Treatment of an impassable tooth canal. Obstruction of the root canals of teeth How dentists deceive patients

I have a toothache

Causes of tooth pain after root canal treatment

The causes of pain in this area are quite objective and partly physiological.

However, it is worth understanding that there is nothing wrong with such diseases. The main thing is to know the necessary information, and then not everything is so scary. Having information about how much a tooth hurts and what causes it, it will probably be easier for you to cope with the pain.

Causes

You return home from dentistry in a good mood, after some time the anesthesia wears off. and then it becomes clear that the tooth hurts after filling no less than before it. How could this happen? What caused the pain to return? Let's try to understand this topic in more detail.

If, when the filling material is removed beyond the apex of the root, the tooth begins to hurt within a short time, then it is due to insufficient filling.

Filling is one of the most popular dental procedures, which almost every person has resorted to. Manipulation helps to cure, as well as restore the anatomical and structural shape of teeth using special materials.

Sometimes it happens that after treatment, the patient feels that the tooth hurts when pressing after filling or when biting while eating. It is quite natural that such a result does not meet expectations; the person again has to endure discomfort, and in case of intense pain, contact the dentist again to resolve the situation.

Physiological causes of pain when pressing

According to dentists, if a tooth hurts when pressed after installing a filling or after filling a canal, this is considered an acceptable norm.

This phenomenon is called a post-filling reaction to dental intervention, so at first a person may experience pain from the cause.

The pain after root canal filling goes away completely on the second day. What to do if the tooth continues to disturb when biting and pressing on the crown? The reason for this may be either a mistake by the dentist during the treatment process or damage to the organ after the dental procedure. Treatment will vary in each situation, and in some cases the pain can be managed at home, but you will most likely have to visit the doctor again to have the root canal filled again.

Why does a tooth hurt after root canal filling? This can be an infection when the tooth cavity is poorly cleaned and the filling material is distributed unevenly. Conditions are created in the canals for the proliferation of microorganisms, inflammation occurs, which causes pain when pressing and when biting on the treated organ.

What to do in such a situation? If the reason is that the tooth was filled poorly, then in any case you will have to do a re-filling and repeat.

Previously, domestic dentistry practiced filling tooth canals using a special paste. The method was very unified and quite cheap. However, not every paste has the necessary fluidity to completely cover all the smallest channel holes. In addition, pastes contribute to the formation of voids, are subject to severe shrinkage and resorption, which causes the opening of channels and the development of the inflammatory process.

The substances can also cause allergic reaction. Due to all the negative properties, this method has not been practiced for a long time. They have been replaced by innovative methods that have high level efficiency.

Features of filling

Timely filling of tooth canals at a professional level when eliminating periodontitis and pulpitis is the key to the absence of complications in the future. The main requirement at this stage of therapy is a high degree of reliability of sealing, excluding.

From this article you will learn:

what methods are best to treat root canals to avoid inflammatory complications.

According to official statistics, in 60-70% of cases, root canal filling in the treatment of pulpitis and periodontitis is performed poorly, which leads to the development of inflammatory complications and subsequent tooth extraction.

The main mistakes dentists make when filling canals are:

In the unfilled part of the canal, an infection develops, which leads to the formation of inflammatory lesions at the apexes of the roots of the teeth.

Single doctor appointment number

The hope of every person is that after undergoing dental treatment, toothache will go away. However, it is not uncommon for a tooth to hurt after root canal filling.

What is this connected with? Should I see a doctor again? How to temporarily remove painful sensations? You will find the answer to all these questions below.

How does tooth filling occur?

To restore the anatomical shape of a tooth or restore the functional features of the dentition in dentistry, the classical method of installing a filling is used.

Timely filling eliminates inflammatory processes and their further development, and also eliminates the risk of pathology. The sequence of tooth filling occurs in 4 stages:

Partial removal of dental tissue affected by caries. Processing the walls of the tooth cavity to install a filling. Laying on.

Most patients go to the dentist only when their tooth hurts very badly and their cheek is swollen. As a rule, such symptoms indicate that caries has turned into pulpitis, and conventional filling will not be enough. First, the doctor will have to treat the pulp, and possibly remove the nerves, then clean the canals and put in a temporary filling. And only then, when the inflammation has been eliminated, can a permanent filling be installed, filling the dental canals along their entire length with the solution.

If the inflammation is eliminated and the entire procedure of filling the canals is carried out correctly, the patient does not hurt anything - this is logical. But in more than half of the cases, after treatment at the dentist and root canal filling, patients complain that the tooth hurts, throbs, twitches, and prevents them from sleeping or eating. Why does this happen, how long will the tooth hurt, is this normal and what should be done in such a situation?

Why and how long does a tooth hurt after filling?

Painful sensations under a filling are a fairly common occurrence. The patient may complain of sensitivity immediately after treatment or inflammation that appears after some time. Tooth pain after a filling procedure is considered normal and goes away after some time. However, if a tooth under a filling hurts after a sufficiently long period of time after visiting the dentist, this may be a consequence of further development of caries and is a reason for an urgent visit to the doctor.

Why does a filled tooth hurt?

The sensation of pain can also be aching or sharp.

In addition, pain can appear 1-2 hours after the end of treatment, and can make itself felt within a day.

Practical experience shows that when pain occurs.

