Dentin provides elasticity and strength of the tooth, which allows him to withstand forces by chewing and injury. Dentin also raises important defense measures aimed at preserving the integrity of the pulp tissue.
Removing and installing dental implants replace endodontically broken teeth has gained popularity in recent years. This measure, of course, can be a valuable option in cases of severely damaged teeth, that either have a hopeless prognosis or cannot be provided with the proper restoration.
Many dentists, RCT, can be described by the words of Winston Churchill's Golf: "it is impossible, the impossible game with " tools". The complexity of the anatomy of root canals, the relative rigidity of the root canal
instruments, being unable often visualize the area properly, and the lack of space in the mouth provide significant problems with the skill and patience of a doctor. Intracanal work exclusively demanding; this is evident in the numerous radiographically based on epidemiological studies, which are often report that many indigenous seals do not correspond to the acceptable standards. As the clinical outcome is directly connected with the quality of treatment, the high incidence of substandard performances is a subject of great concern to the profession.
Pulpectomy RCTS and do not always lead to a successful clinical outcome. For example, the tooth may continue to be gentle or periapical inflammation may persist. Such treatment "failures" are often associated with defective root fillings, which allow organisms from the initial microbiota to survive in a root canal or new bacteria can penetrate through leakage along the border of restoration of the crown (Fig. 1.4).
As mentioned above, the damage to the flesh can lead to necrosis of tissues (Fig. 1.3). Necrotic pulp no defense against microbial invasion and allow microorganisms indigenous to the oral cavity to the pulp chamber, or open a direct impact or through uncovered dentinal tubules or cracks in the enamel and dentin. Side channels exposed as a result of progressive marginal periodontitis may also serve as a way for bacteria to get to the pulp. The specific conditions of the root canal is characterized by degrading pulp tissue and lack of oxygen, will contribute to the microbiota is dominated by proteolytic anaerobic bacteria. These microorganisms can be United in clusters and in the microbial communities attached to the walls of the root canal and within the dentinal tubules root.
In normal physiological conditions pulp is well protected from injury and harmful elements in the oral cavity using an external hard fabrics of a tooth and an intact periodontal (Fig. 1.2). When the integrity of the tissue barriers broken for any reason, microorganisms and substances they produce can access pulp and adversely affect its healthy state. The most common microbial call pulp comes from caries. Even in its early stages substances from tooth decay-causing bacteria can enter the flesh, open the dentinal tubules. Like any connective tissue, pulp reacts by inflammation. Inflammation plays an important goal for neutralization and elimination of hazardous substances. It also organizes the subsequent repair of damaged tissues. Thus, the pulp can respond in a way that allows her to maintain irritation and remain in a functional state. However, when caries expanded the vicinity of pulp, a response may take a destructive course and result in severe pain and death (necrosis) of tissue.
The consequences of inflammatory lesions in the pulp and periapical tissues (Fig. 1.1) tormented humanity for thousands of years. Historically, therefore, the main task of endodontic treatment was to cure toothache due to inflammatory lesions in the pulp and paper (pulpit) and periapical tissues (apical periodontitis). Over a long period of time, commonly used method to resolve the painful pulps was etch fabric with a red-hot wire or with chemicals such as acids. In 1836, arsenic was presented to devitalize the flesh, the method to be used during more than 100 years. Procedure to remove pulp without the use of toxic chemicals were introduced at the beginning of the 19th century and small, hooked instruments were used. The emergence of local anesthesia in the early 20th century made pulpec-tomy painless procedure.