Civitali Dental and Prosthetic Center srl

Endodontic re-treatment. Re-devitalization.

Re-treating a devitalized tooth.

 

Sometimes a devitalized tooth may give origin to a chronic inflammatory process, caused by infection, at the apex of the root. Such process is commonly known as granuloma.


This condition may be silent, not producing any sign or symptom, and diagnosed only during routine radiographic examinations. In other cases it can origin acute symptoms spanning from slight pain affecting the tooth involved (periapical chronic periodontitis) to intense pain, not responsive to analgesics and accompanied by swelling at the cheek (periapical acute periodontitis or abscess). In this latter case medical treatment must be immediate.


Such chronic infections affect devitalized teeth showing, in their roots, residual of infected material (i.e. necrotic residual of dental pulp, bacteria or bacterial toxins). Bacteria in the canals may cause an inflammatory process at the apex of the root, resulting in the clinical set of symptoms described above.


After managing the acute inflammatory event (in most cases through a systemic antibiotic therapy), these teeth have to be treated in order to remove the causes of the chronic infection. An endodontic re-treatment has to be performed. In other words, devitalization has to be done from scratch, with the aim of eliminating all the bacterial load in the root canals.


The first step of the therapy consists in performing a diagnostic/pre-operative radiograph, in order to get all the necessary information concerning the anatomy of the affected tooth. Next, the dental element is isolated with a rubber dam: this is a mandatory aid, to avoid contamination by the bacteria coming from the saliva. This is of paramount importance in a treatment aiming at eliminating bacteria and infection.


The filling or the crown is removed and the pulpar chamber is opened in order to get direct access to the root canals.

All the material inside the canals is removed. This is done by using proper solvents and proper files, which can be either manual or ultrasound handpiece-mounted. Root canals are then shaped and cleaned with a disinfectant irrigating substance such as sodium hypochlorite (a powerful bactericide compound). Shaping is performed with manual steel files or nickel-titanium rotating devices powered by electrical handpieces.


Unfortunately the root apex cannot always be reached. Yet, proper cleaning and disinfection are usually enough to heal the disorder.

After shaping and cleaning the canals, they are sealed with hot gutta-percha. The crown is cemented or a new filling performed in order to prevent re-infection of the canals.


Re-treatment must be monitored over time with control radiographs. These will show how the periapical lesion changes over time and will allow the dentist to diagnose improvement and express a prognosis.


Re-treatment of a devitalized tooth is quite difficult for the operator. Many factors make such therapy complex and complications may rise (perforations, stripping etc) during or after the treatment itself. It’s a therapy requiring high clinical experience. For this reason some dentists commit themselves only to this super-specialized practice.

Pre-surgical radiograph. Two molars have to be re-treated

Clinical appearance. The two molars bear two prosthetic crowns that call for removal

Radiograph after crowns removal

Clinical appearance of the molars after crowns removal. Also amalgam filling must be removed

After removing the fillings and the material in the canals, cleaning begins

The arrow shows the endodontic metal pin that must be removed

The screw-pin after its removal from the channel

Instruments control radiograph during re-treatment of the adjacent tooth

Cones control radiograph during re-treatment of the adjacent tooth

Control radiograph at the end of both two re-treatments

One of the molars after filling canals with gutta-percha

After the surgical lengthening of the clinical crowns