Refilling of dental canals: features of the procedure

If the tooth canals were initially filled poorly, which led to the development of infection, then root canal retreatment will be required to save the tooth. Sometimes the dentist during primary treatment It is simply not possible to correctly identify the source of infection and effectively remove it. The structure of the tooth and depressurization of the installed filling can also affect the effectiveness of treatment. Let's look at all the reasons and conditions for refilling and the conditions for the reliability of treatment.

Refilling is performed under anesthesia

Features of canal retreatment

A special case in the process of endodontic treatment is the process when the dentist has to refill the canals of a previously treated tooth. And to do this you will need to get rid of the old filling and remove the filling material from them.

During the work, complications may arise for both adults and children, in the form of breakage of the flexible rod used to clean the work area.

This can happen if the filling is too dense and tightly attached to the walls of the root canal.

Another difficult moment for the doctor is the refilling of curved dental canals. Cleaning in this case can lead to damage to its walls or breakage of the instrument directly in the tooth. This is not a death-defying moment in endodontics, but it will require much more effort to achieve quality treatment. Therefore, a professional in his field is simply obliged to warn the patient about the complexity of the procedure even before it begins.

Why is dental canal refilling performed?

Retreatment of tooth canals is simply necessary in cases when:

• after treatment, pain returns;
• The areas of inflammation are clearly visible on the x-ray;
• incomplete closure of the channels is visible.

The causes of complications that may arise during tooth treatment include inaccuracies that doctors make at each stage of endodontic treatment.

• infection in the root canal;
• inability to access its basis;
• pathological holes in the bottom of the tooth and its walls, made as a result of a doctor’s mistake.

During processing, problems may arise when dentin gets into the canals, too great expansion the middle part of the canal in case of internal curvature of the root, violation of the root walls, rupture of the physiological narrowing, splitting of the instrument.

Problems requiring refilling

When filling a canal, complications are associated with its heterogeneous (incomplete) filling, carrying the filling material beyond the boundaries of the hole, and a longitudinal fracture of the tooth root. Due to inexperience, the doctor may overestimate the total length of the canal or not completely clean it, which will lead to the development of inflammation.

The process of resealing canals

Features of modern endodontic treatment for the most part give very good results, but dentists can sometimes make mistakes, so refilling dental canals is not such a rare occurrence. Today, dentists use several methods to carry it out.

When using mechanical methods, dentists use special tools - an endodontic motor and an apex locator. The filling material often includes antiseptic components. The doctor must carefully and correctly completely fill the cleaned canal with the material in order to stop the development of inflammation.

The process of re-medication involves the use of products that contain organic solvents and can soften a pre-installed filling. It only takes a few minutes to destroy the filling material. If a cement-based filling was used for filling, it can be removed using endo-nozzles with ultrasound. The procedure is performed in one visit to the dental office.

Sealed canal mouths

New technologies

Today, modern dentistry can offer such a service as re-treatment of dental canals under a microscope. The use of high-tech equipment helps doctors multiply their work area, resulting in increased treatment efficiency and the quality of the procedure.

Using a microscope will allow you to avoid damage to healthy tissue and carry out treatment in a delicate manner.

A dental microscope is equipped with magnifying glasses through which the tooth can be examined under multiple magnification. With this treatment, the doctor will easily see all areas of the lesion that simply cannot be seen with the naked eye. A microscope is an indispensable dentist's assistant, which helps to carry out quick, painless and safe refilling of canals.

The use of anchor pins occurs in parallel with obturation of the tooth root canal. To install the structure, the filling is left in the lower part of the root (provided that it is installed well and hermetically).

In a dental clinic, this procedure is carried out in two visits. First, the doctor mechanically processes the canals, at the second stage he softens the filling material with medication, after which he cleans the passage with an endo-instrument, which is moistened in the same softening solution. After this treatment, the doctor places a cotton swab dipped in the medicine. A follow-up visit takes place two days later. Then the cotton swab is removed and the tooth canals are refilled.

Unsealing under the anchor pin

Conditions for effective retreatment and longevity of the tooth

Subject to professional endodontic treatment, compliance with all techniques and the use of high-quality materials, the tooth will serve for many years. After the canals have been re-treated, the patient must follow all procedures recommended by the doctor to restore the coronal part of the tooth (installation of a crown or inlay).

If, after a qualified and correct procedure, your tooth still hurts when biting, then you should not immediately panic. Some discomfort may persist for 3-5 days after filling. When a tooth does not stop hurting for a long time, you should consult a doctor. Before visiting the dental office, the patient can take a pain reliever on his own.

A special point is lingering pain, which torments the patient for several months or even years and does not go away with painkillers and physiotherapy. The main reason for this exacerbation is the treatment of canals in one session. It is simply physically impossible to immediately influence additional channels and process them poorly. This leads to the fact that parts of the infected pulp remain in the tooth and a chronic infection develops.

All questions that patients have regarding repeated endodontic treatment are based precisely on the appearance of pain, increased sensitivity and swelling at the treatment site. If the x-ray shows that after treatment of the canals there is no positive dynamics or there are unsealed areas, then this indicates the need for mandatory re-treatment.

