Root canal treatment — Endodontology

Maintaining teeth for a lifetime is not always easy — especially if they are inflamed. However, in the vast majority of cases, your own teeth are better than any good replacement. Root canal treatment is highly likely to achieve this. 
On this page we would like to explain the most important aspects of root canal treatment.

Our specialists for endodontology

Dr. Mar­co Geor­gi, M.Sc., is a spe­cia­list in micro­scopic endodon­to­lo­gy, endodon­tic retre­at­ments and micro­sur­ge­ry, and a popu­lar lec­tu­rer in many trai­ning insti­tu­ti­ons. For more than 10 years he has also taught inter­na­tio­nal­ly and has been appoin­ted as Sci­en­ti­fic Direc­tor of Endodon­tic Edu­ca­ti­on in the Sta­te Cham­ber of Phy­si­ci­ans of Hes­se. He regu­lar­ly leads trai­ning events at the PRAXIS AM KURECK for other den­tists and endodon­to­lo­gists.  He is the foun­ding Pre­si­dent of the Asso­cia­ti­on of Cer­ti­fied Ger­man Endodontologists

Dr. Hen­ning Bah­n­e­mann, M.Sc., is also an expe­ri­en­ced spe­cia­list in endodon­to­lo­gy and micro­scopic den­ti­stry. He is also an expert in den­tal hyp­no­sis. Dr. Bah­n­e­mann is Vice Pre­si­dent of the Asso­cia­ti­on of Cer­ti­fied Ger­man Endodon­to­lo­gistsand works as a con­sul­tant in the field of endodontology.
Chris­tof Rif­fel, M.Sc., spe­cia­li­zes in children’s endodon­to­lo­gy, trau­ma­to­lo­gy and den­tal hyp­no­sis. He has been an acti­ve mem­ber of the Asso­cia­ti­on of Cer­ti­fied Ger­man Endodon­to­lo­gists for many years.

Why is my tooth bad?

In most cases a tooth decays due to caries-causing bac­te­ria but acci­dents and den­tal or orthodon­tic tre­at­ments can also be a cau­se. Inflamma­ti­on or infec­tion wit­hin the tooth can result from the­se sti­mu­li. Insi­de a tooth the­re is a bran­ching sys­tem of cana­ls con­tai­ning living tis­sue (pulp) with ner­ves and blood ves­sels. Unfor­tu­n­a­te­ly the defen­si­ve abi­li­ties of this tis­sue are very limi­ted so the body some­ti­mes can­not suf­fi­ci­ent­ly deal with the irri­ta­ti­on and heal the infection.

The­re used to be no way of saving the­se teeth. Becau­se the canal sys­tem in a tooth is often very fra­gi­le and has lots of bends, the­re was no pos­si­bi­li­ty of tre­at­ment so the tooth had to be removed.

What can the dentist do so that I can keep my tooth?

In order to be able to pre­ser­ve an infla­med or dead tooth its root must be trea­ted. The bac­te­ria in the tooth must be remo­ved and the tooth sea­led so that no new germs can get in.

Becau­se the root sys­tem of a tooth has lots of small bran­ches, like a tree (some as small as 0.06mm!), they can only be seen under a micro­scope. This tech­no­lo­gy and the asso­cia­ted fle­xi­ble, minu­te instru­ments enab­le the opti­mum pre­pa­ra­ti­on for remo­val of the bac­te­ria and the dise­a­sed tis­sue – and the­re­fo­re also incre­a­sed tre­at­ment suc­cess. Then the resi­due is remo­ved with a rinsing solution. 

As a final pre­pa­ra­ti­on for fil­ling the root canal sys­tem, the root canal is pre­pa­red with high­ly fle­xi­ble micro-files. For the fil­ling, the mate­ri­al gut­ta-per­cha, which is rela­ted to natu­ral rub­ber, is hea­ted and put into the now per­fect­ly pre­pa­red sys­tem in com­bi­na­ti­on with an adhe­si­ve cement.

Only if the root sys­tem can be tho­rough­ly clea­ned of the bac­te­ria, the infec­tion can be eli­mi­na­ted and the bone can heal again.

What are the chances of preserving my tooth?

Obvious­ly this depends on the indi­vi­du­al cir­cum­s­tan­ces, such as the degree of inflamma­ti­on and your mouth hygie­ne. But the ana­to­my of the tooth and perhaps other fac­tors such as the loss of peri­odon­tal appa­ra­tus through the for­ma­ti­on of cysts play a con­si­derable role.

The good news: The results of long-term stu­dies in the USA and Scan­di­na­via have shown that pro­fes­sio­nal endodon­tic tre­at­ment using the abo­ve methods has a suc­cess rate of over 80%

How much does the treatment cost?

