About the treatment of pulpitis of three-channel teeth and the prices for this procedure

First of all, we note that the price of treating pulpitis of a three-channel tooth really depends on the number of these root canals in it, and here the general rule is this: the more there are, the more expensive the treatment procedure is. And not only more expensive, but, in addition, with a large number of roots, a number of nuances of endodontic procedures often arise, which we will talk about in more detail later.

On a note

Pulpitis Is a disease in which inflammation of the so-called dental "nerve" (pulp) occurs. Large molars (molars) most often have three channels, in each of which there is a neurovascular bundle. When an inflammatory process occurs in the pulp, it swells and squeezes, as a result of which a person can feel severe pain.

Pulpitis requires compulsory treatment: you should not expect that everything will somehow resolve, and the pain will go away on its own, as is sometimes the case with pain with caries. The pain can really disappear when the "nerve" completely dies, but then it starts to decompose right inside the tooth, and without appropriate treatment it will not lead to anything good.

The treatment of pulpitis of a three-channel tooth, unlike a single-channel tooth, is most often technically more difficult, therefore, a doctor has to spend more time and effort to carry out quality work, as well as actively apply the achievements of modern dentistry.

Today, in most clinics, three-channel pulpitis is almost always treated by extirpation - nerve extraction from all channels and their filling at the final stage of intracanal treatment.

It is interesting

In the upper teeth of wisdom, there are the most unpredictable options for the number and location of roots and channels. As a rule, doctors encounter one-, two- and three-channel eighth teeth, but there were also cases of 4 and even 5-molar teeth with up to 8 full channels in it!

 

The main stages of the treatment of three-channel pulpitis

Three-channel pulpitis in most dental clinics is treated in two visits. The technique of the so-called vital extirpation is well suited for these purposes, when under local anesthesia the pulp is removed from all three channels and filled with subsequent placement of temporary filling material on the tooth. And on the second visit, a permanent seal is safely established.

Let's now see how this happens in practice.

First visit:

• tooth anesthesia;
• preparation of carious soft tissues with a turbine tip, removal of necrotic and pigmented dentin;
• washing with antiseptics;
• opening good access to the mouths of the three channels;
• mouth extension;
• Cofferdam overlay
• extirpation (extraction) of pulp from all three channels by pulp extractors;
• passage of channels by files, measurement of their length, expansion by K-files, H-files, machine tools with constant irrigation (washing) of the channel system with sodium hypochlorite solution;
• the use of EDTA for poorly passable canals;
• drying of channels, control measurement of their lengths;
• filling the channels by cold lateral condensation of gutta-percha pins with paste or using the Thermafil system for obturation;
• staging a temporary filling or temporary restoration of a tooth;
• control picture (x-ray).

Second visit:

• tooth retreatment;
• Setting a permanent seal from a light-cured composite or other imported material (an example will be shown in the photo below).

Sometimes pulpitis of a three-root tooth is treated in three visits and even more. It depends on the chosen methodology, the tactics of the doctor, the level of his professional skills and sometimes difficulties arising during intracanal treatment.

If it is impossible to immediately remove the pulp from the canals, the dentist puts a devitalizing preparation on the opened pulp chamber in order to “kill the nerve” for the next appointment. Accordingly, this increases the treatment of three-channel pulpitis by one visit.

In Soviet times, even arsenic was put on arsenic for a period of 24 hours. Such practice at the current level of development of dentistry is already unacceptable. Pulpitis treatment of a single-channel tooth, as well as a two-channel tooth, is almost always carried out in one visit (with rare exceptions).

Large molars (mainly lower) due to structural features of the jaw and the location of the nerves that determine tooth sensitivity can sometimes not be “frozen” to the extent that the nerve can be removed immediately, that is, the pain sensitivity remains. Therefore, the way out of this situation is precisely the preliminary use of killing pulp pastes (in the people they are still called "arsenic", although modern drugs have long been free of arsenic).

On a note

In a number of clinics pulpitis treatment it is always carried out in one visit, and regardless of the number of channels: they are sealed, and a permanent filling is immediately established on the tooth. Studies have shown that often this practice leads to long-term negative consequences, since the material introduced into the channels must first harden. They do not start work in construction until the foundation hardens, since the consequences can be disastrous - and here the situation is the same. That is why it is recommended to treat pulpitis in at least two visits.

 

The use of a microscope in the treatment of pulpitis

A microscope in endodontics is used, in particular, to diagnose the number of root canals and the quality of their passage. Treatment of pulpitis of a three-root tooth under a microscope allows you to quickly find and treat even the most difficult passages, and there are many such cases in the practice of a dentist.

An endodontic microscope allows with almost 100% certainty to say at the end of the treatment that all the channels have been passed and properly sealed. It is he who allows you to control every stage of pulpitis treatment, preventing further complications. Traditional treatment without the use of a microscope is often associated with the presence of long-term negative consequences, for example, due to the fact that the doctor simply could not see the additional channel in the tooth and missed it during treatment, leaving an infected pulp in it.

Sometimes, in the treatment of pulpitis, the doctor finds 3 channels, but in reality there is a 4th (or even a fifth) “well hidden” in the tooth. There are cases of missing not one channel, but several, as there are complex options for their location in the tooth.

It is interesting

For the treatment of canals, the microscope was first used recently - in the USA (1992). A modern endodontic microscope allows you to treat teeth under magnification of almost 30 times. During the procedure, the doctor looks through the eyepiece of the microscope and performs complex manipulations in the canals. A video camera can be connected to the microscope, allowing you to transfer the image to the monitor. At the same time, the doctor is not too close to the patient, since the microscope helps to treat the tooth somewhat remotely, which satisfies those patients who do not like to get into their personal space. This treatment is considered one of the most advanced in the world.