The nerve was removed, but the canal was not sealed

Such situation. On the X-ray of my teeth, they saw that in my six, in which the nerves were ripped out, only one canal was sealed. My employee’s nerve was removed and the canal was also not sealed - the filling was only placed on top. The fillings are not temporary, but permanent. It turned out to be completely random - during a check when another tooth (mine) was hurting. And the employee was sick after that, the hollow one.
Is there any reasonable explanation for the fact that the nerve is removed, but the canal is not filled and the filling is left only on top, or is this real negligence?

I had all the canals filled, from which the nerves were torn out

Canals may not be filled only in children if the formation process is still underway. In adults, the canals must be sealed, and well. Empty or poorly sealed canals cause inflammation over time. Of course this is negligence. Any dentist knows about the consequences.

There are several options. Possibly negligence. But if one channel is sealed, then most likely there is another option. I haven't completed channels 5 and 6 yet. This turned out to be the case in the USA. The previous dentist in the USA turned a blind eye to this. We moved and took the new one to a specialist to do a refilling. Well. I did it in a cool place, with a cool specialist, a professor. I paid more than 3 tons of dollars for two teeth (5 and 6 on the lower left). And still, the channels have not been completed completely. He told me that you have very narrow and winding canals, plus 4 roots. The Russians used a different technology to fill the filling, but it surprisingly didn’t work too badly. Don't touch your teeth anymore. If inflammation occurs, you will have one way out - open the gum, bite off the tip of the root and fill it at the other end.
So go to another doctor. Perhaps it’s the same for you - it’s impossible to get a filling due to some individual characteristics

It definitely needs to be sealed. I had exactly the same situation, author. I sealed it urgently. Elementary negligence of doctors. You will get periodontitis with a cyst. Therefore, treat the tooth as soon as possible.

Why the hell fill a canal if a blood clot or fibrin clot has already formed in it. Everything there sealed itself.

A bad filling in my teens ruined all my sixes. The result now is two cured periodontitis, two implants.

Excuse me, how old are you? Antibiotics as a class medicines invented during World War II. For eighty-three years old, 2 implants are an excellent result!

The doctor removed the cyst on the front tooth by root resection and did not completely fill 1 of the 3 roots on the back tooth and it has been hurting for more than half a year. I read on the Internet that in almost 100% of cases a cyst forms there. It’s just strange, it seems like a good doctor did this and somehow they say your canal is crooked. but it's a little crooked.

Negligence, unprofessionalism, the hands of such healers grow out of their ass, over time the canal will become inflamed, a cyst will grow on the root of the tooth and, most likely, the tooth will have to be completely removed

Regarding the qualifications of dentists in our country, it is a separate issue. I’ve been on painkillers for the 5th day now, I can already say I’m alive in the mornings at the clinic. The same situation happened when a nerve was removed several years ago and, as it turned out, the canal was not properly sealed. Today they finally opened the tooth, the doctor said there was a lot of pus, she cleaned it for a long time, after that, in theory, the pain should have disappeared, but that was not the case. They said they wouldn’t do anything until tomorrow, saying that if it doesn’t go away by evening, then tomorrow it will be removed. As a result, I’m already taking the 2nd tablet of ketarol (analgin doesn’t take me anymore), tomorrow morning I’ll run to lose a tooth because of someone’s mistake. Therefore, I advise you to choose a doctor well. And if it is possible to take a picture of the tooth not only before, but also after treatment.

I'm not even 30. I didn't understand your sarcasm. The teeth were ruined by bad doctors in the children's department of the state clinic.

I had the same story. At one time, a nerve was removed from the front teeth, and not only did they put one filling on two teeth, they also did not fill both canals. After a month, the entire upper gum under the nose was swollen, it was like a hare, and a terrible hare at that. The gum was then opened more than once, and in the end, an operation was performed to remove the granuloma, which contained a lot of filling material. Needless to say, I had to sharpen these teeth and hide them under crowns. Unfortunately, these are the “dentists” we meet here. Since then, I have been distrustful of people in this specialty.

A bad filling in my teens ruined all my sixes. The result now is two cured periodontitis, two implants.

Many dentists are pests. I also encountered a situation where the canal was not completely sealed. In previous years, a good doctor monitored canal filling with photographs, but now they do harm for the sake of further profit. Why are our people so patient? We need to talk to people like that to the letter of the law.

Canals are usually not filled when they cannot be passed through (narrow). In order to go through narrow channels, you need to work with a microscope and titanium needles, which are thinner than nickel ones. They are more expensive, unsealed canals are a time bomb. If there is emptiness in the canal, bacteria develop there, which then consume the tooth flora. The tooth rots from the inside. Inflammation or pain may also occur during a cold. I lost 3 teeth this way. I haven't figured out what's going on yet. And the doctors simply had to admit that they couldn’t pass the canals, or refer me to another place where they could do it for me. No, they have another task - to quickly get money and not fool around. (of course, without telling the patient anything) What about the person’s pain? that teeth are destroyed quickly, because the canals are not filled - they don’t care ((. this is how 90% of doctors in Moscow work. Here, therapists undertake to put crowns, And orthopedists treat teeth. Just to put more money in your pocket. Look for a therapist ( therapeutic education, and not any other), which works with titanium needles and a microscope. Then you will save the tooth. And at the same time learn to read photographs. I had to learn the same thing, (Otherwise in our country it is impossible.), in order to see if all the canals are sealed , or not. I came to the conclusion that doctors are taking advantage, that the patient does not understand anything. Unfortunately.

