All about Endodontology

It is not always easy to preserve your teeth for your whole life – especially if they are inflamed. On this page we would like to explain a few of the most important aspects of root treatment by a specialist.

Inside of the tooth: Endodontists are going to the roots

If your dentist recommends treatment by an endodontologist, she or he probably suspects there is something wrong with the inside of a tooth. The treatment of special cases requires special training and extensive experience in this specialized field of dentistry – and also the special technology to visualise and work on the tiny root canals inside the tooth.

In the past, teeth with root canal disease were often pulled. Today, advanced technologies and medical development make it possible to save almost any tooth.

At ENDOPUR our main goal is to preserve your natural teeth. And our high success rate is very reassuring: The vast majority of teeth treated at our clinic can be saved by expertly carried out endodontic treatment, with good prognosis!

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.


The cost of the treatment depends on the time required. The estimated cost is calculated before the treatment, based on individual circumstances such as the degree of inflammation and the anatomy of the tooth.

However, in Germany such specialized and sophisticated treatment, which is tailored to each patient’s needs, is not covered by the statutory health insurance companies. This means the costs are to be borne by the patient, who will, depending on their level of benefits, be reimbursed by their private health insurance.

We will thus provide each patient with a detailed, binding cost estimate prior to their treatment.

Regular check-ups are essential following successful treatment of periodontal disease (gum disease) to prevent recurrence or a new infection. Only regular visits with your dentist and a thorough oral hygiene routine at home can prevent periodontal disease!

“Critical areas” require regular checkups. Make an appointment for the cleaning of those hard-to-reach nooks and crannies to help prevent the formation of “periodontal pockets”.

Ask about our recall program: we are happy to call you when your next check-up is due. Or just arrange a new appointment after your visit to the dental hygienist. Your healthy gums will thank you for it.



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.

Myths about root canal treatment


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.


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.


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.

The operation microscope: precision and full control

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.

ENDOPUR has ultra-modern OP microscopes for endodontic treatment.

Cone beam CT(CBCT)

X-ray images are routinely taken at all dental offices. While they are relatively easy to produce, there are situations where they are not the right diagnostic tool, such as in case of distortions, with superimposed structures or where images are blurred or unclear due to issues with exposure. In the worst case, this can lead to misinterpretation of the x-ray image.

With Cone Beam CT (CBCT) a new era began in endodontology. The high-resolution 3D images present the tooth in thin layers, there is no distortion or superimposition and all images are to scale. CBCT diagnostics allows endodontologists to detect a wide range of diseases of the tooth and surrounding structures such as bones or the maxillary sinus that would otherwise only be visible with much more elaborate technologies (i.e. computer tomography, magnetic resonance imaging). Another advantage of the CBCT technology is the much lower exposure to radiation compared to conventional CT.

CBCT images are used …

… with suspected infection of the jawbone caused by the root of the tooth
… in the planning of endodontic revision treatments
… in the planning of endodontic microsurgery at the root of the tooth in close proximity to the nerves of the chin
… in the diagnosis after dental accidents (clarification of root and/or jaw fractures)
… with internal and external root resorption

Cliff Ruddle – The “Grandseigneur” of Endodontology

We probably could call him our mentor: Cliff Ruddle has always inspired, supported and encouraged us. As a student of Herbert Schilder, the famous father of “Schilder’s philosophy”, he further expanded Herb Schilder’s technique. He also designed and developed innovative instruments for dental root canal treatment that are much finer and more effective than what was previously available. As we kept meeting him at his lectures and workshops, as well as at meetings of professional associations and training courses we discovered our mutual fascination with endodontology.