Root Canal Treatment – Difficult Cases

We know that the root canal is the fibrous tissue in the middle of the tooth including blood vessels and nerves. The root canal and supporting tissues around the teeth provide nutritional support for the teeth, but in some cases root canal treatment is required. Then the surrounding tissues would be responsible for providing nutrition to teeth

Cases when root canal treatment is required:

  • Inflammation of the tooth pulp or necrosis
  • Large tooth decay close to root canal
  • Root canal is exposed because of accidents, or a prosthetic

The steps of root canal treatment are as follows:

  • Anesthesia (this step does not need to be performed for cases of dead tooth pulp)
  • Open the entrance to the canal
  • Clean and taper for the canal
  • Canal filling using gutta percha

Cleaning and filling canals are important for the success of root canal treament. Previously, K file was used to taper to file the root canal, because the need to use many brooch in order from small to small to large which takes a lot of time, but hard to clean up the pulp, especially in difficult cases, and because the canal cannot be smoothed, the result is sometimes not perfect.

In later years, with the advent of Ni-Ti rotary alignment systems, better cleaning and tapering of the canal was achieved, thus better filling of the canal, and significantly faster treatment time. It can be said that Ni-Ti rotary system improves the quality of dental pulp treatment and increases patient satisfaction.

KFILE – Dr Hung & Associates Dental Center

Picture 01: Treat the pulp with K-File

NITI ROTARY SYSTEM – Dr Hung & Associates Dental Center

Figure 02: Treat the pulp with the Ni-ti rotary broach

Some characteristics of the teeth make the treatment easier or more difficult include:

  • Bsck teeth are more difficult to treat than the front teeth because of more canals and the available space is more restrictive.
  • Lower front teeth are front teeth, but the shape of the teeth is thin, canals are often narrow, the treatment of canal is often more difficult than other teeth.
  • Narrower canals are more difficult to treat than broader ones
  • Tilted canals are harder to treat than straighter ones
  • Long canals are more difficult than short canals
  • Treament through the crown of the crown is harder than without crown

In difficult cases, it is more time-consuming and difficult to treat with K-files because of the length of the canal, the difficulty in removing the pulp and the difficulty in filling the canal.

At Dr Hung & Associates Dental Center, we use Ni-Ti rotary alignment systems including Protaper, Wave-one, Wave-one gold, Reciproc, Hyflex. Most of canal treatments are finished in one appointment, except in some cases of acute myelitis or infection of the root tops that require medication.

The following are pictures of some of the root canal treatment at Dr Hung & Associates Dental Center with Ni-Ti rotary alignment system.

1 / Cure large pulp molars

Case Mr Bonnici:

Cure tooth pulp 17 due to large decay

Ni-ti used: Wave-one

This is the case of upper molars, narrow and curved canals. Using a Wave-one, we prepared the length of his pulp, removed the pulp and created the oblong for the canal, then filled the canal with gutta percha. You can see in the X-ray film after the pulp treatment, the white lines in the teeth are the image of gutta percha used to fill the canal.

2 / Cure large pulp molars

Case Mr Taink:

Cure tooth pulp 47 due to large broken tooth

Nitrile broth used: Reciproc

This is a large pulp molars, with all three canals are bent. We used Reciproc in this case.

3 / Cure through the crown

Case Mr Groza:

Cure tooth pulp 48 through the porcelain crown, due to pulp inflammation

Ni-Ti used: Wave-one

Patients have a porcelain bridge 4 units (from tooth 48 to tooth 45). Due to good bridges, but tooth 48 with painful pulp inflammation, we decided to treat the pulp through the crown to retain the bridges for the patient.

Teeth 48 is the lower wisdom tooth, at the rear end of the jaw, where the tooth 48 is tilted close, and the needle is pierced through the crown, so this is a rather difficult case. Using Wave-one, we have achieved good results

4) Cure the lower mandibular jaw

Case Ms Thao:

Cure tooth pulp 32, 31 and 41 to make dental porcelain aesthetic

Niti used: Hyflex

These are the lower incisors located in the deviating position, designated to have root canal treament to make porcelain aesthetic. This case is treated with Hyflex.

All of the above cases were treated at Dr Hung & Associates Dental Center, completed in one appointment and without pain.

It can be said that the use of Ni-Ti rotary brochure has helped us shorten treatment time, improve the quality and effectiveness of root canal treatment, bring satisfaction and trust to patients.