Poorly sealed tooth canal symptoms

The need for canal treatment appears when inflammation or necrosis of the dental nerve develops. Often this process occurs with a minimum of symptoms or no symptoms at all. For example, the problem of a tooth with a filling will only be indicated by a change in the color of the crown, although there will be no visible carious cavities. Or a random X-ray examination will reveal chronic inflammation in the root apex area. Of course, with careful attention to the condition of your teeth and timely visits to the dentist, the risk of encountering such problems is minimized.

Why treat root canals?

Caries is the initial stage of tooth decay, the main etiological (causal) factor in the development of which is microbes. The penetration of microorganisms deep into hard tissues and the toxic effects of their metabolic products and acids lead to damage to the dental nerve and the development of pulpitis. Clinically, this manifests itself in the appearance of aching toothache from cold or hot, in rare cases there is an absence of any symptoms.

Tissue inflammation is always accompanied by swelling, tissue necrosis, and the formation of pus; only the speed of these changes depends on the state of the person’s immunity, the medications he or she takes, bad habits, age, and much more. Microbes that get into the tooth will not go anywhere. They continue their life activity, destroying the tooth and penetrating deeper and deeper. The main risk of such a process is infection entering the bone or bloodstream. In the first case, the pathological process exits through the tooth root into the bone tissue, causing the development of periodontitis, the formation of a cyst or granuloma. In the second case, the process is life-threatening. The circulatory system of the entire body is one, there are no isolated vessels. This also applies to the pulp of the tooth. Treatment of canals, removal of nerves or tissue decay from the tooth cavity, medicinal effects on the microflora are necessary to preserve the health of not only the tooth, but also the body as a whole.

Why does a tooth hurt after root canal treatment?

The endodontic treatment procedure includes removal of the pulp, mechanical and medicinal treatment of the canals, and their filling with gutta-percha pins and paste under X-ray control. In some cases, all stages can be completed in one visit; in others, 2-3 visits to the dentist are required. The doctor’s tactics depend on the anatomy of the tooth, the degree of inflammation of the nerve, and the characteristics of the patient’s body. The canals are treated under local anesthesia, therefore, when the instrument is removed beyond the apex of the tooth, the patient does not feel anything, although tissue injury occurs and a local hematoma forms. Subsequently, because of this, the tooth may react painfully to mechanical stress, food falling on it, or clenching of the jaws. Usually such sensations go away within a few days.

When treating canals, it is necessary to comply with the requirements of sterile instruments and careful treatment of the cavity to reduce the risk of pushing infected tissue into the bone. If the infection has entered the bone, the pain after root canal treatment can be quite severe. Sometimes it is impossible to touch the treated tooth; a feeling of internal pressure may appear. Filling the canals takes into account the use of a minimum of paste with gutta-percha pins, which should tightly “clog” the internal cavity of the tooth. Extracting the paste beyond the root tip into the bone does not always cause pain after treatment. It all depends on the amount of material that has entered the tissue, its composition, and the presence of allergies in the patient.

There are pastes that dissolve over time. Physiotherapy (UHF, microwave, laser) can help with this. If the pain becomes intensifying, soft tissue swelling appears, body temperature rises, it is necessary to treat the root canals. In some cases positive result provides only excision of the apical part of the root (resection) and removal of material removed into the bone.

How to relieve pain after root canal treatment?

It is worth noting that the nature of the pain, the time of its occurrence and duration can most likely help the doctor make a diagnosis, which is why an experienced dentist carefully asks the patient about all the nuances. Long lasting pain cold water and at night he talks about chronic fibrous pulpitis, It's a dull pain from hot – about pulp necrosis. Pain from pressure on the tooth and closing of the jaws indicates inflammation in the bone.

If, after treatment of the canals, throbbing pain appears, intensifying in the evening and at night, this indicates continued tissue necrosis. In this case, cold compresses and rinses can reduce pain. cold water. Painkillers relieve pain for 2-4 hours (tempalgin, pentalgin, ketanov and others). If you experience pain when food hits your tooth or when you close your jaws, you can rinse your mouth with a soda solution several times a day (1 glass of lukewarm water with 1 teaspoon of soda).

Any folk remedies in the form of compresses on the tooth they give a distracting effect without eliminating the cause of the pain, and sometimes chemical burns as a result have to be treated for quite a long time. If the canals are not sealed, there is a temporary filling in the tooth; sometimes additional rinsing of the cavity with an antiseptic solution stops the inflammation. In rare cases, general anti-inflammatory and antimicrobial therapy is required, which only a doctor can correctly prescribe. Self-medication is dangerous possible complications sooner or later they will make themselves known.

Dentist advice: how to determine how well the canals are filled?

If you have discovered extensive carious lesions of the tooth or inflammatory processes (pulpitis, periodontitis), then, unfortunately, removing the nerve from the diseased tooth can't be avoided. And at the same time, filling the canals.

Root canal filling- This is a complex and responsible procedure. And not only because the doctor must carry out all manipulations with high precision and caution.

Even if the operation went without surprises, after a while you may encounter very unpleasant complications.

And in 60%-70% of cases, the cause of these complications is poor-quality canal filling!

