Technology has advanced a lot in recent years, and currently, root canal treatment is not what it once was. Although it is a meticulous and time-consuming procedure, the introduction of the microscope, rotary systems and laser greatly facilitates the entire procedure. However, no guarantees can be given regarding the final result of the treatment, because the human body is an enigma in terms of its reactivity. Although we have all the technology necessary to ensure predictability over time of root canal treatment, there are certain factors that can jeopardize the final result, and can lead to the appearance of infections, such as, for example, pulp infection.
Factors that may favor infection in the mass after treatment
Endodontically treated teeth are constantly exposed to attack by oral microorganisms, which makes it possible for an infection to occur, even when it appears that healing has been complete.
The factors that influence the prognosis of root canal treatment can be divided as follows: preoperative (age, sex, symptoms, location of the causal tooth, anatomy of the endodontic system, size of the lesion present at the tip of the tooth, periodontal and general health status), intraoperative (chemomechanical treatment, preparation and obturation of the root canals, number of treatment sessions, obturation techniques and materials used, possible accidents and complications), postoperative (restoration methods performed after the endodontic treatment is completed).
- Diagnostic or treatment plan errors – These errors can be avoided through careful clinical and radiological analysis of the case, as well as the symptoms.
- Incorrect access cavity , outside the chosen location, too small and which will not allow direct access of endodontic instruments inside the root canal - this aspect can be remedied by using the magnification provided by the operating microscope, with which we can visualize access to each canal.
- Omission of a root canal - and in this case, with the help of an operating microscope that provides the appropriate magnification, calcified, blocked canals can be detected and with the help of fine instruments, such as ultrasound loops, these canals can also be permeabilized.
- Incorrect chemomechanical treatment – it is important to use an appropriate sequence of solutions such as sodium hypochlorite, EDTA, citric acid, etc., as well as to achieve a correct and safe canal enlargement, using rotating needle systems. For lavage, it is important to use about 5 ml of solution per canal and for this to last about 1-2 min. For safety, sodium hypochlorite can be activated using ultrasound loops and, last but not least and very important, is the use of a dental laser that can remove up to 95% of the bacteria existing in the endodontic space.
- Incomplete fillings – it is important to properly seal the root canals, along their entire length, to avoid the risk of possible subsequent bacterial infiltration. This also reduces the risk of infection in the pulp. For this, gutta-percha cones (the material with which we practically replace the removed nerve) are used, calibrated for the rotating needle system used. In this way, we will obtain a sealed filling perfectly adapted to the walls of the dental canal. Also, the gutta-percha cones will be sectioned using a loop that is automatically heated to 230⁰ C, and the rest of the canal that remains unfilled will be filled with gutta-percha heated by injection. In this way, we will obtain a perfectly uniform, homogeneous filling along the entire length of the canal. It is important to respect the working length of the root canal and this is achieved using devices such as the apex – the locator, which indicates the exact moment when we reach the tip of the tooth.
- Incorrect coronal closure, which will allow microbial infiltration from the oral cavity, thus favoring the risk of infection in the pulp. Even in the conditions of achieving a perfectly homogeneous canal obturation, if the coronal sealing is precarious, there is a risk of infiltration with the subsequent appearance of an infection. Therefore, it is recommended to seal the coronal using adhesive material systems, such as dental composites and then cover the endodontically treated teeth with crowns , for optimal sealing and safety in terms of resistance to chewing forces.
In the case of endodontic treatment, establishing the prognosis refers to evaluating the possibility of infections occurring after the completion of the root canal treatment, such as, for example, pulp infection. Understanding the importance of prognostic evaluation of each case will stimulate the dentist to improve his treatment methods, avoid factors that may favor failure, and understand the healing process.
