Indications and contraindications of endodontic treatments
I-Definition
- Endodontic treatment : is a chemomechanical, biological treatment of the root canal system of teeth in order to ensure the quality of treatment of diseases of the pulp and the periapex and reduce therapeutic failures (periapical infections),
- Biopulpectomy: or dental depulpation or devitalization: This is an intervention which consists of cutting the pulp, healthy or inflamed, but living, near the apex (0.5 to 1 mm below) to its elimination and its replacement by a perfectly tolerated filling. It is performed under anesthesia.
- Root canal debridement is a clinical procedure performed mechanically with a root canal instrument by removing all infected soft tissues until the dentinal surface of the root canal wall is completely exposed, which must become hard and clean. This debridement is associated with a gesture of penetration of the instruments along the entire length of the canal to reach the apical limit, after having widened it.
II-Objectives of the TE
- The purpose of any endodontic treatment is to ensure the maintenance of the depulped dental organ in a permanent state of health by preventing the appearance of periapical lesions or by eliminating them when they exist, this thanks to the closure of the apical forarnina with neocementum.
- The objective of TE is to summarize the durable, asymptomatic and functional maintenance of the tooth on the arch.
III-Principles of TE:
- Absolute necessity for any preparation to allow effective debridement and trimming, which condition the disinfection of the entire canal system
- Respect for biological structures promoting normal mechanisms of apical periodontal repair tissues;
- Respect for the apical anatomical structures allowing the terminal limits of the preparation to be precisely established
- Maintain the sterile state of the canal by possible obturation of the canal system which must be dense, hermetic, stable and three-dimensional
IV-TE indications:
- Irreversible pulpitis or necrotic pulp with or without clinical and/or radiographic signs of apical periodontitis ;
- Live pulp in the following cases: unfavorable prognosis of pulp vitality, high probability of pulp exposure during coronal restoration not allowing direct capping, or restorative or prosthetic treatment requiring prior endodontic treatment
V-Contraindications
- Local order;
- Tooth with insufficient periodontal support
- Tooth with vertical root fracture
- Tooth affected by deep periodontal lesion (advanced furcation involvement)
- Tooth with massive root resorption
- Poor oral hygiene
- Very difficult to manage surgical difficulties e.g. instrumental fracture with apical overshoot
- Non-strategic tooth: isolated without antagonist
- Tooth in bad position preventing the creation of an access cavity
- Difficult access to the tooth due to limited mouth opening or other
- General;
- formal: heart disease with high risk of infective endocarditis if the pulp is necrotic .
- relative: heart disease at high risk of infective endocarditis if the tooth is alive and heart disease at lower risk in all cases.
In these patients, endodontic treatment should only be performed if three conditions are met: watertight operating field [dam], entire endodontium accessible , performed in a single session.
Indications and contraindications of endodontic treatments
Wisdom teeth may need to be extracted if they are too small.
Sealing the grooves protects children’s molars from cavities.
Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.