The consequences of such treatment may be:

• severe toothache due to “refilling”- when excess filling material goes beyond upper limit channel;
• gumboil, development of acute abscesses, appearance of cysts on the toothdue to “underfilling” of the canals- then an infection develops in the voids of the canal;
• complete tooth extraction, which is caused by inaccurate treatment of the canals before filling and perforation of the root wall.

First of all, let's figure it out -

What difficulties may arise at each stage of canal treatment?

This way you will understand what the dentist does and in what order, and for what reasons complications arise.

After all, the tools and materials that the doctor uses directly affect the success of the entire operation. A small mistake and the whole procedure will have to start all over again.

IN modern dentistry All manipulations are performed under anesthesia.

1. First of all, the doctor removes the tooth tissue affected by caries.

To open access to the root canals and pulp, diseased and (partially) healthy tissue must be removed.

To do this, the doctor drills the tooth in the same way as when filling.

2. After this, you need to remove the tooth pulp.

This is a bundle of nerves that fills the crown of the tooth and the canals themselves.

It is important to remove the pulp fully, because it is the incomplete removal of the nerve that often leads to prolonged pain.

3. Determine and record the length of the root canals.

This is an important stage of treatment, because it depends on how much exactly The doctor will determine the working length of the canal, the correctness of the filling depends.

Incorrectly determined channel length - main reason all the complications that you already know.

An unfilled or insufficiently densely filled canal, in the remaining space of which bacteria can multiply.

In this case, you need to reseal the canals as quickly as possible. Otherwise, you risk losing your tooth!

Filling material (gutta-percha or paste) that extends beyond the root apex can lead to sharp pain during months(!) after operation.

In some cases, the pain will go away on its own, while in others, resection of the root apex and removal of excess material will be required.

In their work, specialists at our clinic use high-precision methods for measuring the length of canals:

• X-ray - based on X-ray images;
• electrometric - using special apex locator devices;
• a combination of both methods.

Today, using an apex locator together with x-rays is the most accurate way to determine the length of the canals.

In this case, much fewer x-rays are needed for diagnosis, which means that your treatment will be more relaxed and comfortable.

Too much canal treatment can lead to post-operative pain. Therefore, having accurately determined the length and shape of the canal, DentaBravo specialists fix it with a limiter, after which all manipulations are carried out within this length.

4. Now let's move on to processing the channel.

As a rule, the channels are too narrow, and their walls have unevenness. Therefore, before filling, the doctor expands and aligns them in order to evenly fill them with filling material.

Our clinic specialists use two types of mechanical canal treatment:

1. using hand instruments that the doctor himself rotates in the root canal;
2. machine processing using endodontic tips and a special device.

We use both techniques in our work, but we recommend machine processing. In our clinic, the latest tools are used for canal treatment - nickel-titanium files (tapers):

• more flexible, and therefore suitable for processing the most complex curved canals;
• more durable, which means they are safer - because they will not break off inside the tooth and the fragments will not damage the tissue;
• more efficient Due to their special shape, they clean the channels better.

Moreover, in our clinic this is exactly what doctors focus on attentive to prevent such complications.

Careless movement of the instrument can lead to perforation of the canal wall and then the filling material will get inside the bone tissue.

If measures are not taken immediately, further treatment of this tooth will be ineffective!

After preparing the canals, they are treated with antiseptics and filling begins.

5. At this stage, the canals are filled with filling mass.

There are several methods for filling canals, but we will look at the most common of them - the lateral condensation method.

The root canal is filled with a special paste (sealer). Then gutta-percha pins are inserted - first the main one, and then additional ones. As a result, from 8 to 12 pins are tightly placed in one channel.

6. Final control of the filling is carried out and excess gutta-percha is removed.

At the DentaBravo clinic, they first use an X-ray to check that the material densely fills the entire canal. And only after this the remains of gutta-percha protruding above the mouth of the canal are cut off.

7. A temporary filling is installed.

Immediately after filling the canals, restore the tooth crown it is forbidden, so it is carried out at your next visit to the dentist.

And finally, the most important thing...

How can you make sure that the canals are sealed correctly?

There are only two ways.

1. Focus on your own feelings.

You should be wary:

• pain that does not go away after several days;
• excessive tooth sensitivity and discomfort while eating;
• any changes in the color and density of the oral mucosa.

However, pain may be an individual reaction and a variant of the norm, so be sure to consult a doctor. And best of all→

2. Take a control x-ray.

From the image, you can even independently determine how well the dentist did his work, whether there are voids or excess material in the canals. It is clearly visible in the photographs: the sealed canals have a bright white color.

And to finally calm down, come to free consultation at our clinic with photographs. It’s possible without them - after all, we also have our own latest X-ray machine, with which we can check the quality of the previous treatment in a few seconds!

Or immediately in order to fill teeth using 100% reliable methods, using modern equipment and an experienced doctor.

Clinical case of endodontic treatment of upper incisors with heavily sclerotic canals. How to navigate a situation where there are “no mouths.”

The reference patient was referred by a colleague with a request to help carry out endodontic treatment before prosthetics in teeth 12 and 21. The doctor made an independent attempt at treatment, but unexpectedly the problem of severe obliteration of the orifices in both teeth was revealed, which did not allow the doctor to find the entrances to the root canals. The referring dentist only had binoculars in his arsenal, which, alas, did not allow him to confidently navigate inside the tooth.