The cost of the tre­at­ment depends on the amount of time taken. This is asses­sed befo­re the tre­at­ment, based on indi­vi­du­al cir­cum­s­tan­ces such as the degree of inflamma­ti­on and the ana­to­my of the tooth.

A tre­at­ment as spe­cia­li­zed, indi­vi­du­al and necessa­ri­ly sophisti­ca­ted as this, is howe­ver not pro­vi­ded for in the ran­ge of ser­vices cove­r­ed by sta­tu­to­ry health insuran­ces. They only con­tri­bu­te to a small por­ti­on of the cos­ts. The majo­ri­ty is to be paid for pri­va­te­ly by the pati­ent (e.g. his  pri­va­te health insurance).

The­re­fo­re a detail­ed, bin­ding cost esti­ma­te is drawn up befo­re the start of tre­at­ment for your indi­vi­du­al case.

What alternatives do I have?

The only alter­na­ti­ve is usual­ly to remo­ve the tooth and fill the resul­ting gap with an implant. The cos­ts of res­to­ring your natu­ral smi­le are not to be unde­re­sti­ma­ted eit­her. They are often much hig­her than tho­se of a root treatment.

The surgical microscope: exact control of the treatment process

The ope­ra­ti­on micro­scope enab­les the pre­cise visu­al moni­to­ring of the tre­at­ment pro­cess. In order to tre­at the finely bran­ching cana­ls safe­ly, a good view is not only hel­pful but essen­ti­al in modern endodon­to­lo­gy. The fine canal ope­nings are often impos­si­ble to see with the naked eye. If you lea­ve it to touch, many cana­ls and nooks and crevices remain hid­den. The tis­sue resi­du­es and bac­te­ria that remain the­re could lead to recur­rence of the inflamma­ti­on even years after the tre­at­ment. Only 39% of root canal tre­at­ments car­ri­ed out in Ger­ma­ny using the con­ven­tio­nal methods are suc­cess­ful and only 12% of tre­at­ments give a result that ful­fills requi­re­ments of the ESE (Euro­pean Socie­ty of Endodontology).

Modern ope­ra­ti­on micro­scopes, equip­ped with a sophisti­ca­ted optics (up to 35 times magni­fi­ca­ti­on), mean we are no lon­ger working “in the dark”. The ope­ra­tor can now see deep into the insi­de of the tooth. This means he can also see irre­gu­la­ri­ties that devia­te from the norm. In many cases it is even pos­si­ble to see right to the end of a strai­ght canal. Intri­ca­te­ly bran­ching cana­ls can also be trea­ted in a tar­ge­ted, safe man­ner. Pro­blem cases like holes in the root canal wall or instru­ments that have bro­ken off in the root canal can also usual­ly be sol­ved with the help of the OP microscope.

The PRAXIS AM KURECK has three ultra-modern OP micro­scopes for endodon­tic treatment.

PRAXIS AM KURECK has three sta­te-of-the-art ope­ra­ting micro­scopes for endodon­tic treatment.

Procedure of a root canal treatment

1. Dental dam

First the tooth is iso­la­ted from the mouth cavi­ty using a rub­ber cloth (den­tal dam). For one thing this pre­vents the bac­te­ria from the sali­va get­ting into the tooth and for ano­t­her thing it pre­vents the rinsing liquids from going down your throat.

2. Access

The den­tal sur­ge­on gains access to the canal sys­tem in order to look at the extre­me­ly fine canal struc­tures. In doing so he must be very care­ful not to unne­cessa­ri­ly wea­ken the tooth. Magni­fi­ca­ti­on sys­tems (such as magni­fy­ing specta­cles or a micro­scope) are often abso­lute­ly essen­ti­al in order to be able to clear­ly see the smal­lest details and per­form tre­at­ment while pro­tec­ting healt­hy material.

3. Root canal preparation

The den­tal sur­ge­on then cleans the cana­ls with fine instru­ments and dis­in­fec­tant rin­ses. The most important thing is to clean the cana­ls along their ent­i­re length. This requi­res an X‑ray to be taken. The length of the canal can also be very accu­rate­ly deter­mi­ned elec­tro­metri­cal­ly. Some­ti­mes several appoint­ments are nee­ded for medi­ca­ments to be inser­ted to remo­ve bac­te­ria from the tooth.

4. Root canal filling

After the cana­ls have been tho­rough­ly clea­ned, the den­tal sur­ge­on fills the canal sys­tem with gut­ta-per­cha, a bio­com­pa­ti­ble natu­ral mate­ri­al. This pre­vents bac­te­ria from colo­ni­zing and infec­ting the canal sys­tem again. The access through the crown of the tooth is sea­led with a fil­ling material.

