Dental aggression and periapical curettage

Teeth are what help us in everyday life to perform the main functions of the oral cavity.

They are indispensable in chewing, aid in speech and give the patient a pleasant facial appearance.

Not infrequently, however, teeth and the entire oral cavity are subject to harmful factors that can seriously damage their integrity.

Among the most dangerous aggressors and the ways in which the structure of the teeth can be altered are:

  • Microorganisms – the oral cavity is an environment where bacteria live alongside defence cells.

There is a permanent balance between them, which is why there are no manifestations that the patient feels.

However, in case of increased bacterial contamination, the host’s defence mechanisms can no longer cope and the teeth will be demineralized.

  • Acidic substances – whether they come from the external environment, through food or accidentally, or whether they are the result of gastric disorders such as gastro-esophageal reflux disease, they leave their mark on the teeth. Thus, on the buccal surfaces in the case of acids from the external environment, or on the oral surfaces for endogenous acids, hard matter will be shed.

The loss of layers of dental substance will over time lead to sensitivity or, in severe cases, even fracture of the teeth.

  • Trauma – accidents, especially play accidents in children, can cause significant loss of dental hard substance, especially in the front teeth.

On the other hand, even hard foods can have similar effects to trauma.

Thus, hard particles lead to loss of tooth substance.

As a result of the aggressors mentioned above, the tooth can suffer in different ways.

The lost tooth substance can be replaced with composite materials or prosthetic work and the tooth will regain its altered function.

In other cases, the tooth will continue to suffer and the infection will spread to the dental apex, i.e. the tip of the root.

In this case, endodontic treatment is the treatment of choice. By opening the pulp chamber, the canals are cleared of the altered dentin and sealed to seal the tooth. By sealing it, bacteria no longer have access to deep tissues and the infection confined to the root apex will remit and heal, the tooth being free of painful symptoms.

If endodontic treatment fails and the infection is not completely removed, there is another treatment plan before we consider performing an apical resection or extracting the tooth and that is periapical curettage.

Periapical curettage is similar to apical resection, but the former is only applied to teeth that already have endodontic treatment.

It consists of removing excess filling material found beyond the root canal.

In some cases, during root canal filling, the material may exceed the limit imposed by the endodontic treatment plan.

It usually integrates into the surrounding tissue and is not harmful.

However, at other times it causes reactions in the periodontium.

In the latter case, apical curettage is necessary to remove the irritating material.

This method is successful and reduces postoperative pain, especially in the case of recent endodontic fillings.

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