This is how these teeth came to me. What do we see?

Firstly, we see that the doctor is great for realizing in time the risk of searching for the mouths “blindly”, without magnification. Since in both cases there were a couple of strokes of the tip left before the root wall was perforated.

Secondly, the search vector was shifted to the palatal side in both cases.

Thirdly, the obliteration really did not leave even a hint of the mouth where it should have already appeared. The situation in tooth 21 turned out to be especially difficult.

The green line shows the outline of the actual root canal. And here you can clearly see how the search for the mouth was carried out away from the true course of the root canal, threatening to end in perforation.

How to find the entrance to the channel when even the thinnest file (No. 6, No. 8) does not “catch” anything? It is necessary to remove sclerotic dentin. This can be done with a rotating instrument on a long stem or with an ultrasonic nozzle. But the main thing to remember is 2 important rules:

1. Any actions with aggressive instruments inside the tooth (canal) can ONLY be carried out under visual control. Ideally, under the control of armed vision, i.e. good lighting and magnification. We predictably can only do what we see with our eyes. If we work virtually, by touch, “by experience” - predictably, we can only do perforation, which will significantly worsen the future prospects of the tooth and the confidence of your patients.

2. Use practical laws of orientation in the pulp chamber when searching for orifices. One of the most important is the color of the fabrics...

This helps to understand where to “dig” to find the entrance. By removing a certain amount of sclerotic dentin under a microscope, we obtained a point that was barely noticeable at high magnification.

However, this turned out to be quite enough to make sure that this was the entrance to the root canal. Further work on processing and expanding channels in this situation was quite simple. The working length was determined using manual K-files No. 10, No. 15. Further instrumentation of the channels was carried out with the BioRaCe system to sizes No. 50.04.

Filling of the canal in the 12th tooth was carried out only in the apical third using hot gutta-percha (for subsequent restoration of the tooth using a pin structure). In 21 teeth, cold hydraulic obturation of gutta-percha with a bioceramic coating and a bioceramic sealer was used.

Progress of treatment of both teeth according to radiographs:

The patient was returned to the referring doctor for continued treatment and prosthetics.

Conclusions from this case, especially for young doctors:

• Inside the channels, do only what you see, do not work by touch!
• If you encounter a problem, stop on time! There is no need to be a hero if you do not have enough equipment, skills, or experience to cope with the situation. Refer the patient to more experienced and equipped colleagues, or at least warn the patient of the significant risk to him if he continues. This will be better for both of you and will save you from unnecessary conflict situations.
• use the rules of orientation in the pulp chamber! They are very effective, there are only a few of them, we talked about one of them today.

In subsequent articles and cases, I will tell you about other rules of orientation inside the tooth, which will help you not to make any mistakes. Stay tuned!

Dentistry is a branch of medicine where unnecessary services are often offered.

How dentists deceive patients

Every year, the “horror” stories about dishonest doctors do not decrease, but just the opposite. Then a child’s teeth are removed by a cleaning lady who decides to make money. Then instead of an anesthesiologist in the hospital there was a visiting “tourist”, and as soon as the situation got out of control, he quickly retreated. No less scandalous stories involve dental treatment by persons who have nothing to do with medicine.

More often, such “non-doctors” can be seen in the field of cosmetic dentistry. Just think about it - teeth whitening at home by 8-20 shades on the Vita scale - this is the result most “beautiful smile” offices promise.

For reference, Vita is a standard scale of enamel colors and shades used in dentistry and has 16 shades.

Such guarantees do not leave many patients indifferent, running to appointments in such “beautiful smile” offices and wanting to receive their portion of beauty and perfection. What's the result? As a rule, expectations and reality do not coincide, but possible consequences can be more than sad: enamel damage, necrosis.

The Dental Society has identified points that protect patients from such unscrupulous entrepreneurs:

• Clinic documentation: permits, diplomas, certificates and the right to operate must be freely available to patients. Typically, these documents are located in the information window;
• Only persons with medical education can perform any manipulations with teeth, even professional cleaning;
• A clinic performing complex surgical procedures: implantation, treatment under anesthesia, sedation must have the appropriate permits, equipment, a separate room for patient recovery and a staff of anesthesiologists;
• Choose only proven clinics that have reviews, including bad ones;
• You need to quickly retreat from the clinic if the doctor insists on immediate, complex treatment and offers to take out a loan (well, if you don’t have enough money). Any dental procedure, unless it is an acute emergency, can be delayed for a short period of time. And such persistent actions on the part of dentists should be alarming.

Heal a healthy tooth? Easily!

How dentists scam money

The issue of deception in medicine, even in the provision of paid services, is controversial and very delicate. It cannot be said unequivocally that dentists deceive patients when one amount is announced before the start of treatment, and then another.

Let’s say, based on the results of a preliminary examination, a diagnosis of “deep” is made; during treatment it turns out that this is no longer caries, but complications. It is difficult to disagree that the cost of treatment with mandatory canal treatment, rinsing and filling will be different. And this is not a money scam, but a necessary dental procedure.

Of course, there is another side to the coin when deception occurs. For example, the volume of medical procedures, materials and work units spent has not changed, but the cost of treatment has increased significantly, in this case, patients have the right to understand, demand a detailed report and explanation.