Retreatment of a Root

Why does my tooth need another root canal treatment?

The aim of a root canal tre­at­ment is to clean the bac­te­ria out of the tooth’s root cana­ls and pre­vent re-colo­niz­a­ti­on using a tight­ly sea­led root canal fil­ling. But if bac­te­ria remain in the canal sys­tem, the­se can mul­ti­ply again, if

• Cana­ls were over­loo­ked
• Cana­ls were not trea­ted along enough of their length or width.
• The effect of the clea­ning was not suf­fi­ci­ent due to com­plex canal anatomy

Ano­t­her rea­son for reinfec­tion cau­sed by bac­te­ri­al colo­niz­a­ti­on of the fil­led canal sys­tem can be a root canal fil­ling that is expo­sed to sali­va and the bac­te­ria it con­tains. This is often the con­se­quence of tooth decay or tre­at­ment with a fil­ling or crown that is done too late.

If my tooth is “dead” why does it still hurt?

During root canal tre­at­ment the vascu­lar ner­ve bund­le is remo­ved from wit­hin the root. But the tooth is embed­ded in a tooth socket which can beco­me infla­med. If bac­te­ria from wit­hin the tooth cau­se acu­te inflamma­ti­on of the tooth socket, this can result in pain, swel­ling and pus formation.

Can all teeth be preserved by a revision?

The­re are limits to every medi­cal the­ra­py. In com­plex cases, for examp­le, it may be impos­si­ble to com­ple­te­ly clean the sewer sys­tem. Some­ti­mes a sur­gi­cal pro­ce­du­re has to be car­ri­ed out in a sup­por­ti­ve man­ner in order to pre­ser­ve the tooth.

If I am not in pain does that mean my tooth is healthy?

With chro­nic forms of infec­tion the­re is often no dis­com­fort at all. It is not uncom­mon for the con­se­quen­ces of the infec­tion to only be dis­co­ve­r­ed on an X‑ray. The den­tal sur­ge­on sees that bone has dis­in­te­gra­ted from around the root of the tooth. This degra­dati­on is pro­gres­si­ve and can turn into acu­te inflamma­ti­on with pain, swel­ling and pus formation.

Procedure of a Retreatment

1. Dental dam

First the tooth is iso­la­ted from the mouth cavi­ty using a rub­ber cloth (den­tal dam). For one thing this pre­vents the bac­te­ria from the sali­va get­ting into the tooth and for ano­t­her thing it pre­vents for­eign objects from going down your throat.

2. Removal of the old root canal filling

First the den­tist has to remo­ve the exis­ting fil­ling from the cana­ls. If the tooth has a den­tal post this must also be taken out.

Depen­ding on the type of mate­ri­al used in the root canal fil­ling and the type of den­tal post, remo­val can be very dif­fi­cult and very time-con­suming. Magni­fi­ca­ti­on sys­tems (such as magni­fy­ing specta­cles or a micro­scope) are very hel­pful for this and some­ti­mes even essen­ti­al in order to clear­ly see the smal­lest details and per­form tre­at­ment while pro­tec­ting healt­hy material.

3. Root canal disinfection

It is also important to tho­rough­ly clean the who­le canal sys­tem. If the old root canal fil­ling did not com­ple­te­ly fill the canal sys­tem, the unt­rea­ted parts must also be acces­sed. If this is suc­cess­ful, the root cana­ls can be clea­ned using fine instru­ments and dis­in­fec­tant rinses.

4. Root canal filling

After the canal has been tho­rough­ly clea­ned, the den­tal sur­ge­on fills the root canal sys­tem. The access through the crown of the tooth is initi­al­ly tem­pora­ri­ly sea­led with a fil­ling material.

When does my tooth need root canal surgery?

Root canal tre­at­ment is used for tooth pre­ser­va­ti­on. The basis for the suc­cess of the tre­at­ment is a care­ful clea­ning of the extre­me­ly fine root canal sys­tem. Even with the use of opti­cal magni­fi­ca­ti­on and deli­ca­te instru­ments, in some cases old root canal fil­lers or root posts, for examp­le, can­not be remo­ved from the canal.

