European International Journal of Multidisciplinary Research
and Management Studies
65
https://eipublication.com/index.php/eijmrms
TYPE
Original Research
PAGE NO.
65-69
DOI
OPEN ACCESS
SUBMITED
20 February 2025
ACCEPTED
19 March 2025
PUBLISHED
21 April 2025
VOLUME
Vol.05 Issue04 2025
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Modern View on
Problematic Issues in
Endodontics
Shukurova N. T.
Samarkand State Medical University, Assistant of the Department of
Therapeutic Dentistry, Uzbekistan
Abstract:
In this article presents information about the
most serious problem in endodontically. In clinical
practice were described the basic rules and principles
of endodontics cavity preparation (coronal and root
canals)
for
prevention
errors.
The
main
recommendations gives by authors for quantity
endodontically treatment of teeth.
Keywords:
Errors, performance the preparation of
coronal and root canals, prevention of problems,
recommendations.
Introduction:
An important and urgent problem of
modern dentistry is the treatment of complicated
caries - pulpitis and periodontitis. Diseases of apical
periodontium is unfortunately one of the main reasons
for tooth extraction. In addition, teeth with apical
periodontitis often cause odontogenic inflammatory
processes in the div due to destructive processes at
the root apex. In recent years, more and more attention
is paid to the quality of endodontic treatment. As is
known, the oral cavity is a unique part of the div,
which always contains different strains of bacteria
(beneficial and aggressive). From the position of
evidence-based dentistry, bacterial plaque on teeth
(biofilm or biofilm) is regarded as a set of different
strains of bacteria designed to survive together, among
which there may be both non-cariesogenic and
cariesogenic. Scientifically substantiated evidence of
the pathogenic role of biofilm forms the foundation in
revealing the mechanisms of oral disease development,
including caries and its complications At the same time,
low level of patients' awareness about the rules of oral
care, untimely diagnosis of diseases, gingivitis and early
forms of caries contribute to the development of
irreversible forms of pulpitis or apical periodontitis.
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European International Journal of Multidisciplinary Research and Management Studies
From these positions, the main goal of endodontic
treatment is to affect the biofilm to reduce the number,
eliminate pathogens in the affected tooth and
surrounding tissues, as well as to prevent re-infection
of the root canal system. In endodontic treatment, a
fundamental understanding of the rules for performing
the steps of crown and root endodontic preparation of
each tooth, adequate disinfection and quality
obturation of root canals under X-ray control is
mandatory
The facts presented by many scientists show that about
60% of endodontic treatment failures are directly
related to incomplete obturation of the root canal
system, which is part of the radicular space. And this
can further lead to various inflammatory diseases of the
maxillofacial region and the formation of focal foci in
systemic organs. The complexity of endodontic
treatment is that a lot of work must be done on a small
space, which is mostly not amenable to visual control.
However, along with objective difficulties and failures
in the performance of endodontic treatment, it is
necessary to know the errors and complications that
can occur at the stages of examination, diagnosis,
performance of endodontic crown and root
preparation, as well as ways to prevent them in order
to preserve the function of the tooth and the health of
the patient as a whole. In recent years, due to the
introduction of new technologies, tools and materials
into endodontic practice, positive trends in improving
the efficiency of endodontic treatment of teeth have
been noted. However, this does not mean that in the
clinical practice of a dentist the number of unsuccessful
outcomes of treatment of complicated caries has
decreased. It is important to emphasize that problem
solving in endodontics is closely related to fundamental
knowledge and skills. The guarantee of effective
endodontic treatment and its prognosis are three
components: a good level of oral hygiene, quality
mechanical treatment with subsequent obturation of
the root canal system and restoration of the anatomical
shape of the tooth. Despite the variety of reasons why
mistakes are made in endodontic treatment of teeth,
they are based on violations of the algorithm of the
algorithm of the stages of preparation of the crown part
of the tooth and root canals, which leads to the
development of complications. The data of radiological
studies show that in about 13.4% of cases root canals
