Guarantee for the success of root canal therapy
In clinical practice, there is no doubt that more and more patients want to keep their teeth. If the root canal system is fully prepared, flushed and sealed tightly, it can achieve the common desire of doctors and patients in most cases.
In order to better achieve our wishes, it may be important to pay attention to some small details in clinical practice - details determine success or failure. We should learn to analyze problems, evaluate problems, and finally find a reasonable solution to problems encountered in clinical practice.
All work around the core of problem solving, but we should solve the problems within our ability. If the difficulty is beyond our ability, we should refer to others in order to achieve the core purpose of problem solving. Remember that we solve existing problems, not create new ones.
In order to better solve the problem, the details that should be paid attention to in terms of root canal therapy in order to achieve the desired effect are summarized as follows:
1. Simplify the difficulty
The difficulty of root canal treatment of a tooth is not only determined by the curvature, fineness, tooth position of the root canal, and whether to treat it again. The straight-line access of the pulp opening and the proper treatment of the root canal orifice in advance can simplify the great difficulty, and the pulp opening is the basis for the success of the root canal.
The straight entrance to the crown of the curved root canal is particularly important. A good straight entrance to the crown can avoid problems such as lateral penetration, steps, and missing root canal. The good condition of the straight entrance to the crown depends on the doctor's concept and reasonable instrument selection. The size of the pulp opening is not determined by the wishes of doctors and patients, but by the size of the pulp cavity of the teeth to be treated.
2. Believe that more root canals exist
It is believed that the number of root canals is more than we thought, and the complexity of root canal system is more complex than we thought. We can only achieve the desired goal by using all efforts and methods.
For MB2 of maxillary first molars, it used to happen occasionally, but now it does not happen occasionally. The proportion reported in various literatures is also inconsistent. It is almost not seen in the isolated teeth, and it is also the same in clinical practice. As for the method of searching, I think it is most important to believe in talent. First, I believe that there must be talent, and I will find all kinds of methods, and I will have more chances to find them. If conditions permit, the efficiency will be higher with the cooperation of microscope and ultrasound.
3. Infection control determines success or failure
The degree of thorough infection control in root canal therapy directly determines the success rate of root canal therapy, which is equally important for the control of main root canal, dentinal tubule and lateral branch root canal.
The main reason for the failure of affected teeth after the improvement of root canal treatment is the stubborn infection of root canal system or the stubborn bacterial infection outside the root canal around the root tip. Of course, it may also be a non bacterial factor, but the infection inside the root canal is the main reason.
When preparing the root canal with high efficiency machinery, it is necessary to use a syringe with a special side opening needle to flush the root canal for many times. Sodium hypochlorite should be used after heating, and fresh liquid should be added to the root canal system in time.
The use of EDTA liquid can well remove the smear layer produced during root canal preparation. 1% CHX liquid can kill Enterococcus faecalis in 30 seconds, and has a delaying effect. It is an excellent final rinse solution.
The effect of ultrasonic cleaning of root canals is better than manual flushing. Many doctors consider the concentration of sodium hypochlorite. In fact, the concentration of sodium hypochlorite flushing solution is not important, but the time and times of flushing, the frequency of changing fresh liquid and whether the liquid is heated are important.
4. Dare to deny oneself
Some cases seem to be perfect, but the patient just feels obvious discomfort, so we should consider whether there is an untreated infection area in the root canal. After analyzing the root canal, isthmus, branch, gap and other reasons, we should take timely measures.
The treatment method of failed cases is non surgical retreatment or surgical retreatment. Generally, non surgical retreatment is preferred, but the expected results of retreatment should be evaluated. If the trauma of non surgical retreatment to the affected teeth is too large or the expected effect is uncertain, surgical retreatment should be considered, and the method should be determined after comprehensive consideration of analysis. It is necessary to timely decide the next step of treatment. Long term repeated follow-up observation is meaningless, and the final result is the loss of patients.
5. What date is the preparation finished
The ideal situation of root canal preparation is to determine the taper and number, and whether the root canal space is the pyramid or the Eiffel Tower. The experts found that the apical stenosis was much larger than expected after the study of the root tip slice of the extracted teeth. If the root canal preparation was too small, there would be residual infection, and part of the space of the root canal would not be prepared. The residual infection would cause the treatment effect to fail to achieve the desired goal. Only when sufficient preparation is made and as much washing as possible can good results be obtained.
Root canal therapy should be clear, clean, filled and sealed tightly to achieve the desired results. 2200 years ago, only 1/3 of the cases were filled with crowns, which is understandable and acceptable; Today, 2200 years later, we have advanced equipment and materials, which will be filled with perfect results of large taper and high density. Ideas determine technology, and standards determine the improvement and progress of technology.
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