INDICATIONS AND CONTRAINDICATIONS OF ENDODONTIC TREATMENT
1-Definition of endodontic treatment
Endodontic treatment is based on shaping, disinfecting and filling the canal network. It is classically indicated in the treatment of irreversible pulp pathologies, the endodontic act still remains a difficult procedure today.
2-The objectives of endodontic treatment
The goals of endodontics are
–According to CNEOC (2010): prevention, diagnosis and treatment of pulp diseases and their periradicular manifestations (CNEOC, 2010).
–According to HAS (2008): the conservation of the healthy tooth made functional on the arch represents the general objective of endodontic treatment.
–Endodontic treatment involves a chemo-mechanical preparation that aims at cleaning, disinfecting, shaping and filling the canal. The latter offers the possibility of walling up the microorganisms that were not destroyed during the shaping phase in order to deprive them of their nutritional source.
–Filling of endodontic voids helps to create a biological environment favorable to periapical healing (Schilder, 1966).
–Endodontic treatment also helps, combined with coronal restoration, to prevent subsequent bacterial recontamination.
3-Imperatives of endodontic treatment
3-1 Mechanical requirements
From a mechanical point of view:
– the access cavity must allow visualization of the canal orifices and penetration of endodontic instruments without interference (Simon and Ctorza-Perez, 2010).
– the canal preparation must respect the endodontic anatomy:
* homothety of the preparation in relation to the initial shape of the canal: regular conicity from the coronal portion to the apical portion of the canal.
* maintenance and respect of the foramen: position and diameter.
– watertight and three-dimensional obturation of the endodontic network.
3-2 Biological imperatives
Biological objectives involve:
– tissue economy when creating the access cavity.
– preservation of periodontal health. This notion implies the limitation of toxic, mechanical, and chemical irritation (Simon et al., 1972).
– sealing of the coronal restoration (limitation of secondary contamination).
– respect for the functional and aesthetic integrity of the dental organ treated.
– carrying out endodontic treatment under optimal aseptic conditions: placing a rubber dam and using sterile instruments.
– the implementation of antiseptic procedures (via intracanal irrigation).
4) Indications and contraindications of endodontic treatment (ET) according to the High Authority of Health (November 2008):
5- Criteria for success and failure of endodontic treatment
Endodontic treatment should be subject to immediate and periodic clinical and radiographic evaluation (up to 4 years after treatment).
ANDEM (replaced since 1997 by ANAES) has proposed the criteria for success of endodontic treatment:
— clinical criteria:
– no sensitivity to percussion and palpation,
– physiological mobility,
– absence of fistula,
– functional tooth, no signs of infection or swelling ,
– no subjective signs of discomfort,
– no symptoms.
— radiographic criteria:
– normal or narrow desmodontal space (< 1mm),
– disappearance of a pre-existing image of bone rarefaction,
– normal dura lamina similar to that of the adjacent tooth,
– no apparent resorption,
– dense obturation, confined to the endodontic space and appearing to reach the cemento-dentinal junction.
Similarly, ANDEM defines the failure of an endodontic treatment.
Clinical criteria:
– persistence of symptoms,
– recurring fistula or swelling,
– pain on percussion or palpation, discomfort when chewing ,
– non-repairable dental fracture,
– excessive mobility or progressive destruction of supporting tissues,
– functional impotence of the tooth,
– sinusitis related to the treated tooth,
– adenopathy, fever.
Radiographic criteria:
– increase in the width of the desmodontal space (>2mm),
– absence of bone repair or increase in size of bone scarcity,
– absence of new lamina dura or significant increase in bone density of periradicular tissues,
– appearance of new areas of periradicular bone rarefaction,
– canal space visibly unobstructed or presence of void within the obturation,
– excessive extrusion of filling material into the periapex,
– signs of active resorption associated with other pathological signs detectable radiographically.
Conclusion
The success of an endodontic treatment is based on many parameters, such as irrigation, obturation, coronal sealing, etc., but remains greatly influenced by the quality of the shaping and, above all, knowing how to place the indication.
Untreated cavities can damage the pulp.
Orthodontics aligns teeth and jaws.
Implants replace missing teeth permanently.
Dental floss removes debris between teeth.
A visit to the dentist every 6 months is recommended.
Fixed bridges replace one or more missing teeth.