are filled satisfactorily. It is known that teeth with
poorly filled root canals are sources of chronic
odontogenic infection that can cause changes of
varying severity in other organs. As a rule, this is due,
on the one hand, to virulent microorganisms and their
toxins, which are located in the affected tubes of the
dentin of the tooth root, and on the other hand - the
seepage of tissue fluid from the side of the apical
opening. It is as a result of microleakage of decay
products through the apical foramen and lateral
tubules of the tooth root that foci of inflammation are
formed in the surrounding periodontal tissues
(periradicular inflammation)
. The term “pulp space”,
which includes the pulp chamber of the crown of the
tooth and the root canal with all its branches, is
essential. The structure of the pulp space may undergo
changes due to the deposition of secondary, tertiary
denticles and calcifications. It is important to take into
account that the pulp and periodontal communication
is carried out not only through the main canals, but also
through additional tubules (lateral), which can be a
reservoir of infection in case of poor antiseptic
treatment of the canal or without the use of sillers. In
the apical third, as a rule, deltoid branching in the form
of additional tubules - the so-called apical delta - is
found in the apical third, which should be taken into
account to prevent errors in endodontic treatment. In
practical endodontics, doctors most often encounter
difficulties in the stages of work in the crown part of the
tooth and root canals. This is mainly due to the fact that
in the domestic literature there is insufficient
information about the rules for performing the stages
of endodontic crown preparation, there is no
information about the characteristic features of each
tooth in three projections. Knowledge about the signs
of teeth characterizing the first projection, which is
determined radiologically, as well as the assessment of
anatomo-topographical parameters help to exclude
errors in the work at the stages of examination of both
crown and root parts of the tooth. To exclude errors in
the treatment of complicated caries (pulpitis or apical
periodontitis), the endodontic preparation of the
crown and root parts of the tooth using appropriate
instruments under antiseptic control is of decisive
importance. Targeting each step of endodontic
preparation helps to prevent errors and complications.
From these positions it is necessary to know,
understand the purpose and stages of crown
preparation, including key issues: preparing access to
the roof of the pulp chamber for its complete removal
(on the indication of amputation of the crown pulp), the
formation of the walls and bottom of the pulp chamber,
taking into account the topography of the creation of
the main transition to the mouth of the root canal of
the tooth (for example, in the form of a triangle or
rhombus in upper and lower molars). Mastery of
endodontic crown preparation skills for each tooth will
undoubtedly help to reduce the risk of potential errors
in the subsequent stages of root canal work. It is at the
stages of root preparation that errors most often occur
due to lack of knowledge of the signs of the teeth of the
second projection, which are not radiologically defined.
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European International Journal of Multidisciplinary Research and Management Studies
Therefore, it is necessary to take into account these
signs in a thorough examination of all levels of the root
canal with a pulpoextractor (extirpation as indicated)
with mandatory irrigation. The decisive stage of root
preparation is the expansion and formation of the walls
of the root canal using appropriate endodontic tools
with mandatory irrigation of antiseptics and qualitative
obturation (sillers and gutta-percha) under the control
of radiography up to the root apex. In general, the
correct performance of crown and root preparation
contributes to the qualitative obturation of the root
system of the tooth, which determines the success in
endodontics. The most important condition for
achieving positive results in endodontic treatment is
the correct preparation of the crown cavity of the tooth
with complete removal of the pulp chamber roof,
taking into account the anatomotopographic features
of each tooth, and the formation of free access to the
root canal. The main requirements for the formed
tooth cavity: - there should be no overhanging edges
with complete removal of the pulp chamber roof; the
walls of the pulp cavity are formed with a smooth
transition to the root part of the tooth for favorable
work with instruments; - examination of the bottom of
the pulp cavity allows you to find the mouths of root
canals, taking into account the topography of the teeth.
