Microscopic Root Canal Treatment: A Comprehensive Guide for Patients

Q: Microscopic Root Canal Treatment: A Comprehensive Guide for Patients

Hello： Your X-ray examination shows a shadow indicating a bacterial infection within the root canal. <br>It is necessary to remove the original filling and undergo retreatment. <br>Microscopic treatment can indeed provide a safer and more reliable therapeutic effect. <br>You may

Microscopic Root Canal Treatment

Hello, about fifteen years ago, I had treatment done on the upper right incisor and the adjacent teeth (teeth 2, 3, and 4) and received a dental prosthesis, but it was not handled well.
Tooth 4 started to hurt again three years ago, and an X-ray showed a dark spot on the root.
The doctor drilled, treated it, cleaned it, and placed medication, but I still experience sharp pain.
I happened to be pregnant at the time, so I could only keep changing medications until now.
I initially wanted to remove the prosthesis, but since I was still breastfeeding, the doctor was concerned that it would be painful and require medication, so I decided against it.

Last week, I decided to see a different dentist because this clinic is fully computerized, and the X-rays were very clear.
It turned out that for teeth 2, 3, and 4, the medication was not placed deeply enough, leading to inflammation in a small section of the root.
However, after opening tooth 4, it was not as bad; instead, tooth 2 became problematic.
When it was opened, air got in, causing significant pain.
The doctor examined it very carefully and suspected that the dentist from fifteen years ago might have inserted a pin and then filled it with gel, which is why the X-ray showed a thick white image.
However, the doctor could not remove the hard filling, so he said if it doesn't improve, extraction may be necessary.
Since I have more than half of my teeth as prosthetics, I do not want to lose any more teeth.

I went to another clinic, and the findings were similar.
The dentist offered three options: one is to perform microscopic root canal treatment, another is extraction, and the third is a minor surgery to cut from the bottom to remove the darkened root.
However, he recommended that I go to a larger hospital for the best option, preferably for microscopic root canal treatment, and he does not recommend extraction.

I live in Xinzhuang and would like to ask if the Taipei County Health Bureau Provincial Hospital is a good option? Or would it be better to go to Linkou Chang Gung Memorial Hospital or Taipei Mackay Memorial Hospital? Do these three hospitals have the facilities for microscopic root canal treatment? Thank you!

Helen, 30~39 year old female. Ask Date: 2006/04/15

Dr. Liu Tiancai reply Dentistry

Hello: Your X-ray examination shows a shadow indicating a bacterial infection within the root canal.
It is necessary to remove the original filling and undergo retreatment.
Microscopic treatment can indeed provide a safer and more reliable therapeutic effect.
You may visit Taipei Mackay Memorial Hospital to consult with Dr.
Du Bo-ren for treatment.
Sincerely, Dr.
Liu Tian-cai, Dentistry.

Reply Date: 2006/04/15

More Info

Microscopic root canal treatment (MRCT) is an advanced dental procedure that utilizes a microscope to enhance the visibility of the tooth's internal structures, particularly the root canals. This technique is particularly beneficial for cases where traditional root canal treatment has failed or when the anatomy of the tooth is complex, such as in cases of calcified canals or previous unsuccessful treatments.

In your situation, it appears that you have a history of dental issues with multiple teeth, including previous treatments that did not resolve the pain and inflammation. The presence of dark spots on X-rays typically indicates infection or necrotic tissue within the root canal system. The fact that you have experienced ongoing pain, especially after attempts to treat the affected teeth, suggests that there may still be infected tissue or that the root canals were not adequately cleaned and sealed during previous treatments.

1. Risks Associated with Broken Instruments in the Root Canal: The concern about broken instruments (files) left in the root canal is valid. While the instruments themselves are made of stainless steel and are not inherently harmful, their presence can obstruct proper cleaning and sealing of the canal, potentially leading to persistent infection and pain. In your case, the recommendation to undergo MRCT is appropriate, as this method allows for better visualization and retrieval of broken instruments, as well as thorough cleaning of the canals.

2. Microscopic Examination: The term "microscopic examination" in the context of MRCT refers to the use of a dental microscope, which magnifies the tooth structure up to 25 times or more. This enhanced visibility allows the dentist to identify and treat issues that may not be visible to the naked eye, such as small canals, fractures, or remnants of previous filling materials. Not all dental practices have access to this technology, which is why your dentist recommended a referral to a larger hospital or specialized clinic.

3. Choosing the Right Facility: Regarding your question about which hospital to choose for MRCT, it is essential to select a facility that has the necessary equipment and experienced specialists. The hospitals you mentioned—Taipei County Health Bureau Provincial Hospital, Linkou Chang Gung Memorial Hospital, and Taipei Mackay Memorial Hospital—are reputable institutions. However, it is advisable to confirm with each facility whether they have the specific capability for MRCT. Generally, larger hospitals or dental specialty clinics are more likely to have the required technology and expertise.

4. Treatment Options: If MRCT is performed and the canals are successfully treated, it can significantly alleviate pain and restore function to the affected teeth. If the treatment fails again or if the tooth is deemed non-restorable, extraction may be necessary. However, as you mentioned, you prefer to avoid extraction due to the presence of other prosthetic teeth. In such cases, discussing alternative options like apicoectomy (surgical removal of the tip of the root) or even considering dental implants after extraction may be worthwhile.

5. Post-Treatment Expectations: After MRCT, it is common to experience some discomfort as the tissues heal. Pain management may involve over-the-counter pain relievers or prescribed medications. If pain persists or worsens, it is crucial to follow up with your dentist to rule out complications such as reinfection or the need for further intervention.

In summary, MRCT is a valuable option for addressing complex root canal issues, especially in cases of previous treatment failures. It is essential to choose a facility equipped with the necessary technology and expertise to ensure the best possible outcome for your dental health. Always communicate openly with your dental care provider about your concerns and treatment options to make informed decisions regarding your oral health.

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