In order not to fall into the trap of unscrupulous doctors, every patient has the right to inquire about the procedures performed, their purpose and justified necessity. Prices for services that are not included in the compulsory medical insurance system should be freely available in front of the reception desk. If there are no documents, run away from such a clinic.

By the way, we must not forget about compulsory medical insurance and voluntary medical insurance - after all, in Russia there is free medicine.

How dentists cheat on fillings

Filling is the most common manipulation in the dentist's chair. Today, light-curing fillings are recognized as the best materials; they are more durable, meet aesthetic qualities and differ in cost. The cost of filling is precisely the stumbling block between the doctor and the patient.

The price for the material varies widely and, perhaps, unscrupulous doctors take advantage of this. To protect yourself from expenses, you need to read the price list in advance and ask the treating doctor how much the filling will cost, or better yet, ask him to draw up a treatment plan on paper. Dentists are required to answer your questions for your money. In addition, each clinic has filling materials of varying prices from economy class to VIP.

Before talking about dentists cheating on fillings, evaluate the doctor’s qualifications and the upcoming procedures. Filling the chewing group of teeth, even with the restoration of fissures, tubercles and aesthetic restoration of the anterior group, cannot be compared in terms of cost and cost of materials.

By the way, poor-quality filling is another opportunity to deceive the patient. Below are some examples of work. The conclusions, as they say, are obvious.

If they try to sell you a Lada Vesta for a couple of million, then, of course, it’s a scam. But if they offer to buy a luxury car for this money, then no complaints will arise. The same principle applies to fillings. A good doctor can evaluate his services accordingly and it cannot be said that he is simply overestimating himself and trying to cheat everyone out of money: demand creates supply.

Was the photo necessary?

How we are being tricked into additional procedures

You can often hear that doctors impose additional and paid services during treatment; this can be anything: various photographs, whitening (by the way, this procedure is not satisfactory), saturating teeth with minerals, etc.

So a patient came to an appointment to treat a disturbing problem, and the doctor: examined the oral cavity, wrote a dental formula, reflected all the existing problems, cured it, then began to recommend professional teeth cleaning, saturation of teeth with minerals, prosthetics, etc. What is this? Divorce? No way.

Dentists work according to a specific algorithm, and their scope of action does not end only with dental treatment. This also includes prosthetics, prevention, bite correction, aesthetic restorations, which the doctor will recommend.

If the patient has any doubts about the importance of a particular procedure, then you can consult with your doctor about the need for it. Each procedure, no matter whether it is therapeutic or prophylactic, has its own indications and contraindications.

It is impossible to say with certainty that in dentistry, and in all medicine, there are no entrepreneurs who are trying to profit from patients and earn extra money. But the problem does not have such a serious scale as is commonly said and thought.

Today, many patients position themselves as clients and can make recommendations for treatment. And if the plan drawn up by the patient and the doctor does not agree, conflicts arise. To avoid misunderstandings and conflicts, you need to choose a dentist you really trust!

head of the expert magazine about dentistry Startsmile.ru,

“We did this back in 1990!”

Dentistry, like medicine in general, does not stand still. But individual professionals are still treading water in the same spot where they were presented with a diploma. If, of course, you want to save as much as possible on your health, you can put, for example, a chemical filling instead of a light-curing one completely free of charge. However, good doctors do not cling to the sacred traditions of Soviet dentistry, but willingly use new, advanced techniques in practice - from laser to 3D diagnostics.

“I can’t tell you the price yet - everything is individual”

And then patients urgently need Corvalol and valerian when they are shown the bill. In fact, the doctor has access to price lists for all services he provides. If a doctor says that he knows nothing about prices, he is, to put it mildly, disingenuous. The professional is honest about everything, including the cost of treatment. Moreover, he should recommend you several options for solving the problem - both expensive and budget ones.

“So, I don’t see any problems. Are you sure it hurts?

Visual inspection - that's all? When a piece of a tooth breaks off, the naked eye may be enough. However, if you come with a complaint of hellish pain in half of the jaw, then refusal to conduct an X-ray diagnosis is an argument in favor of immediately leaving the doctor alone with the dental chair. A good dentist not only studies the image before treatment, but also, if necessary, checks the result after, for example, when filling canals. In the absence of proper diagnostics, you can easily miss serious problem.

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“Everything is very bad: two caries, pulpitis, removal”

The opposite situation is when the doctor suddenly finds so much caries and other diseases in your mouth that it is unclear how you survived to your age. Most often, such unexpected discoveries are also accompanied by a refusal to show, at least on an x-ray, where all this horror is hidden.

The goal is to lure you out of as much as possible more money for the treatment of healthy teeth. This is how you can distinguish a good doctor from a bad one: an honest specialist will always show the real condition of your teeth and gums using an intraoral video camera. When you see for yourself in 56-fold magnification how far the caries has reached in the seven below, the doctor will not need to convince you of anything.

“No need to tell me, let me see for myself”

So, you did something, but after treatment it got worse, or the filling scratches your cheek, braces don’t allow you to close your mouth, and whitening makes you want to bang your head against the wall. A good dentist will always say the magic phrase at the end of the appointment: “If anything bothers you, contact us immediately!” If you experience discomfort, the doctor will try to find the cause, and not throw you out the door so that he can quickly take care of a new patient.