Violation of the rules of endodontic preparation of
crown and root parts, without the use of radiographs
and without taking into account the anatomo-
topographical parameters of each tooth, as well as the
wrong choice of instruments can lead to errors and
complications. Often perforation can occur in the area
of bifurcation of lower molars when violating the stages
of crown preparation and without examination of the
bottom of the pulp chamber. Clinically, probing in the
area of perforation also causes acute pain. However, an
apex locator and X-ray should be used to diagnose the
perforation more accurately. The best prognosis is if the
perforation is closed immediately, minimizing trauma
and infection of the surrounding tissues. The main
conditions for the prevention of perforations: -
compliance with the rules and principles of endodontic
crown and root preparation, taking into account the
features of the tooth in three projections; - correct
performance of all stages of crown preparation to
ensure good access to the mouths of the volume of
anatomo-topographical features of the teeth; - taking
into account the inclination of the crown of the tooth,
its displacement, anatomical features, radiological
control; - the choice of appropriate endodontic
instruments; - indispensable removal of the artificial
crown of the tooth before endodontic treatment.
Prevention of root perforations When treating severely
curved root canals it is necessary: - mandatory
preliminary radiologic study of the configuration of root
canals; - giving hand instruments a bend corresponding
to the curvature of the root (in this case, their directions
should coincide); - use of anticurvature technique of
passage with Safety Hedstroem files (Kerr) - H-file with
one-sided smooth surface of the working part; - use of
special instruments (flexible files, profiles, etc.) made of
nickel-titanium steel for effective passage of narrow
calcified root canals; - constant radiologic examination
of the root canals. Unfortunately, it is not uncommon
to encounter the following problems in practice: -
discoloration of the tooth crown - occurs due to partial
opening of the pulp cavity cap of the tooth (after
pulpitis treatment is completed, even with high-quality
obturation of the canal); - breakage of the root canal
instrument - occurs with insufficiently formed access to
the root canal, which makes it difficult to work with
endodontic instrumentation and violation of coronal-
apical technique; - poor-quality filling of the canal - may
occur with violation of the technique of root canal
preparation at all its levels (cervical, medial and 1/3
Practically important when performing the stages of
work in endodontics: - take a radiologic image before
preparation; - observe the maximum angle of rotation
of the instrument in the canal: K-rimers - 180 °, K-files -
90 °, with narrow curved canals the angle of rotation is
recommended to reduce to 20-30 °. H-files can not be
rotated; - when indicated, use gels to expand root
canals; - timely discard unusable instruments. When
working with files (ProfillFlexMaster, ProTaper, etc.) to
determine the length of the canal use measuring
devices - DentaPORT, Raypex5 and repeat the
radiograph. In conclusion, it is necessary to emphasize
the main classical standards of endodontics that
contribute to a favorable prognosis: - professional oral
hygiene (periodic motivation and cleaning of sextants)
- exposure to pathogenic microflora (biofilm); -
adequate diagnosis of the affected tooth with
evaluation of the surrounding tissues and work with
cofferdam; - compliance with the technique of
endodontic preparation (crown and root) taking into
account the characteristic features of teeth in three
dimensions and age-related features; - selection of
appropriate endodontic instruments and antiseptics for
irrigation; - root preparation at all levels of the root
canal with appropriate endodontic instruments (a
certain type of FlexMaster) and performance of
coronal-apical and apical-coronal techniques with
abundant irrigation with antiseptics; - for narrow and
curved roots, nickel-titanium files (NiTi) are more often
used - ProfillFlexMaster, Reamer-type, ProTaper, etc.
with obligatory irrigation with antiseptics; antiseptics
Calcium hydroxide, Sodium hydrochloride (0.5-5%),
Chlorhexidine (0.2%), etc. are used for disinfection. -
dense obturation at all levels of the root canal
(appropriate sillers and lateral condensation of gutta-
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percha) with the use of an apex-locator and radiologic
control with the final qualitative restoration of the
tooth; - dynamic observation of the oral cavity
ecosystem and radiologic control (in 1-3 years) after
endodontic treatment; - control visits to the dentist to
maintain oral health (correction of OHI-S, KPI, KPU,
etc.). Assessment of endodontic treatment quality and
prognosis is carried out according to clinical and
radiologic signs: - there are no symptoms in the patient;
- the patient should be taught the rules of oral care; -
OHI-S, CRPI, CPPU indices should be corrected; - root
canals should be filled to the apex (in apical
periodontitis) or to the physiologic opening (in certain
forms of pulpitis) on radiographs
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