Removal of the tooth nerve: why and how it is done, prices in Moscow

Endodontic treatment, or root canal treatment , is a long-term procedure that involves removing non-viable nerves and pulp from the tooth. This treatment method is indispensable in dentistry and can significantly extend the life of the tooth in diseases such as pulpitis, periodontitis, etc.

For endodontic treatment, our clinic uses a dental microscope, which allows us to greatly enlarge the canals of the tooth and not treat blindly.

What is a root canal?

Each tooth, except for enamel and dentin, has an internal space - a pulp chamber, communicating with thin cavities running along the entire length of the roots of the teeth - root canals. Different dental groups have different numbers of roots, and, accordingly, canals. The front group has 1 channel, the side ones - from 2 to 4.

Narrow, winding, thin tubes with many branches - this is how to characterize the root canals of teeth. The entrance to them is located at the apex of the tooth root, it is called the apical foramen. Through it, through each root canal, passes neurovascular tissue, which is responsible for the blood supply and innervation of the tooth.

Endodontic treatment is a procedure for removing infected, inflamed or dead neurovascular tissue, followed by cleaning and disinfection of the resulting space, and completely sealing the dental canals.

Diseases that require endodontic therapy

Treatment of tooth canals is performed only if there are strict indications, since as a result of the intervention, the tooth is deprived of the vessels and nerve endings that feed it, which makes the dental tissues less durable and more susceptible to destruction. Indications for intervention include inflammation and infections accompanying caries or traumatic tooth damage:

• Pulpitis is inflammation of the pulp (neurovascular tissue) - soft, fibrous tissue, including blood and lymphatic vessels, nerve endings and connective tissue.
• Periodontitis is inflammation of the tooth root and surrounding tissues (periodontal tissue).

These diseases are usually accompanied by the following symptoms:

• Acute, throbbing or aching pain in the tooth, increasing at night or intensifying with load on the tooth.
• Swelling, discoloration of the gums, formation of ulcers and fistulas on it.
• Putrid odor from the mouth.

In some cases, there are no pronounced symptoms and the development of pulp necrosis is detected only during a doctor’s examination. Only a specialist can accurately determine whether endodontic treatment will solve the problem and select the most effective therapeutic regimen.

Why does a tooth from which the nerve has been removed hurt?

Patients often complain that the tooth from which the nerve was removed continues to hurt. This is a completely natural pain, the result of intervention in the body. In a couple of days the pain will go away. It can be observed when clenching teeth, when reacting to hot and cold. To reduce discomfort, take analgesic medications.

But if, due to improper treatment, the nerve was not completely removed, the pain and inflammation will return. It is possible that the canals were poorly treated, and there may also be an allergy to the filling material. It is necessary to go to the doctor immediately, since advanced inflammation can lead to tooth loss.

The tooth from which the nerve has been removed becomes dead, but it still remains and is not lost, so if you have a toothache, immediately go to the dentist. There is nothing to be afraid of - modern treatment is painless, and after it your diseased tooth will serve you for many years to come.

Methods of treatment of dental canals

Not so long ago, arsenic paste was used for endodontic treatment. The dentist opened the dental chamber, put the paste into it and, after the pulp died, removed it from the tooth. Next, the tooth was filled and considered cured. The resorcinol-formalin method was also widely used - a resorcinol-formalin mixture placed in the cavity slowly hardened, stopping the disintegration of the partially removed pulp.

But such technologies have significant disadvantages:

• Arsenic and formalin saturated with resorcinol are very dangerous, toxic substances that can accumulate in various organs.
• These substances cannot always kill the nerve completely, which contributes to severe pain when trying to extract the pulp.
• Infected neurovascular tissues that are not completely removed become a source of repeated inflammation.

These methods were used because there were no sufficiently strong anesthetics that would allow removal of the affected pulp painlessly. Today they are completely irrelevant - modern dentistry treats tooth canals using a completely different technology.

Contraindications

Doctors at the SDent aesthetic dentistry center collect all data about the patient’s condition before starting treatment. In the health questionnaire, the patient notes the characteristics of his body, and the doctor conducts a survey. Planned nerve removal is not performed if:

• high blood pressure, hypertensive crisis;
• first, third trimester of pregnancy (provided there is no acute pain);
• acute inflammatory diseases of the mucous membranes and facial skin;
• acute respiratory and viral diseases, etc.

Modern methods of dental canal treatment

There are two main methods of treating tooth root canals:

• Therapeutic (biological) in which the entire pulp or part of it is preserved. Manipulations can be carried out directly - the dentist puts a medicinal product into the dental cavity, separates the pulp chamber with an insulating gasket and installs a temporary filling. Or drugs can be delivered through the dentin, using antibiotic dressings, etc. Such drug therapy is effective only at the initial stage of inflammation.
• Surgical (pulp extirpation) - removal of all neurovascular tissue, cleaning, disinfection and sealing of dental cavities. Root canals are treated in one of the following ways: classic filling of tooth canals - filling the voids with filling material.
• Vertical condensation by injection of thermoplasticized gutta-percha.
• filling using thermophiles - hot gutta-percha on a carrier.

In some cases, endodontic treatment requires resection of the root apex - in the presence of granuloma, fibroma, cyst, perforation and other problems near the root apex.

Stages of treatment

• Diagnostics

If damage to the dental canal is suspected and in order to detect a pathological focus, an X-ray examination (orthopantomogram, CT) or a study of the patient’s existing images is performed. Based on the examination results, the endodontist selects the appropriate treatment method.

