthophosphoric acid

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Sealants for pits and fissures

Sealing pits and fissures are an effective way of treating them. The resin sealant polymerizes the pits and fissures by penetrating into them. The area is sealed off against the entry of bacteria and debris thus preventing dental caries. Generally, sealants are applied with low viscosity so that they flow readily into the pits and fissures. Etching acid is first used to condition the tooth. Microporosities are then exposed to low-viscosity sealants thereby ensuring mechanical retention of the sealant. Sealant materials used are urethane dimethacrylate and BIS-GMA.

Pits and fissures if left untreated will lead to pain, loss of tooth and infection. Due to their inability to be cleaned, they grow rapidly and are one of the leading causes of cavities. Pits and fissures have the capacity to spread rapidly due to which it is always advisable to treat it as soon as it is diagnosed.

Dental Solutions, Bangalore use the latest diagnosis and preconditioning techniques for pits and fissures.

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Microscopic Endodontics

Dental operating microscopes are considered as one of the best innovations in dentistry. Macro-dentistry drew a closure with the introduction of precision through micro-dentistry. Dentists can work under high magnifications and resolutions to derive better and accurate results. The success of root canal treatments took a gigantic leap with the introduction of microscopes in dentistry for procedural execution.

Advantages of Microscopic Endodontics

It can retrieve broken instruments

Endodontic treatments tend to be more accurate than other conventional treatments

Microscopic Endodontics at Arya Dental Clinic, Fazilka

Excellent treatment methodologies along with high levels of precision and exquisite clinical skills are found at Dental Solutions, Bangalore. The Team of doctors at the facility are well-trained on both surgical and non-surgical endodontics to ensure premier and precise results. One of the biggest advantages of microscopic endodontics is that the dental microscope enables visualization inside the tooth and into the root canal system. With added lighting, the magnification is up to 20 times greater. This makes it extremely important to view the extra root canals that cannot be viewed even with loupes. Sometimes the inside of the tooth cannot be seen due to the crown fillings – but the special light from the microscope allows the dentist to see the floor of the teeth clearly. Any abnormal anatomy and fractures can be treated beforehand when detected early.

Only few dentists will incorporate microscopic dental practice where dental solutions provide unique microscopic dental practice. Technique can be utilised for any service.

With a combination of skills and advanced microscopic technology Dental Solutions is positioned to provide some of the best endodontic services to their patients.

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Periapical Cyst Treatment

What is a Periapical Cyst?

Also known as a radicular cyst, the periapical cyst is a common occurrence in the jaw. Necrosis of the pulp occurs as a result of infection of the tooth. Due to toxins emerging from the apex of the tooth periapical inflammation settles in. The Malassez epithelial rests are stimulated in the periodontal ligament causing the formation of a periapical granuloma. Blood supply is arrested in the epithelium and a necrosis develops. The lesions are incidentally discovered on radiographs more often. A periapical cyst develops between 20 years and 60 years of age with the maxilla being affected more than the mandible.

Clinical features of Periapical Cyst

The periapical cyst is progressive and forms slowly. It is usually asymptomatic but can cause pain secondary to infection. There is swelling, which expands rapidly due to inflammatory edema. As it advances, part of the mouth wall is resorbed and a soft fluctuant swelling bluish in color beneath the mucous membrane is formed. The bone has the thickness of an egg shell and upon pressure a crackling sensation is felt.

Phases of the Periapical Cyst

The radicular cyst pathogenesis is divided into three phases:

1. Initiation: Epithelial cell rests of Malassez respond to stimulation due to bacterial infection of the pulp and as a response to necrotic pulp tissue.

2. Formation: The proliferating epithelium lines the central cavity in the periapical area. The epithelial mass increases in size with the peripherial division of cells and the cells from the mid portion of the mass are separated from nutrition. The epithelium-lined cavity is filled with fluid due to liquefactive necrosis of the innermost cells.

3. Enlargement or expansion: The innermost cellular debris raises the lumen of the cyst increasing the size of the cyst. Gamma globulin levels are found in the fluids of radicular cysts. Radiologic evaluation

Ovoid to round radiolucency is noticed with a narrow, opaque margin. The margin is indicative of rapid enlargement of the cyst and is contiguous with the lamina dura. Most cysts are < 1.5 cm in diameter and root resorption of the offending tooth and the adjacent teeth are noticed in long-standing periapical cysts.

Treatment of Periapical Cyst at Dental Solutions

At Dental Solutions, cyst enucleation is performed with the use of conventional laser techniques. Research indicates that Nd:YAG and Er:YAG lasers can successfully eliminate the E.Faecalis and Escherichia coli thus making laser the most appropriate device for the treatment of periapical cysts. Some efficacious wavelengths that are used: ER:YAG 2940 nm and Nd:YAG 1064 nm diffuse dentin infections of varied thicknesses. The microbial population in the canals is removed with the maximum effect when the laser is combined with sodium hypochlorite in ideal concentrations for irrigation. Laser penetrates areas of the secondary canal where irrigation solutions cannot reach

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