The high price for the treatment of pulpitis of a three-channel tooth can scare away patients even with a normal income, since there may be two or even three times more than the traditional treatment option (and imagine how things were with the treatment of pulpitis of a four-channel tooth). However, such an increased price is often quite justified given the specifics of a complex and lengthy endodontic treatment, so do not immediately think that they are trying to fool you and lure money.

 

What is the price for the treatment of three-channel pulpitis?

First of all, we note a characteristic point regarding the pricing policy of most clinics for the treatment of pulpitis - the cost depends on each channel found in the tooth. The fact is that each channel is an additional laborious work of a doctor and additional costs of materials.

For example, in a person’s tooth, instead of one channel, they may have three, four or more. Therefore, it is not difficult to guess that the price for the treatment of three-channel or four-channel pulpitis consists primarily of the amount of work performed by the doctor: passage of channels, their irrigation (flushing), expansion, filling ...

Pulpitis treatment cost also includes:

• Local anesthesia;
• Additional hardware methods for monitoring and treating canals: apexlocation (determination of length), X-ray examination, ultrasound or laser treatment, irrigation, the use of a microscope, placement of temporary medicines under a dressing in channels, etc.
• Permanent filling material. After filling the canal on the next visit, the doctor establishes that permanent filling, which the patient chooses, focusing on an acceptable price for him.

With this in mind, it becomes quite obvious that regardless of the dental institution the patient is contacting for help, treatment of pulpitis of a single-channel tooth will cost much less than a three-channel one.

It is interesting

One channel in 100% of cases is present in the upper incisors and canines. Moreover, in canines, most often the canal is very wide and long. In the lower incisors, there is mainly one channel, but two are often found. The lower canine is only 6-channel in 6% of cases, and single-channel in the rest. The second premolar (5 upper and lower teeth) in more than 70-80% of cases have one channel.

 

Different clinics - different cost of services: what exactly do you pay money for?

Depending on the “price-quality” indicator for the services provided, all dentistry can be conditionally divided into three categories:

1. Budget organizations (clinics, hospitals);
2. Private clinics of economy class;
3. Private business class clinics.

Benefits of a budget organization:

• Free treatment or low price for services (as a rule, only the cost of paid materials is taken into account);
• You do not need to sit in a chair for a long time, as quickly as possible.

Minuses:

• In general, the relatively poor quality of services due to the constant rush of the doctor, lack of technical equipment, lack of materials and often the professionalism of the dentist himself.
• Long waiting times in lines, where you can often hear such that any desire to go to the doctor disappears.
• Rudeness and bad attitude towards the patient is, unfortunately, not uncommon in many clinics and hospitals.
• There is no guarantee for the treatment of the canals and for a permanent seal.

As a result of poor-quality treatment of three-channel pulpitis in a budgetary organization, the following problems may arise in a short time:

• tooth pain on the background of poorly washed, incomplete canals or due to the removal of filling material outside the root (it will hurt to bite);
• swelling of the gums and cheeks with missed canals (with infection), or a fragment of a dental instrument left in the canal, which is also not uncommon (see photo below);

and etc.

The mistakes of a budget doctor can be listed endlessly, but it is worth remembering that there are many doctors even in hospitals and polyclinics that are provided with material and have a high level of professional qualities that allow treating at least three, at least four-channel pulpitis at a fairly high level, although today it is rather an exception to the rule.

Benefits of a private economy-class clinic:

• Availability of services for the middle-income population;
• Lack of large lines;
• As a rule, a fairly high professional level of the doctor;
• Availability of necessary equipment and materials for the implementation of economy class services;
• Warranty for canal treatment and filling.

Minuses:

• Lack of maximum quality control of treatment at all stages (the risk of complications after filling the canals can be described as average);
• Materials that are not good enough for artistic restoration, which often do not allow making the seal completely invisible to the eyes of others.

A private business-class clinic, unlike previous options, allows you to provide very high-quality services thanks to the availability of modern equipment and the high training of qualified dentists.

The use of a microscope, as an intermediary between a doctor and a patient’s tooth, significantly increases the already considerable price for the treatment of pulpitis of a three-channel tooth. However, thanks to such equipment, the patient can forget for the whole time that treatment was once carried out in the channels of his tooth, and he will only have to come to the dentist sometimes to examine the condition of the filling.

Often there are situations when a patient, turning to a local clinic, loses a tooth in a year or two due to developed at the root of the cystand, as a result, carries out an expensive prosthetics of an absent tooth at a price even higher than the treatment of three-channel pulpitis, but already in a business-class clinic.

There are also cases when, for example, 5-7 years after the treatment of pulpitis in an economy-class clinic (for about 6-7 thousand rubles), it is discovered that a huge granuloma developed on the root against the background of the instrument fragment left in the canal, due to which tooth to preserve is not possible. In such a situation, it’s already difficult to say for the patient what is better for him: to lose a tooth in 5-7 years and engage in expensive prosthetics or implantationor go to a business-class clinic right away, where treatment of pulpitis of a three-channel tooth will cost around 12-14 thousand rubles, but such a tooth will last almost the rest of its life.

 

Interesting video: treatment of pulpitis of the upper tooth, which turned out to be not three-channel, but 4

 

And here you can see all the stages of pulpitis treatment, including filling