Root canal treatment – advances in recent years
The most important advancement in the field of Endodontics in the past decade has to be the use of the Dental Operating Microscope (DOM). The use of magnification upto 24 times and illumination has revolutionized the treatment protocols in routine, difficult and re treatment cases. The location of hard to find canal orifices, removal of separated instruments and improved success rates in the field of endodontic surgery can be done easily thanks to the DOM. Some of the available brands here are Zeiss, Seiler, Global etc.
In the field of endodontic instruments, there have been rapid improvements in the file systems like Heat treatment, M wire technology, electropolishing etc. This has led to increased flexibility, better fatigue strength, reduced chances of separation and increased torsional resistance. All these are freely available here and being used widely. Protaper series, Edge files, Hyflex, Endostar, V Taper, Neo Endo, Hero Shaper, One Curve, etc are some of the files available.
Use of irrigation has been an important part of cleaning and shaping the canals. There has been a lot of research in the delivery systems which has resulted in the advent of thin gauge side vented needles, apical negative pressure irrigation system Endovac, XP shaper files, activation systems like Endo Activator, Ultrasonic tips and so on. The use of increased concentration of Sodium Hypochlorite, continuous chelation systems and Chlorhexidine has improved the cleaning of the canal walls.
Use of endodontic sealers has progressed from the traditional Zinc oxide Eugenol based type to MTA based sealers, resin based sealers and Calcium Hydroxide based sealers. They have better flow and increased working time so that the clinician will have sufficient time for filling the canals. The use of biomimetic sealers has also been a step in the right direction. Some of the sealers available are Fillapex/ ProRoot/ e MTA/ iRoot SP/ EndoSequence BC sealer (Biomimetic type), Sealapex/ Apexit (Calcium Hydroxide type), AH Plus/ Adseal/ Endoseal/ RC Seal (Resin type).
**Medical conditions we need to be cautious about during RCT**
One of the challenges being faced by clinicians today is the increased life expectancy of the patients leading to a myriad of medical conditions which may have a bearing on the treatment planning. Patients will be taking a variety of prescribed and over the counter medications which needs to be noted. There may be interactions with the items being used during the treatment which may lead to unforeseen consequences. For eg, use of ginger, garlic, ginseng, Vit E may interact with anesthetics and cause bleeding during the procedure.
RELATED ARTICLE: Know More About Oral Health Care
Problems which may have occurred during previous dental treatment, if any, needs to be noted as potential allergies, phobias and difficulties in achieving anesthesia can have a bearing on the procedure. Patients with systolic BP of upto 160 and diastolic BP upto 100 can tolerate most dental procedures. Patients with Angina should be instructed to get their anti angina medications when they arrive for their treatment. Antibiotic prophylaxis is mandatory for patients with valve replacements, pacemakers, IHD etc. Non surgical RCT does not require any modification of anti coagulant therapy. Surgical endodontic treatment may need consultation with the patient’s physician to stop the anti coagulant therapy few days prior to the procedure.
Prophylactic antibiotics are needed in poorly controlled diabetics while it can be avoided in well controlled ones. Risk of hypoglycaemia should be kept in mind during dental procedures. Healing may be compromised in severe diabetics and risk of fungal infections are present in such cases.
Asthmatics should get their inhalers in the event of any emergency. Use of macrolide antibiotics and certain NSAIDs should be done with care in such patients. Use of dental dam may cause feelings of suffocation in COPD.
The most important thing to note here is that a thorough medical history should be taken down by the clinician before start of the treatment planning. This will give an idea about the protocol, drugs to be used and to be avoided, timing of the appointments, analgesics and antibiotics to be used. There is no age limitation in performing a RCT. It depends on the ability of the patient to sit through for a sufficient period of time or the procedure can be carried out in multiple visits.