Des­pi­te all the care taken and the latest tre­at­ment tech­no­lo­gy, bac­te­ria that cau­se pro­blems can also be left behind. Even after a non-sur­gi­cal root canal tre­at­ment, a sup­por­ti­ve sur­gi­cal inter­ven­ti­on may be necessa­ry if the root canal is not hea­led. In such cases, inflamma­to­ry tis­sue usual­ly forms at the root tip or sym­ptoms ari­se. If the pos­si­bi­li­ty of a repe­ti­ti­on of root canal tre­at­ment does not appe­ar pro­mi­sing, sur­gi­cal root canal tre­at­ment in the form of root tip res­ec­tion remains in most cases the only way out for tooth preservation.

How does a surgical root canal treatment work?

Basi­cal­ly, it must be said that often in con­nec­tion with a root tip res­ec­tion, the pre­vious­ly per­for­med root canal fil­ling must be rene­wed. This means that the root canal is clea­ned, dis­in­fec­ted and fil­led again (revi­si­on). The sur­gi­cal inter­ven­ti­on takes place in the fol­lowing steps:

1. Exposure of the root tip

In the first sta­ge, after admi­nis­te­ring an anesthe­tic, the oral muco­sa abo­ve the root tip is loo­se­ned and lifted to expo­se the bone abo­ve the root tip. Then in a second sta­ge the infla­med tis­sue is remo­ved and the area around the root tip is cleaned.

2. Cleaning the root canal

The root canal is pre­pa­red and clea­ned from the root tip upwards using deli­ca­te ultra­so­nic tips. For a gent­le and safe pro­ce­du­re, espe­cial­ly in terms of clea­ning and fil­ling of the root canal star­ting from the root tip, deli­ca­te spe­cia­list instru­ments such as fine ultra­so­nic tips, the finest fil­ling spa­tu­las and con­densers are necessary.

3. Root canal filling and wound closure

After clea­ning, the root canal is refil­led through the root tip and the wound area is stit­ched up. The result is che­cked using an X‑ray.

 

 

4. Healing and follow-up checks

Fol­lowing suc­cess­ful tre­at­ment, the bone defect heals wit­hin a peri­od of several mon­ths. The healing pro­cess is che­cked using X‑rays at regu­lar intervals.

False prejudices against root canal treatments

Prejudice no. 1: Root canal treatments are painful.

Reality: Root treatments do not cause pain, they eradicate pain.

Most pati­ents visit their den­tist or endodon­to­lo­gist when they have a per­sis­tent toot­ha­che. This pain often comes from dise­a­sed pulp (ner­ve) tis­sue wit­hin the tooth. In root canal tre­at­ment the dise­a­sed tis­sue, and thus the cau­se of the pain, is removed.

Sto­ries about pain­ful root canal tre­at­ments have no place in modern endodon­to­lo­gy. The­se days, anesthe­tics (anesthe­tic injec­tions) and the tar­ge­ted tech­ni­ques of endodon­to­lo­gy make root canal tre­at­ment no more uncom­for­ta­ble than put­ting in a fil­ling. A sur­vey show­ed that pati­ents who have expe­ri­en­ced root canal tre­at­ment were six times more likely to descri­be it as “pain­less” than pati­ents who had not had root canal treatment.

Prejudice no. 2: Root canal treatments cause diseases.

Reality: Root canal treatments are a safe and successful treatment

In the past, a small group of medi­cal prac­ti­tio­ners alle­ged that the­re was a con­nec­tion bet­ween teeth that had under­go­ne root canal tre­at­ment and the emer­gence of cer­tain ill­nes­ses. This opi­ni­on was based on the long out­da­ted stu­dy by Dr. West­on Pri­ce from 1910–1930!

Many sci­en­ti­fic stu­dies that have been publis­hed in this area over the last 70 years show that the­re is no con­nec­tion bet­ween root canal tre­at­ment and any kind of ill­ness. The latest rese­arch into this issue shows that a tooth that has had good root canal tre­at­ment does not pose any risk to health whatsoever.

Prejudice no. 3: A good alternative to root canal treatment is tooth extraction.

Reality: Preserving your natural tooth is surely the best option.

Not­hing can com­ple­te­ly replace your natu­ral tooth. Arti­fi­cial teeth some­ti­mes for­ce you to chan­ge your eating habits. Retai­ning your own teeth means that you can still enjoy eating and the plea­su­re of dif­fe­rent foods. Root canal tre­at­ment is the most orga­nic way of trea­ting dise­a­sed tis­sue wit­hin your tooth (pulp).

Good root canal tre­at­ments have a very high suc­cess rate. Many teeth that have had root canal tre­at­ment last a life­time. Repla­cing lost teeth using brid­ges, den­tures or implants usual­ly requi­res more time and incre­a­sed finan­cial out­lay. The tre­at­ment of the adja­cent teeth and under­ly­ing tis­sue is also usual­ly necessary.