• Pulpectomy

After anesthesia, the dentist opens the tooth, removes all damaged and necrotic tissue, gives the canal the required shape and rinses it with an antiseptic.

• Canal filling

Open channels are hermetically filled with filling material. For this purpose, plastic (gutta-percha, paste), hardening (cement group) and hard materials (pin structures) are used. The most progressive method is filling the canals with hot gutta-percha.

• Restoration of the crown part of the tooth

The correct anatomical shape of the tooth is restored using direct (filling) or indirect (crown, inlay) restoration.

Features of root canal treatment under a microscope

Modern dentistry cannot be imagined without the use of innovations that take root canal treatment to a new level. One of the most advanced methods of root canal treatment is the use of a dental microscope. Powerful optics allow you to increase your view by 32 times, given that the diameter of the channel is usually no more than 1 mm, it is simply impossible to process it efficiently without the help of optics.

Advantages of dental treatment under a microscope:

• The endodontist sees in detail the mouths of the canals, the features of their structure, each branch, depth and direction. This is especially important if the tooth canal has a complex, convoluted shape.
• The microscope makes it possible to remove only diseased and dead tissues without damaging healthy ones.
• Thanks to the targeted effect on the tissue, the best result of the intervention is ensured, eliminating the likelihood of perforations, as well as other problems and complications.

The use of a dental microscope allows the dentist to successfully solve even the most complex clinical problem.

Removal of a nerve and filling of one canal

Removal of the nerve and filling of one canal is usually performed in the treatment of the upper anterior canines and incisors and lower premolars, which usually have only one canal. In this case, the treatment process will be easier compared to the procedure for removing a nerve from multi-channel teeth. Therefore, its price will be lower.

On average, the cost of removing a nerve and filling one canal in Moscow will cost you 5-6 thousand rubles

. The indicated price will include nerve removal, anesthesia, canal treatment, and tooth restoration with a permanent filling.

YOU NEED TO REMEMBER! As you can see, removing the nerve of a tooth and its subsequent restoration is an expensive procedure, but most importantly, it leads to the tooth becoming dead. If you do not want to spend all your money on dental treatment and wisely save on dental services, do not delay treatment of caries and do not ignore regular preventive examinations at the dentist’s office.

Recommendations after treatment

Endodontic treatment demonstrates high success rates. After the intervention, you must adhere to the following recommendations:

• Avoid too hot, spicy, or cold foods for several days (while teeth sensitivity remains).
• Maintain good hygiene – brush your teeth twice a day, use dental floss and an irrigator.
• Do not chew anything hard (do not chew nuts, candies, etc.), as this may result in damage to the root canals and tooth destruction.
• Undergo medical examinations with a dentist and hygienist (at least 2 times a year).

Immediately after the procedure, tooth sensitivity increases greatly. This is explained by the reaction of the tissues to the filling material. The discomfort will disappear in a few days.

How to put arsenic in a tooth

Depending on the age of the patient, the condition of the pulp and the size of the tooth, the doctor determines how much paste is needed. Typically, its amount varies from 0.0002 to 0.0004 mg.

Let us describe the stages of the procedure:

1. The dentist uses an excavator to remove food debris, damaged tissue and thinned dentin from the carious cavity;
2. A ball-shaped paste is placed on the pulp horn and covered with a bandage;
3. Hermetically seals the cavity with a temporary filling.

Sometimes doctors put the paste on the unopened pulp. Then, after the procedure, the tooth may be very painful, especially when pressed, because swelling occurs and pressure in the tissues increases.

Usually, adults put arsenic in single-rooted teeth for 24 hours, in multi-rooted teeth for 2 days, but this period can increase to 6 days depending on the manufacturer and brand of the drug. Then the patient comes back for an appointment, and his pulpitis is treated in the traditional way: the temporary filling is removed, the cavity is prepared, the pulp is removed or amputated, the canals are processed and sealed.

Expert opinion

Lyubov Ivanovna Kopylova

dentist-therapist

Experience: more than 10 years

If you have the opportunity to go to a dental clinic equipped with an electron microscope, take advantage of it! Even the most experienced dentist works with canals without a microscope by touch. This means that there is a risk of underfilling or, on the contrary, excessive deepening into the canal, leading to perforation. The use of a microscope, when the working field is clearly visualized and the doctor efficiently cleans and seals even the thinnest and most curved canals, will allow this situation to develop.

Cost of root canal treatment in Moscow

The price of endodontic treatment depends on the number of root canals of the diseased tooth, the method used, complexity (including re-treatment) and volume of intervention, type of filling, etc. Processing 1 channel requires less work than 2 or 3, which affects the cost.

The price includes the entire list of procedures performed for the treatment of dental canals. When using a dental microscope and laser equipment in complex therapy, the cost of treatment increases.

Is it painful to remove a nerve?

It is difficult to say for sure how much a tooth hurts after nerve removal, since much depends on the person’s pain threshold. The depulpation procedure itself is performed under anesthesia. First, the doctor treats the injection site with special painkillers, and only after that introduces local anesthesia. It turns out that the process is painless from start to finish.

Pain may occur after the anesthetic wears off. The cause of discomfort is cleaning the canals, which injures soft tissues. If the procedure is performed by a qualified doctor, usually the tooth after nerve removal only hurts during the first day, then the pain gradually decreases.