The same rule applies to your individual characteristics: increased sensitivity of teeth and gums, drug intolerance, and even panic fear of a drill. A professional will never brush aside information that a patient tells him.

“There is no point in treating, only removal”

The goal of a good dentist is to preserve as many of the patient’s natural teeth as possible. Tooth extraction is almost always a last resort. The doctor must argue why this tooth needs to be removed, which brings us back to the question of the intraoral camera, X-rays and detailed answers to all the patient’s questions. Acute excruciating pain may turn out to be pulpitis, which is now successfully treated by keeping the tooth in its proper place. When the dentist just sends something for removal, it is better to look for another doctor.

“We cannot do without these procedures. Yes, yes, they are not cheap, but there is no other choice."

There is another category of doctors who avoid intraoral video cameras like hell. Those who certainly want to treat you for a long time, a lot and with the help of the most expensive techniques, devices and materials.

Yes, modern technologies are a good thing: such treatment is faster and more comfortable, and gives reliable, long-term results. But only you have the right to decide whether you want to use these super-sophisticated technologies or whether it’s better to do everything the old fashioned way. Blackmailing a patient with his life and health is unacceptable! It is also important to remember that the doctor should always offer alternative treatment: either traditional methods or modern ones. And the choice is yours.

“It shouldn’t hurt you, don’t make things up!”

Favorite phrase with which the toothache of our mothers and grandmothers began! Now is a good reason to never again cross the threshold of the office where such a “specialist” sits. Modern dentistry uses a wide range of painkillers, including those without adrenaline, which can be injected even into pregnant women in the second trimester. A good dentist will always select the drug necessary for your case and make sure that you do not squirm in pain.

“Sorry, pregnant women are not allowed anesthesia”

But no. Long gone are those wild times when toothache during pregnancy it was necessary to either endure or be treated without pain relief. Of course, there are procedures that expectant mothers cannot undergo: for example, installing an implant, removing complex figure eights, or performing a telex-ray. But, despite the special caution that should be observed when treating teeth in pregnant women, doctors, armed with modern techniques and methods, will always find a way to help. A doctor who, upon learning about your “interesting situation,” changes his face and refuses to look for ways to solve the problem is not your option.

“All these pieces of paper are just fooling your brains”

Having diplomas and certificates is not always a 100% guarantee of high professionalism. But nevertheless, if you are going to submit to a doctor for a complex operation, say, installing an implant, then it is better to choose a specialist who has received a certificate confirming his knowledge and skills. It’s especially good if this “piece of paper” is an international-class document issued by an implant manufacturing company.

Often, during endodontic dental treatment, dentists are faced with obstruction of the root canals. But in most cases, this problem can be solved thanks to the high professionalism of specialists and the excellent equipment of the DentaBravo clinic.

Why does tooth root canal obstruction occur?

There are several causes of root canal obstruction:

• Anatomical structure of the root. The canals may be flattened, curved, with small branches or transverse bridges.
• Inflammatory phenomena in the pulp. Chronic, subacute and mechanical overload of the tooth provoke overgrowth of the canals.
• Age-related changes. Over the years, deposits of dentin or dentin-like tissue (dentals) accumulate on the walls of the canals. They narrow the lumen and often contribute to root canal obstruction.
• Treatment using phosphate cement. This is a dense material that cannot be removed by ultrasound, solvents, or mechanical methods.

How to determine tooth canal obstruction

Diagnosis of root canal obstruction is very important, because quality treatment requires careful preparation. And in order to freely manipulate during cleaning and expansion, the doctor must determine the working length.

The most common research method is. A photograph of the root of a tooth with an instrument inserted into it makes it possible to see:

• tooth length;
• direction of movement of the endodontic instrument;
• obstruction of the root canals of the tooth;
• canal curvature;
• presence of perforation;
• periodontal condition, etc.

If there are symptoms of root canal obstruction, they need to be opened to the apical narrowing so that endodontic treatment can be carried out.

How is tooth canal obstruction treated?

Usually, during treatment, the doctor works with a pulp extractor. If there are no problems with the channels, then difficulties usually do not arise. But if the canal is curved, narrowed, closed, or adjacent to an adjacent root, a special approach is needed.

Treatment of a blocked tooth root canal requires the use of special chemicals and a stronger extractor to avoid metal fatigue and instrument fracture. For example, nickel-titanium files (titanium needles) are used - rotating extractors, which make it possible to pass root canals without preparation and reduce the risk of pinching or breakage of the instrument.

Also, in case of obstruction of the tooth canal, thin drill burs are used - instruments with spiral blades designed to eliminate old filling material (pastes, cements, gutta-percha).

Unsealing is also done using solvents that work well with soft and flexible materials. Difficulties arise with channels filled with resorcinol-formalin paste. When it hardens, it becomes very hard, and to eliminate the obstruction of the tooth canal it is necessary to use strong substances, drilling with a bur and nozzles with ultrasound. Unsealing a resorcinated canal is a long and labor-intensive procedure associated with the risk of tooth perforation. And if the patient has a phosphate-cement filling, the root is generally amputated or its apex is cut off.

Treatment methods for dental canal obstruction are selected individually. For consultation and diagnostics, visit the DentaBravo clinic!

Here you can sign up for appointment with a dentist(St. Petersburg).
Removing the root of a damaged and rotten tooth painless tooth extraction.